The big story in the Montana legislature this coming week will be the showdown over what is known as Medicaid Expansion. There’s a hearing on Monday for HB 590.

Governor Bullock included it in his budget and has been touring the state promoting it, and numerous bills have been introduced to address or defeat it. It’s one of his signature proposals this session. Republicans are trying to oppose it because it is a new federal spending item, which is something Republicans profess to hate (except when it’s in the form of farm subsidies).

There’s also a lot of noise about it, many false arguments, and a good deal of misinformation.   So here is an explanation which I hope is helpful to my readers and especially to avocates.

It’s actually pretty simple.  If the Governor’s proposal is voted up and made law, Montana will receive roughly $750 million a year of new federal money into our healthcare system for the next eight years.  It will go into the state Medicaid program, and when it is spent it will not only give medical coverage to 70,000 additional citizens but will also be a huge boon to our economy and to many Montanans who will now have access to medical care–especially people working in agriculture, construction or tourism jobs. And the money will also help business owners avoid a tax under Obamacare that is levied on businesses of a certain size who do not provide health benefits to workers.

If it is defeated, this $750 million will instead go to other states.

And that’s the basic story.

The Affordable Care Act, a.k.a. Obamacare, allows states to “opt in” to this new federal Medicaid increase.  Medicaid is the program by which the lowest income people (mostly kids and seniors) in Montana get medical care.  This new addition of funds to the program, if Montana accepts it, will allow a new class of people–the working poor, such as many dishwashers, farm workers and day care workers–to be eligible for Medicaid.   if we so chooseAnd the state will not have to. match these payments at all.  Montana currently shares the cost of Medicaid with the Feds, but this expansion will be entirely covered for three years by the annual $800 million. After the first three years, we will be required to match about 7%.

A few right-wing imbeciles, including Governors like Bobby Jindal in Louisiana (who is suffering under the delusion that he might get the GOP nomination for president in 2016), are “making a stand” and refusing this federal cash.  This is what some conservative Governors did with the stimulus money back a few years ago.  It’s a move that conservatives employ to beef up their Tea Party bona fides. To refuse federal assistance is to prove one’s aversion to Obamacare, and thus one’s manhood.

The problem is that Jindal, by doing this, is not preventing federal tax money from being spent.  Instead, it simply goes to the other states who are opting in. They will get a sweeter deal.

And Jindal is royally screwing business owners in his state.  Obamacare (which is now the law of the land, whether you like or not), will require large businesses to pay a $2,000 tax for each person the business employs but does not give health benefits to–amounting to a $15 million tax increase in Montana.  But if we get the $750 million and thus increase the Medicaid eligibility, these businesses will be spared.

And of course, if we accept this federal money it will heavily boost the Montana economy.  It is expected to create 13,000 new jobs, not only in the healthcare industry but in ancillary industries.

For these reasons, many conservative Republican governors have approved the expansion of Medicaid in their states, such as Jan Brewer (AZ), John Kasich (OH), Chris Christie (NJ), Susana Martinez (NM), and even Tea Party poster boy Rick Scott (FL) among several others.   Actually, North Dakota governor Jack Darwhimple, also a Republican, has endorsed it too. He’s taking the cash. North Dakota is a state that the Montana GOP is constantly saying we should try to emulate.  Nineteen states have already indicated they’re expanding Medicaid – eight are Republican.

In a funny twist, hospitals executives, doctors and nursing home executives–who generally whine about Obamacare and like to support politicians who whine about it–are now hoping that the Medicaid expansion is passed by the Montana legislature, by their Republican pals who control the House and Senate.  This is why Bullock has been visiting hospitals and communities with big health industries, including those represented by Republican legislators.  He is letting these communities know that their Republican representatives, who claim to care about jobs and the economy in their districts, are not doing their job and are actually considering denying these communities the federal money, which would then go to other states.

And while you would think that these medical industry players would have influence in the Capitol to get a few votes from the GOP, don’t be so sure.  The lobbyists for the healthcare industrial complex who hang out at the legislature do little more than drink lattes, go to cocktail parties with their GOP legislator pals, commiserate with them about Obama, and during election season make campaign donations to them.  They have so far shown no ability to get votes, which is another way of saying that if Medicaid expansion fails, they should all be fired.    Because Democrats are already on board.

And always remember Bob Wagner, may his political career rest in peace. Wagner voted against stimulus money for his district, because he felt it was the Tea Party thing to do.  He got primaried by a moderate Republican, who used the vote him, and Wagner was roundly defeated.  If Medicaid expansion fails due to similar conservative shenanigans, there will be many more Bob Wagners in 2014.