MONTANA SELF INSURERS' ASSOCIATION

MSIA UPDATE December 2024

Legislative Leadership
Montana Medicaid Expansion
2025 MT Economic Outlook Series – Coming to You Soon
20 Issues to Watch in 2025 – FREE Webinar 1/14
St Vincent’s Hospital $1 Billion Expansion in Billings
Welcome New MSIA Member – North Shore Risk Consulting!

Legislative Leadership

The last legislative race has been finally decided. House District 57 – covering northern Gallatin county and east to Cooke City was recounted and the winner declared by 17 votes. The winner lost 3 votes in the recount, so it was a very tight race but the result is the same as expected election week. Gallatin County Democrat Scott Rosenzweig defeated Park County Republican Marty Malone. Democrats, largely as a result of re-districting, picked up 10 seats in the House (and two in the Senate), ending the super-majority Republicans had last session. The Republicans continue to hold a clear majority in both Chambers.

Legislators and legislators-elect came to town last month to select leadership and to set rules for the next session. They will be formally ratified on January 6, the first day of the new session. In the Senate, Republicans chose Senator-elect Matt Regier (R-Kalispell), last session’s House Speaker over current Senate President Jason Ellsworth (R-Hamilton) and Senator Greg Hertz (R-Polson). Regier’s father, Keith, lost to Ellsworth for the same leadership post last session. Tom McGillvray (R-Billings) was selected as Majority Leader. Democrat Pat Flowers (D-Bozeman) was reelected to the Minority Leader position, as expected.

In the House, Republicans selected Brandon Ler (R-Savage) over Bill Mercer (R-Billings) as Speaker. Former Senator Steve Fitzpatrick (R-Great Falls), son of Representative John Fitzpatrick (R-Anaconda), was selected as House Majority Leader. Representative Katie Sullivan (D-Missoula) was chosen over Mark Thane (D-Missoula) as Minority Leader.

Some personal thoughts:

First, if you see the same last name – they are related. We have more family members in the legislature than I have ever seen before, in any state. I don’t know exactly what that means, but I will be working on the assumption that if one family member tells me they are going one way on an issue the others in the family will be going the same way. I don’t count on assumptions and always touch base with each individual member who’s votes we care about, but…..
Second, I think Republicans have learned from the last session, where they held a super-majority in both Chambers. Based on party in-fighting last session, Republicans were not able to focus their efforts as much as expected prior to the session. Interestingly as well, both Senate President Regier and Speaker Ler defeated primary candidates supported by Governor Gianforte. I don’t know, but it is possible that was part of the reason for a new rule this session requiring second term Governors to re-submit Agency head names for legislative approval. That may be a harbinger of legislative / executive branch ‘discussions’ on priorities as the session progresses.
Finally, the Republicans seem to have been able to sharpen their focus on limiting the judicial branch much more so than last session. Over the past few sessions, the judiciary has struck down a number of laws passed by the Republicans on issues ranging from elections, abortion, privacy and marijuana – and then there is the judicially appointed panel on attorney behavior and ethics which sanctioned current and re-elected Attorney General Austin Knudsen, a former House Speaker.

Montana Medicaid Expansion

What does it all mean? Workers’ Compensation is not perceived to be a crisis and therefore we are unlikely to make headlines. However, if something we want gets caught up in party in-fighting, we will have a difficult time controlling the issue. I don’t foresee that as likely, but anything is possible when the legislature meets.

Likely our most important issues will be defensive – choice of physician and presumptive coverages. While not top of mind issues for the legislature and issues where we should be pretty solid with the majority – there will be a split in the majority over Medicaid Expansion. Both Senate President Regier and Speaker Ler identified this as a fight that will happen within their caucus and they will not dictate to their members how to vote. That being said, both are opposed to continuing the law.

The bill will be carried by House Business & Labor Chair Ed Buttrey (R-Great Falls), who defeated a more conservative candidate in a primary. Medicaid expansion sunsets on June 30, 2025 regardless of federal funding. Proposals to institute work requirements, or a set a minimum level of federal funding for continuation are kicking around. It is simply too soon to know how this will go. Regardless, it will be one of the key pieces of legislation this year. We get involved, peripherally, because most if not all business organizations in the state are supporting a continuation of the existing law. Health care interests (including self insurer health care interests) will be involved, all aspects of Montana business will be involved, labor will be involved and we’re likely to hear from attorneys, as well as politically oriented consultants from across the country on the issue. There is also a concern on what the federal government will do. President-elect Trump has opposed Obamacare, and reducing Medicaid funding may be a way to achieve the goal without outright repeal, which has repeatedly failed.

From the comp side, there is enough research to show that comp costs and claims are lower in states with Medicaid expansion. The research identifies these results based on more people having access to health care – and theoretically at least -not needing to rely on workers’ compensation as much for their health issues. MSIA does not need, nor desire to be a lead on this issue and we will not be. Our typical allies will be however.

Issues often take an ‘interesting’ turn during the session. And, I never forget what a NY Surrogate Court said in 1866, “No man’s life, liberty or property are safe while the legislature is in session.” (1 Tucker 248, N.Y. Surr. 1866).

Montana Economic Outlook Seminars – Coming to You Soon

The University of Montana Bureau of Business and Economic Research (BBER) has been hosting Economic Outlook Seminars for 50 years. Every year, the academic researchers in our University system share their thoughts and insights on the global, national and particularly, state economy history, projections and their prognostications. It is always an interesting program and is held throughout the state, from Miles City to Kalispell and Missoula to Sidney.

This year, there will be an added focus on the impact of Artificial Intelligence and its potential impact in and on the state. Everything from finding workers – and maybe be a solution to our worker shortage – to innovations and investment opportunities. A.I. mimics human brain functions – but at higher speeds and lower costs. I grew up professionally during the time where we went from manual typewriters to, now A.I. While a human can make one mistake at a time, a computer makes thousands of mistakes all at once. At the same time, we simply cannot operate without technology.

The presentations start on January 28 in Helena and end on March 12, in Miles City. Registration and more information is available here: 2025 Economic Outlook Seminar (yet another example of technology making our lives better!). I have attended the last 20 years or so of the programs and find them an annual event well worth the effort to learn the most recent results and projections about business in our state.

20 Issues to Watch in 2025 – Free Webinar 1/14 10a MST

Out Front Ideas, featuring MSIA member Safety National’s Mark Walls and Kimberly George of Sedgwick, is celebrating their 10th anniversary of their 20 Issues to Watch series. This too is one of the annual Webinars I attend. Walls and George’s insights and perspectives help keep me grounded in what is happening nationally. I am able to take that information and relate it to our system to help represent our interests in the public policy discussions in Montana.

It never ceases to surprise me how many of our issues are also national issues. As well, we have addressed many of the problems other state systems continue to grapple with. Typically we will address PAs becoming treating physicians, mental health issues, social determinants of health, physicians dispensing of medications, independent contractors, opioids and so many more during our public policy discourse over the year. Some states have addressed the issues well - - some states have addressed the issues particularly poorly. Regardless – knowing what goes on nationally, has helped us identify the right approach for Montana. Generally, we have done well – our claim counts are down, our injury durations are down, and of course, overall costs are down. The Montana economy has grown significantly over the past 10 years as well - if nothing else we should know all of this is connected.

This Webinar is FREE – January 14, 10a MST – register here: Out Front Ideas - 20 Issues to Watch 2025.

St. Vincent’s Hospital $1 Billion Expansion in Billings

Intermountain Health (parent company of St. Vincent’s Hospital among other Montana hospitals), an MSIA member has announced a construction project to replace the existing hospital with a new 14-story facility. This will be a complete replacement of the existing facilities. The $1 billion investment is the largest capital project in the state’s history.

Groundbreaking will be in the spring and completion is projected to be in 2029. The new building will change the way people in the hospital setting work, recover and interact with each other as they seek medical treatment. The economic impact in the Billings area alone is somewhat staggering. In addition to construction jobs, there will be hotel, restaurant, banking and other service workers who will be needed. And then, there is the efficiency of replacing some of the buildings which are 100 years old, and not suited for modern healthcare delivery. Some of the existing buildings could be converted to other business use, or housing.

The new facility’s patient rooms will be designed to be universal – that is they can be used as ICU or regular patient rooms. The operating suites will also be fully integrated to accept changes in surgical technology and multiple types of procedures. As well, the pre-op, operation rooms and recovery areas will all be in the same location – easing the process for providers, patients and families. All in all, this is obviously a significant investment in Montana, Billings and out health care systems in the state.

Welcome New MSIA Member – North Shore Risk Consulting!

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