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Montana Medicaid Expansion Initiative (2014)

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The Montana Medicaid Expansion Initiative will not appear on the November 4, 2014 ballot in Montana as an initiated state statute. The measure would have expanded Medicaid as prescribed under the Patient Protection and Affordable Care Act, commonly known as “Obamacare,” to cover people earning up to 138% of the federal poverty line.[1]

Supporters called the measure the Healthy Montana Initiative.

On June 19, 2014, Kim Abbott of Healthy Montana Initiative said the organization and supporters failed to collect enough signatures. They collected about 25,000 unverified signatures and needed 24,175 verified signatures.[2]

Text of measure

The ballot question would have read as:[3]

I‐170 expands Montana’s Medicaid program, the health coverage program for low‐ income adults, by increasing eligibility for the program according to federal health care law. I‐170 creates a special revenue account to accept federal funds and establishes an advisory committee. Expansion of Montana’s Medicaid program through initiative is contingent upon the Legislature appropriating funding for the expansion. This law terminates if federal funding of the program drops below the levels in current federal law.

Federal funds cover the cost of I‐170 and allow for savings to the state through fiscal year 2017. After 2017, Montana will be required to expend state funds to pay a percentage of the costs, capping out at ten percent of the costs in fiscal year 2020 and thereafter.
[ ] YES on Constitutional Initiative I-170.
[ ] NO on Constitutional Initiative I-170.[4]


The committee that sponsored the initiative was called the Healthy Montana Initiative.[1]




  • Montana Human Rights Network[5]
  • AARP Montana
  • Montana Nurses Association
  • Montana AFL-CIO
  • SEIU Healthcare 775NW
  • Western Native Voice
  • Montana Primary Care Association
  • Association of Montana Public Health Officials
  • Montana Women Vote
  • Planned Parenthood of Montana
  • Montana Coalition Against Domestic & Sexual Violence
  • MHA – An Association of Montana Health Care Providers
  • Blue Mountain Clinic Family Practice
  • Child Care Resources
  • Montana Budget and Policy Center
  • Montana Organizing Project
  • Rural Dynamics, Inc.


Sarah Howell, co-director of Montana Women Vote, argued for the initiative, saying:[6]

  • "Take Janet. Janet’s health care plan is, as she says, to hope she doesn’t get sick. She won’t be rafting or biking or travelling this summer because she can’t afford the possibility of an accident. Janet works two part-time jobs but isn’t offered health insurance by either job. Her combined income isn’t enough to purchase private insurance, even with the new subsidies offered by the Affordable Care Act, and she currently makes too much to qualify for Medicaid. So she walks carefully when it’s icy, drives slowly, takes her vitamins, and hopes for the best. This is no way to live."
  • "Medicaid expansion is important for our small towns and rural hospitals. Having access to health care close to home is something that many people take for granted. But people in small towns and rural communities often have long drives to reach the nearest provider. Losing the rural hospitals and clinics we have now would only make this burden greater. Medicaid expansion benefits these small town clinics by reducing uncompensated care and bringing in new resources and jobs."
  • "In addition, Medicaid expansion is important to the people who make Montana great. Veterans, American Indians, farmers and ranchers, and home health care workers would all benefit from expansion. Right now, Montana has one of the highest rates of uninsured veterans in the country, and many people working in the service and tourism industries also go uninsured. We think our neighbors deserve access to health care, whether they are restaurant workers, ranch hands, raft guides, or single moms. Uninsured folks are more likely wait to see a doctor when they find a lump, avoid an oncologist because they can’t afford cancer meds, or just neglect basic preventative care. Not only does waiting jeopardize their lives, but it drives up health care costs by increasing the likelihood of more expensive, catastrophic and uncompensated care."

Other supporting arguments include:

  • Gov. Steve Bullock (D) said, "In Montana, we take care of our neighbors. When an avalanche strikes in Missoula, we all grab a shovel. When a fire breaks out, we donate clothing and blankets and open churches and schools to house the victims. When 70,000 people are shut out of getting quality and affordable health care, we have to step up and help. There are people with cancer who cannot afford the medical attention necessary to save their lives. This is not how we do things in Montana. I am committed to do whatever needs to be done to ensure Montanans get the coverage they deserve."[5]
  • Montana Budget and Policy Center noted that the initiative would "create 12,000 new jobs and give the state’s economy a $5.4 billion boost by accepting federal funds."[5]






  • Sen. Fred Thomas (R-45) deemed the initiative "unconstitutional" because it orders the legislature to appropriate funds. He said, "It doesn’t matter what the effective date is; it’s still an appropriation, saying we’re going to (spend the money). It triggers this (spending) happening."[7]


See also: List of ballot measure lawsuits in 2014
2014 measure lawsuits
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Ballot text
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Motivation of sponsors
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Signature challenges
Initiative process

Fiscal note lawsuit

On April 15, 2014, Attorney General Tim Fox (R) asked the Montana Supreme Court to review and order a new fiscal note for the Medicaid Expansion Initiative. He said the fiscal note is legally flawed and overstates by $100 million how much the state would get from the federal government if the initiative passes. He stated, "Voters are not well-served by erroneous fiscal information on ballot measures that have substantial policy and fiscal implications to state government."[8] Gov. Steve Bullock (D) disagreed with Fox, saying, "[the initiative's purpose is to] fully utilize available federal funds to provide health coverage for uninsured Montanans."[9]

The Supreme Court ruled unanimously that they would not force a change in the fiscal note because Fox did not seek early comment. Chief Justice Mike McGrath said, “The fiscal statement now at issue was prepared by the attorney general with the benefit of public comment, though it does not appear that petitioners availed themselves of this early comment opportunity.” If the Supreme Court agreed with Fox, then the signatures already gathered for the initiative would have been thrown out.[10]

Path to the ballot

See also: Laws governing the initiative process in Montana

Kim Abbott, the initiative’s primary sponsor, submitted the initiative proposal to the Secretary of State’s Office for approval on November 21, 2013. Abbott withdrew the proposal and resubmitted the proposal on December 13, 2013. This process of withdrawal and resubmission has occurred three times due to criticisms regarding the measure’s text. The second attempt was rejected by the Attorney General because the measure’s text suggested that an appropriation of money to Medicaid expansion would begin immediately following the measure’s approval. This would cause money to be spent before the legislature could designate funding within the state’s budget. The Attorney General recommended changing the initiative's effective date to July 1, 2015 and resubmitting the initiative for reevaluation.[11] On February 19, 2014, the Montana Department of Justice gave the third attempt the go ahead to start collecting signatures.[12]

To gain ballot access for the November 2014 ballot, supporters needed to collect valid signatures from ten percent of the total number of votes cast in the last gubernatorial general election, including ten percent of the voters in each of the forty legislative house districts. In total, supporters needed to collect 24,174 valid signatures. Those signatures needed to be submitted by the petition drive deadline on June 20, 2014.

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