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Montana’s Republican-controlled House voted Thursday, 54-46, to approve federal subsidies for Medicaid expansion. Although Democrats are outnumbered 59-41 in the Montana House, a unified Democratic caucus joined forces with 13 Republicans who defected from their party’s leadership, to push Senate Bill 405 through the House chamber. The bill would expand Medicaid coverage to between 27,000 and 46,000 low-income Montanans who earn less than 138 percent of the federal poverty level.

All 41 House Democrats approved the Medicaid expansion. Republicans opposed it 46-13, but the 13 defectors were enough to tip the balance to pass the measure. House Republican leaders tried to kill the bill, but they were unable to keep their party unified in opposition. One defector, Rep. Geraldine Custer (R-Forsyth) argued in defense of the bill, noting that its main beneficiaries would be the working poor. Custer stated:

They (the working poor) are not people who are lying on the couch, waiting for a handout. Why should they be penalized and not able to afford health care?…This bill is a Montana solution for the Montana people who are too rich for (current) Medicaid but too poor for (help from) the Affordable Care Act.

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Another Republican proponent, Rob Cook, who represents the rural community of Conrad, urged fellow Republicans to support the measure. Cook implored his colleagues:

I think this is the right thing to do, it’s the right time to do it. Let’s pass this bill.

A dozen Republicans listened and did just that.

The bill, as amended by the House is expected to pass the State Senate, and be sent to the desk of Montana’s Democratic Governor Steve Bullock. While Bullock has not yet identified whether or not he will sign the bill, his top health adviser has testified in favor of SB 405 in legislative committee hearings, so supporters of Medicaid expansion have good reason to be optimistic.

Medicaid expansion is a common sense idea that brings affordable health care to the working poor who live paycheck to paycheck to make ends meet and have little left over to cover the costs of health care. The Montana plan would lock premiums in at two percent of the recipient’s income. It is the kind of common sense, compassionate approach to health care that the Republican Party leadership has rejected in state after state.

Yet, in several states, including Montana, a small number of Republicans have defected from the toxic ideology of the Tea Party leadership. By joining Democrats in putting their constituents ahead of anti-government party orthodoxy, 13 Montana Republicans may have just helped tens of thousands of residents qualify for affordable health care under Medicaid expansion. In a state as red as Montana, that is no small accomplishment.