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Nick Engelfried, a local freelance writer and environmental organizer, attended a special event at the Missoula Public Library in December in hopes of signing up for the Affordable Care Act. But the volunteers on site explained that he makes too little money to receive subsidized health insurance under the new law. Even more maddening? As a young adult with no children, he isn't eligible to receive Medicaid either. Thanks to Montana's Republican legislature voting against Medicaid expansion last year, Engelfried is one of the 70,000 Montanans who fall into a coverage gap that threatens to undermine the efficacy of health care reform in the state.

"It's frustrating just because the new health care law is set up so that everybody should be able to be covered now by health care," he says. "But it is purely because the state of Montana has chosen not to expand Medicaid, not to take the money that is being offered by the federal government, that people like me are still not able to get health coverage."

To remedy that coverage gap, citizens are taking Medicaid expansion into their own hands. As of Jan. 22, a coalition of labor, advocacy and health organizations filed a revised ballot initiative with the Montana Secretary of State that would allow voters in November's elections to directly approve Medicaid expansion. The initiative's organizers need to collect more than 24,000 signatures for it to get on the ballot.

If the Healthy Montana Initiative passes, individuals with income up to 138 percent of the federal poverty line will be eligible for Medicaid coverage. The federal government will foot 100 percent of the bill for the first three years, and then 90 percent of the bill going forward.

"We can't afford to turn away these federal dollars and send them to other states. These expansion funds are money that Montana taxpayers and providers have actually been paying for since 2008," says Sarah Howell, director of Montana Women Vote, one of the initiative's backers. "Expanding Medicaid is our opportunity to bring that money back to the state."

Citing a report by the Montana Budget and Policy Center, she says that a Medicaid expansion would add more than a billion dollars and roughly 12,000 jobs to the state's economy each year.

"Providing health insurance to low-income people is good economic policy," Howell says, "and the bottom line is that it is the right thing to do."


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