Republicans are about to pass an immoral budget that will yank healthcare coverage from millions, put hospitals out of business, and reduce services for all Americans. Montana already tried this, and it was a disaster.

Like Donald Trump, our Montana Governor Greg Gianforte is a very wealthy man who strongly opposes government programs that benefit those less fortunate than himself. Like Trump, he’s never hidden that he wants fewer services and more tax breaks for the wealthy. Gianforte has even gone so far as to proudly appear with Grover Norquist, the anti-government crusader famous for demanding that all government services and programs be strangled down small enough so that they could be finished off, or as Norquist says, easily “drowned in a bathtub.”¹

Gianforte’s predecessor, Democrat Steve Bullock, believed in a more balanced approach and fought hard to expand Medicaid, eventually forming a celebrated bipartisan majority that dramatically expanded the federal program’s coverage in Montana in 2019. Not only was this the morally right thing to do, but covering more people with Medicaid also saved money and helped stimulate the economy. A story in the Daily Montanan extensively quotes Montana economist Bryce Ward on the numerous ways the expanded federal health coverage dramatically improved outcomes, reduced healthcare expenses for all citizens, boosted economic growth, and strengthened hospitals across the state.

“In 2023, more than 52,000 adults went to the dentist for preventative screenings, which represents a 277% increase from the number of dental screenings provided in 2015. Moreover, screening for cholesterol increased by 405% since 2015.

The data suggests that more than 1,400 cases of cancer were averted, with breast cancer and colon cancer the top types. Other categories of care also increased. For example, hypertension treatment has risen by 312% since expansion; diabetes cases treated has risen 245%; and substance use disorder treatment has seen a 636% increase.

Over time, the study tracked the new enrollees’ trips to the emergency room, often the most expensive care available. For patients enrolled in the expansion for more than two years, the 2025 report suggests that there is nearly a 10% drop in need for the services, and over time, that number continues to decrease.

Trips to the emergency room for preventable dental diseases also plunged by nearly 40% for those enrolled for more than three years.”²

Small businesses in our state reported a more stable workforce. Expensive trips to the emergency room were avoided. Hospitals and clinics used Medicaid reimbursements to help cover programs such as ambulance services and substance abuse programs. Without this federal coverage, many of our rural clinics and health facilities would have been shut down.

Business leaders approved, and healthcare executives were believers; social workers praised the funding. However, this did not stop Gianforte from attacking the program, and just like Republicans in the Senate today, he too found a way to gut coverage by claiming to improve it.

Here’s how it happened: When the federal COVID-era laws mandating automatic re-enrollment for Medicaid recipients were dissolved in 2023, the federal government allowed states broad leeway in reassessing who was eligible, and Gianforte, who often claimed that the system was riddled with fraud, seized the opportunity. Yes, this is just like the Republicans in DC who are now using “work requirements” as a sleight of hand to kick people off the program.

He used that administrative excuse to remove more than 132,000 people from the Medicaid rolls in Montana (that’s more than 1 in 10 Montana citizens!), claiming they were likely fraudsters or freeloaders, effectively reversing all the advantages gained by Bullock’s expansion in 2019.

The similarities to MAGA/DOGE are even more direct because Gianforte had first appointed a 28-year-old lackey with no management or healthcare experience to “run” our state’s largest agency, the Montana Department of Health and Human Services (DPHHS), which is responsible for assessing eligibility providing services to those who seek coverage. So when it came time for this wave of 132,000 people to reapply, the agency was so dysfunctional that there was no way for them to do it.³ The resulting stories of purposeful paperwork losses, nonresponse, and days of single mothers staying on the phone hold for more than 8 hours bordered on criminal and were well-documented.

The human toll was heartbreaking. Thousands of children, Native Americans, the permanently disabled, and working Montanans were instantly without coverage. This mismanagement and decline in coverage for children was so extreme that it triggered a siren alert from the federal government.⁴ Hospital administrators began sounding their own alarm. Not only was this immoral, but the costs for their hospitals were skyrocketing. Some of those costs threatened services, some were being passed along to insured customers, and Montana Businesses were losing workers.

One simple and true story from that time in Montana illustrates the insanity of the Republican approach and gives you a good idea of what national Republicans are cooking up for America: On a warm July day during my 2024 campaign, we met with the administrators of the Billings Clinic, which is the largest hospital system in the state. The executives were eager to explain the severity of the Medicaid situation, and they had an illustrative example in their hospital to support their point. Turns out they had just admitted a older Native American man, who, if he lived, would be in for an extended and extremely expensive stay in the cardiac ICU. He had multiple heart attacks that morning, and it was touch-and-go. He was uninsured, and so the hospital would have to find a way to absorb or pass along the costs.

“This man should not be here,” they told me. “Two weeks ago, he came to a clinic and needed a refill on his heart meds, but we had to tell him he was no longer covered by Medicaid. Gianforte declared him ineligible. We told him he had to go back and restart the application process. With all of the dysfunction, he could not get anyone at the state to help him, so he went away without his medication, and even after two weeks, he still had not gotten a call back. Because he was no longer medicated, he went into cardiac arrest and showed up in our emergency room nearly dead. He’s in very bad shape. It’s incredibly sad and very expensive. Everybody loses when this stuff happens.”

When Gianforte was confronted with these and thousands of other stories, including in a fiery press conference from our campaign, his administration told Montanans that his plan was “working as intended.”⁵

Gianforte defeated me in that election, but his self-imposed Medicaid disaster did not last long. It was so bad that he had to reverse course and support renewal of the program in our 2025 legislative session. I guess he’s seen the light, but he should not be forgiven for the impacts of his earlier mismanagement, and we should not repeat his mistakes.

What Gianforte did to one small state and 132,000 people, Senate Republicans are now planning for 16 million Americans. We’ve run this experiment, we’ve got the proof, and this is a very bad idea. It’s terribly immoral to people like that man in Billings, Montana, and it’s detrimental to our country.

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