Teamwork Rx for MT health

MISSOULIAN EDITORIAL DRAFT

Montanans have good reason to be worried about health care.

From rising costs to shrinking access, there’s plenty to keep us awake at night. Then there’s the current congressional reform efforts - yet another reason to fear the worst.

Montana’s senators are in a critical position, as a critical moment, to help determine who will receive health care in the future - and who will pay for it.

These are literally life-and-death decisions. We cannot afford to divide them along party lines. Montana needs both its senators to work together to ensure all Montanans have access to affordable health care.

The health bill that was approved by members of the U.S. House in early May, before the Congressional Budget Office released its scores, is a haunting illustration of just how badly health reform can go wrong.

The CBO report concludes, among other things, that the American Health Care Act would reduce federal deficits by $337 billion by 2026 - and leave 24 million Americans uninsured. People who live in rural areas like Montana would face the highest cost increases and the most risk for loss of coverage. Insurers would be free to raise prices for people with pre-existing conditions.

The Center on Budget and Policy Priorities notes that the AHCA would basically put an end to Medicaid expansion - cutting $834 billion from Medicaid over 10 years - which would leave some 11 million low-income adults without health care coverage of any kind. Billions of dollars in costs would be shifted to individual states, a losing proposition for Montana any way you look at it.

The Montana Department of Health and Human Services estimates that our state stands to lose $251 million in Medicaid funds. More than 240,000 Montanans currently receive Medicaid. Nearly half of them are children enrolled in the Health Montana Kids Program, according to the Montana Budget and Policy Center, which also notes that nearly half of the 77,000 low-income residents who enrolled in the Montana’s Medicaid expansion plan live in rural parts of the state.

And even in Montana’s most populous county, Yellowstone County, those over the age of 60 would be hit with average premium increases of more than $10,670 per year, according to the Montana Budget and Policy Center.

Montana’s U.S. Sens. Jon Tester and Steve Daines have both talked about working toward more affordable health care and greater access in rural communities. The ACHA clearly does not do this.

The Patient Protection and Affordable Care Act, often called “Obamacare,” is no cure-all, but it’s a damn sight better than its proposed replacement. Neither senator should support the ACHA’s callous approach to deficit reduction. Instead, they should present a united front for reforms that focus on fixing the significant problems left over from the ACA.

Both senators have acknowledged that there are indeed serious problems with the ACA. For one, premiums have continued to rise under the ACA, with the Department of Health and Human Services’ most recent report showing that average monthly premiums have increased by 133 percent over the past four years, to $581 in 2017.

Meanwhile, providers continue to drop out of the market, and some counties now have no insurers. Only a handful of the 23 co-ops that started with ACA are still standing, and those that remain are struggling. And the CBO expects Medicaid expansion through the ACA to add $1 trillion more spending over next decade.

In his Senate discussions, Daines told the Missoulian editorial board last week, he has been concentrating on looking at “backstops” to prevent further collapse. His priorities, he emphasized, are improving affordability and protecting access. This means, Daines says, stabilizing the market and maintaining coverage for those with pre-existing conditions, as well as the elderly and the indigent.

Daines must understand that any reduction in federal Medicaid funding will hurt Montana. It will hurt those providers in rural communities who rely on Medicaid reimbursements to pay their bills, and it will hurt individuals who cannot pay for health care any other way. Proposals to shift more “authority” to the states, while they may sound like a solid strike for state’s rights, will not alleviate Montanans’ worries about costs because Congress has a long history of failing to follow through. The budget gets tight, the political winds shift, and the money that was supposed to be dedicated to the states dries up. Montanans have seen it happen time and again.

Montana’s senators have teamed up on important matters in the past, but they are not yet working together on this pressing issue of health care, despite claiming to share many of the same priorities.

As a Democrat, Tester is being shut out of Republican-led discussions in the Senate. Republican Daines, meanwhile, is deeply involved in those same discussions. It’s important for Daines and Tester to get on the same page, both because it’s what’s best for Montana and because their united front will lend any resulting legislation some much-needed credibility.

Involving Montanans in these discussions is also key to credibility, and Daines has suffered a blow on that score for an apparent lack of availability. While Tester has held at least a dozen listening sessions specifically on health care in communities from Missoula to Glasgow, Daines has opted to host “tele town halls” on more general topics in which tens of thousands of Montanans called in, hoping for a chance to address health care. Daines has held 16 such events since he was seated in the Senate, including one just this past week in which he expected some 30,000 callers to participate.

Meeting with and hearing from Montanans face-to-face is a very different experience than tele town halls. Tester could provide that crucial perspective from his in-person meetings around Montana; Daines could then elevate it to Senate leadership - before they present their draft legislation, which might happen before the end of this month.

If, in spite of their combined efforts, that legislation looks anything like the AHCA, both of Montana’s senators must join together in voting against it.