The same week lawmakers in Washington took the first step to dismantle Obamacare, Montana health-care workers gathered at Kalispell Regional Medical Center to outline what the law’s disappearance could mean for health agencies and patients.
“We are the largest industry in the United States, and we have no idea what’s going to happen to us in the next 12 months,” said Jason Spring, with Kalispell Regional.
Spring was one of more than 20 health-care workers to attend a forum with Sen. Jon Tester, D-Mont., Friday afternoon.
The meeting came days after Republicans introduced a resolution that would essentially gut President Barack Obama’s signature health-care law.
The law covers nearly 20 million Americans. But in its wake, states have struggled with double-digit health insurance rate increases two years in a row.
While most consumers qualify for tax breaks — 83 percent in Montana — about 10 million people will face the increases, according to the Congressional Budget Office.
Throughout the 2016 national elections, Republicans most ardent campaign promise rested on replacing the Affordable Care Act.
While Tester has been a voice in favor of Obamacare, he said a partial or full repeal vote of the law is inevitable.
“Whether that happens in the next week, or two or three months, I think it’s going to happen,” Tester said. “The question becomes, is there going to be a replacement plan we can look at to show us if we’re taking a step forward or a step back.”
So far, lawmakers haven’t defined that plan.
Republicans have said after repealing the law, they intend to let it sunset while they come up with a replacement — one that will consider the millions of people covered under Obamacare.
Tester said the health-care law needs improvement, but repealing it isn’t the solution. He warned Republicans within Congress, “If you’re going to do this, make sure you think through it well … if you screw something up, it’s going to have real-world consequences.”
Especially for rural communities, he said.
IF CONGRESS repeals the Affordable Care Act, 142,000 Montanans could lose their health coverage, according to a new report from the Montana Budget and Policy Center.
Friday afternoon was part of Tester’s tour across Montana to hear from providers about the possible rollback’s impact. Tester also made stops in Libby, St. Ignatius and Missoula.
Tate Kreitinger, chief executive officer for North Valley Hospital in Whitefish, said more patients are getting care before it’s an emergency. He said that’s largely due to Obamacare’s major Medicaid expansion, which allowed roughly 70,000 more Montanans to qualify for coverage.
He said pre-expansion, Medicaid covered roughly 9 percent of the hospital’s total patient charges.
“And now ... we’ve been hitting high teens, I think one month we actually hit 20 percent,” he said.
Kreitinger said neither North Valley or Kalispell Regional have saved money do to the growth of insured patients. He said that largely comes from cases of patients with high deductibles and copayments they can’t pay.
But the positive impact has been greater for the hospitals’ satellite clinics, he said.
Of Montana’s roughly 60 hospitals, 48 are defined as critical access — facilities that often work with fewer resources to serve isolated communities. These hospitals provide the greatest amount of charity care as they absorb the cost of treating patients who can’t pay.
Dr. Greg Hanson, chief executive officer for Clark Fork Valley Hospital in Plains, said the hospital’s bottom-line costs have dropped as Obamacare has rolled out. There are about 11,000 residents in Sanders County. Since the expansion, he said Medicaid covers more than 950 of those residents.
As a result, the hospital has been able to plug more money toward equipment. He said if the health-care law is repealed, that flexibility in spending could disappear.
“Physicians need tools to do their job, and when they’re in a place that can’t get the tools that they need, they become very discouraged,” he said. “It makes retention as well as recruitment that much more difficult.”
Joe Russell, public health officer for the Flathead City-County Health Department, said losing the Affordable Care Act goes beyond treating sick patients.
He said Montana has received almost $7 million through the act for preventative care such as cancer screening, disease detection and control studies.
“If we can’t detect disease, then we’re going to be in a lot of trouble,” Russell said.
TESTER SAID it’s important to keep improving the law as it unfolds.
“If we’ve got something that’s working here, we’ve got to try to keep it, and keep taking steps forward,” Tester said.
But 48 percent of Americans don’t think it’s working, according to a new poll by the Kaiser Family Foundation. However, of the 48 percent who said they want the law rolled back, roughly 60 percent said they want an alternative plan in place first.
Tammy Harmon with ASSIST, a Kalispell nonprofit that connects isolated Montanans with services to stay healthy, said the act hasn’t been a solution for everyone. She said she’s witnessed a population of people who don’t yet qualify for Medicare and who make too much to qualify for subsidies.
“My brother and sister-in-law’s health insurance premium this year went from $1,300 to $2,000 per-month, and the deductible went to $12,000,” she said. “That means $36,000 in medical expenses before the insurance could pay anything.”
While the Affordable Care Act has become a battleground between political parties, Tester said he hopes lawmakers can prioritize creating a plan that works for everyone.
“[We need] accessibility, affordability — not one, both,” he said.