Missoulian - June 22, 2017
Little has improved for Montana in the U.S. Senate version of a health care bill that was that was debated and altered behind closed doors over the last few weeks.
"Make no mistake: the Senate bill is just as devastating as the widely unpopular House-passed bill and sends us back to a time when health care was out of reach for many in our state," said Heather O’Loughlin, co-director of the nonprofit Montana Budget and Policy Center on Thursday after the text of the bill, called the American Health Care Act, was released.
Montana would still face the same elimination of Medicaid expansion that was predicted to happen under the House version of the bill, which passed at the start of May. Previous reports from the Montana Health Care Foundation estimate the state will lose $4.8 billion in federal Medicaid funds by 2026 under the AHCA’s elimination of an enhanced match for expansion states.
In 2015 Montana became one of 32 states and Washington, D.C., that chose to expand access to Medicaid to those earning up to 138 percent of the federal poverty level under the Affordable Care Act, former President Barack Obama’s hallmark health care legislation also known as Obamacare.
More than 79,000 Montanans are covered under expansion, which was previously estimated to largely vanish by 2024 under the House version of the bill. Health care analysts say the Senate version of the bill just pushes back this date and could result in even greater cuts to Medicaid over time, compared to the House version, by resetting the inflationary adjustment in 2026.
Medicaid represents 38 percent of federal funds coming into Montana. The state’s share of Medicaid cost makes up 10 percent of state spending. Previous estimates from the state Department of Health and Human Services show Montana would need an extra $251 million a year to maintain present coverage under reduced federal funding.
"The bill will end Montana’s Medicaid expansion plan and cut assistance for average Montanans trying to access affordable health insurance, all to pay for massive tax cuts for the wealthiest Americans. This bill could be life or death for many Montanans, as lower-income, rural, older, and sicker Montanans risk losing affordable coverage,” O’Loughlin said.
Compared to the House version, the Senate version of the bill expands tax credits to help offset the cost of buying insurance on marketplaces, but the credits are still below what’s in the Affordable Care Act. The revised Senate bill also cuts off support at 350 percent of the federal poverty line, which hits older Montanans.
The Senate bill raises the amount middle-income people would pay for coverage. For example, a 60-year-old who makes $35,000, which is 300 percent of the federal poverty level, would have to pay 16.2 percent of their income in premiums under the Senate bill. Under the Affordable Care Act, that number was 9.69 percent. That represents spending $2,200 more before getting any assistance from the Republican bill.
U.S. Sen. Jon Tester, the only Democrat in Montana’s congressional delegation, released a statement Thursday blasting the bill and how it was crafted.
“Thirteen Senators have secretly drafted a bill that threatens health care for thousands of Montanans and risks wiping out Montana's rural hospitals while giving tax breaks to millionaires,” Tester said. “Montanans deserve a voice in this process.”
Tester is holding a town hall to discuss the health care bill Saturday in Great Falls at the Montana Electric Cooperatives’ Association, 501 Bay Drive. The town hall starts at 6:30 p.m.
“Montanans deserve a voice in this process, and that’s why I’m holding this town hall. I want to hear from my bosses, the people of Montana, about what they like and don’t like about this legislation,” Tester said.
U.S. Sen. Steve Daines, R-Mont., is also holding a town hall, though not in person. Daines has faced criticism for not holding an in-person town hall this year.
On Thursday, he did not release a statement addressing his opinions of the bill, but said his tele-town hall will be Wednesday. “I’m glad to see the draft text of the bill made public for everyone to see. I look forward to hearing directly from Montanans on this legislation.”
Daines released the text of the Senate bill on his website, as well as through social media, as soon as he got a copy of the bill, according to a statement from his office.
The newest member of Montana’s congressional delegation, Republican U.S. Rep. Greg Gianforte, released a statement saying he was still studying the bill.
"I look forward to studying this bill and receiving input from Montanans on its impact,” Gianforte said. “I believe Obamacare needs to be repealed and replaced but my support for any health care reform is based on protecting Montanans with pre-existing conditions, lowering premiums, and preserving rural access."
The Congressional Budget Office has not yet released its assessment of the bill. By early next week the Montana Health Care Foundation and Manatt Health, which produced analysis for earlier versions of the bill, will release their updated assessment.
Gov. Steve Bullock, a Democrat, said Thursday that the bill does not improve on the previous version and will still increase costs and cut coverage.
"Drafted in secret without bipartisan support or public input, this bill will threaten the health of hard-working Montana families in order to cut taxes for the wealthy," Bullock said. "Forcing a dangerous and costly health care bill like this one onto Americans isn't making our health care system better, it's hurting those who need it most."
Aaron Wernham, the CEO of Montana Health Care Foundation, said Thursday that after briefly reviewing the bill, it appears the two main concerns for Montana — the federal enhanced matching funds for Medicaid expansion and the per capita cap on how much the federal government will pay for Medicaid enrollees — are still in the Senate bill.
“It looks to me like the per capita cap would be more restrictive and therefore result in even greater reductions in the federal spending in Montana than what the House bill proposed,” Wernham said.
The House bill tied the future cap to the Medical Consumer Price Index, while the Senate bill ties it to the All Goods Consumer Price Index, which is typically lower.
“It looks like these cuts are probably more severe than we projected,” Wernham said.
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.