Showdown on health care looms on horizon

Jun 27, 2017

By MBPC Staff

Great Falls Tribune - June 27, 2017 Pressure mounted last weekend for U.S. Sen. Steve Daines to reject any legislation that caps or blocks federal funds that would impede Montana’s Medicaid expansion as the Senate is set to consider a proposal to repeal and replace the Affordable Care Act. An advertisement ran on page A8 of Sunday’s Great Falls Tribune that listed 120 people and groups calling on the Republican lawmaker to oppose legislation that reduces health care coverage for families, charges seniors “a lot” more for health coverage or lessens cost-sharing aid for low- or middle-income people who buy plans through the marketplace. “Cuts to Medicaid will put at risk Medicaid expansion, Healthy Montana Kids and traditional Medicaid that helps seniors, individuals with disabilities and children with special needs,” the ad reads. Daines has remained uncommitted on the Senate proposal, saying he has a townhall meeting Wednesday to hear from Montanans. The Senate is expected to vote on the bill Thursday. “We have a real opportunity to help the American people, and I’m optimistic that we can find a solution that addresses the failings of our current health care system,” he said Friday. Democratic Sen. Jon Tester opposes the proposal, saying it would hurt Montanans. He said seniors will face an age tax, thousands of Montanans will lose coverage, and rural hospitals will be put on the brink of closure, "It’s time for Congress to work together in a bipartisan manner to improve affordability and accessibility for all Americans,” he said via email. Among those whose names appear in the ad are Benefis Health System, Indian Family Health Clinic of Great Falls Inc., Montana Budget and Policy Center, Montana Food Bank Network, Montana Hospital Association, NeighborWorks Great Falls, several faith leaders, patient advocates, mental health providers, nurses, tribal health centers, disability advocates and other health care service providers, The ad included patient advocates like the American Cancer Society, the American Lung Association and the American Heart Association. John Goodnow, chief executive officer of Benefis Health System, called on a rejection of the Medicaid provisions being considered by Congress. “The Senate must reject federal caps and cuts that will hurt our most vulnerable Montanans — like low-income children, seniors, and people with disabilities, and the over 75,000 Montanans who have benefited from the expansion of Medicaid in Montana,” Goodnow said. He said proposals to cap federal Medicaid funds will devastate not only Montana’s Medicaid program and Medicaid expansion patients but also health care providers, particularly small rural hospitals and their communities. Since passage of Montana’s bipartisan Medicaid expansion, the uninsured rate in Montana has dropped to 7.4 percent in 2016, from 20 percent in 2012, according to the Montana Commissioner of Securities and Insurance. The American Health Care Act was approved by the House of Representatives in May and the nonpartisan Congressional Budget Office said it would result in about 23 million Americans losing coverage and more than $800 billion in cuts from Medicaid over 10 years. The Montana Healthcare Foundation said Montana would lose $4.8 billion in federal Medicaid support by 2026, putting pressure on the state budget and likely forcing deep cuts in benefits, enrollment and payments to hospitals and providers. The Healthcare Foundation also claimed more than 70,000 Montanans would lose Medicaid coverage. The Montana Budget and Policy Center warned in May that under the House-passed bill tens of thousands of Montanans would lose their coverage or have increased costs. It noted that more than 240,000 Montanans get health care coverage through Medicaid, half of which are with the Healthy Montana Kids program. The Senate released its version of the health care plan last Thursday. The proposed bill, which would provide 22 million fewer people with health care coverage by 2026 would also cut the federal deficit by $321 billion over the next decade, USA Today reported Monday. That is nearly triple the reduction in the House bill's $119 billion. A June 25 report by the Center on Budget and Policy Priorities, which describes itself as a nonpartisan research and policy institute, said the Senate proposal makes five major changes. It cuts premium tax credits by linking them to less-generous health coverage. It rearranges the current tax-credit schedule, reducing premium tax credits for older people and increasing them for younger people. It eliminates tax credits entirely for people with incomes between 350 percent and 400 percent of the poverty line. Fourth, it lets insurers charge older people up to five times as much as young people compared to a 3-to-1 limit today and it eliminates cost-sharing reductions that lessen deductibles, copayments and co-insurance for lower-income people. “While the Senate bill’s cuts to tax credits are structured differently and are somewhat smaller on average (than the House proposal), their broad consequences would essentially be the same: coverage and care would become much less affordable for millions of people with modest incomes,” the center’s report states. The same report places Montana in the top 10 for premium increases under the Senate bill for a 60-year-old with an income of $42,000. That premium would increase by $5,492 under the Senate plan. Heather O’Loughlin, co-director of research and development at the Montana Budget and Policy Center, said she hopes lawmakers will give the issue the time it deserves now that the Congressional Budget Office report is out. “I think the hope is that Senate slows down a little bit and look at what the impact will be,” she said, noting the bill hurts the “most vulnerable population,” adding that low-income people will pay higher premiums for less generous coverage. O’Loughlin said there needs to be more focus on providing stability to the marketplace and more affordable coverage. Tester said in a telephone interview his office has received 1,300 calls about the Senate proposal and said maybe 50 of those calls were in favor of it. He said the bill was drafted in an untraditional way, shrouded in secrecy, by 13 Republican Senators in a smoke-filled room. “The bill we are going to take up Thursday will not help the working poor or pre-existing conditions,” Tester said, adding health care coverage was taking a step back 10 years ago, nothing to address to premiums. He said if the bill passed the Senate, it would likely pass the House and end up on President Donald Trump’s desk unchanged. He said the Affordable Care Act was passed “so that everyone could afford to get sick.” Tester said a lot of people took advantage of Medicaid expansion under the act championed by then-President Barack Obama. He said the ACA took care of pre-existing conditions, prevention and also took care of issues such as pregnancy and mental health care. “It had a lot of really good stuff in it,” Tester said, adding Trump said it was in a death spiral. That was because the Trump administration did not advertise the enrollment period. “The administration was encouraging people not to participate,” he said. He said he has heard about health care at his recent 14 town halls. Tester said Republicans are talking strictly numbers and not talking about people. “You have to look at people, man,” he said. He said he agreed completely that the Senate delay any decision Thursday. “This is an opportunity to slow down, get people’s input and do the right thing,” he said. Time to be heard Montana’s U.S. senators have townhalls via telephone and Facebook this week to hear from residents about health care and proposed changes to the Affordable Care Act. Democratic Sen. Jon Tester will have a Facebook Live Town Hall 6 p.m. Tuesday at facebook.com/senatortester. Tester heard from Montanans in person Saturday during his town hall meeting in Great Falls. For more information or to post a question early, go to: http://bit.ly/2tcvnNZ GOP Sen. Steve Daines will have his telephone townhall at 6:15 p.m. Wednesday to gather comment from residents on the health care draft proposal to repeal and replace the Affordable Care Act, also known as Obamacare. Daines said Montanans can join his teletownhall by texting “SenatorDaines” (one word) to 828282 or by calling any of Daines’ offices to get registered for the event. Office locations and phone numbers are available here: www.daines.senate.gov. The Senate health care proposal is also posted on his website at /www.daines.senate.gov.