Montana News
The 2024 elections could mean big changes for health care in Montana
With Montana News, I'm Eleanor Smith. Montana Public Radio is bringing you election coverage this year that focuses on the issues voters say are a priority for them. Healthcare is one of those, from abortion access to getting timely care. MTPR's health care reporter Erin Bolton has more information on voter concerns. Hey Erin, thanks for being here today. Hey Eleanor. We're going to get to as many health care topics as we can over the next few minutes. There's already been a lot of reporting done on the fight over abortion access in the state constitution. So we'll spend our time elsewhere now and listeners can find that coverage on MTPR.org. But Erin, what else have you been hearing from voters when it comes to health care? Yeah, I've heard a lot, but I want to start out with the big bucket of Medicaid programs. Can you remind us what Medicaid is? Medicaid is the health care coverage program for low-income people. It provides health care to 20% of adults and nearly 40% of children in the state. Part of that coverage includes mental and behavioral health care. Our fellow MTPR reporter, Shalee Rager, spoke with Amy Still of Great Falls this summer. Still relies on Medicaid so her kids can get behavioral health treatment through a special program at school. I'm not Democrat and I'm not Republican. I just, I vote on what I believe in and what I've studied. And like these kids didn't choose these lives, you know, it's not fair to them. And they don't get to, they don't get to vote or anything like that to decide their futures. So I think it's very, it's up to us to help them have better lives than we have. Okay, so a lot of Montanans use this to get care. Any changes to the program at stake this election year? State lawmakers elected this year will vote early in 2025 on whether to renew Medicaid expansion. This expansion was brought about through the Affordable Care Act under the Obama administration. In short, it provides Medicaid coverage to people above the poverty line. They don't qualify for traditional Medicaid, but they also can't afford private insurance. It's there to fill an insurance coverage gap, nearly 100,000 adults and children are on the program. What happens if Montana's Medicaid expansion goes away? Montana's uninsured rate could go up when Montana became an expansion state about 10 years ago. The rate of uninsured Montanans was cut in half. That rate has hovered at about 8% ever since. The Montana Healthcare Foundation estimates that the money hospitals lost from uninsured patients declined 59% because of Medicaid expansion. That's more than $15 million. The program is lauded as the main reason we haven't seen small hospitals close, like in non-expansion states. The federal government also picks up 90% of the tab for many programs under Medicaid expansion. That's compared to the feds paying for two-thirds of the cost when Montana wasn't an expansion state. What are the chances lawmakers in the governor renew the program next year? Governor Greg Gianforte says he generally supports Medicaid expansion and suggested he may also support work requirements for people enrolled in the program. Democratic challenger Ryan Bussey says he fully supports Medicaid expansion. But lawmakers would have to first approve the program's renewal. What do we know about the chances in the legislature? I wish I had my crystal ball to give you an answer, but we just don't know. But I can tell you lawmakers renewed the program back in 2019 after a lot of fights over work requirements, which were passed but not implemented. That could certainly be a fight again, especially if Trump wins the White House. That's because the federal government has the authority to approve that. But the vote last time was tight, passing with only a one-vote margin in the Senate. That's because some Republicans think the program is too expensive and say the private sector should fill this gap. So coming out of the weeds of Medicaid expansion, what else are voters talking about? Indigenous voters told NTPR that they struggled to access care through the Indian Health Service. That's the federal health system for Native Americans. Don Blatt of Rocky Boy says she's been trying to get a referral for her mom. Like I'm waiting for a referral to get out to see neurologists because she's got something like a tumor grown in her head. Funding for IHS was brought up in the recent U.S. Senate debate between incumbent Democrat John Tester and Republican Tim Sheehee. Both candidates agreed the agency was underfunded, but how bad is it? Congress gave the agency $7 billion this current fiscal year, a congressional workgroup made up of tribes, estimates the agency needs seven times that amount to meet current patient needs. Wow, so that is why people like Blatt are waiting to get things like referrals for care. The agency just can't afford to pay for that. Yeah, IHS has a specific pool of money for community care. It has said it will make referrals if it has the funding to pay for it, but a lot of times it doesn't. Sarah Rosenbaum is a health policy expert at George Washington University. She says to make matters worse, the uninsured rate for indigenous people is high. People are not insured, and so they really depend on the IHS to finance the care they need. For uninsured Native Americans, that means they don't get the care if IHS doesn't have the money to pay for it. Going back to the Tester Sheehee debate, what did we hear on IHS funding? I think it's worth pointing out that funding for IHS hasn't been a big campaign topic, and the debate is really the only time we've heard any congressional candidates extensively weigh in on it. Here's Tester responding to a question about what the federal government can do to increase life expectancy for indigenous Montanans, which is the lowest among all racial groups. And you can take a look at the amount of money that's spent in Indian country for health care, and it is a pittance compared to what's spent in the private sector. He says more funding needs to go to IHS to meet patient needs, and Sheehee said he agreed. We also heard a lot of talk about other federal health programs during the debate, specifically care for veterans. Montana has some of the most vets per capita of any state in the country. What did both candidates say? He said as a veteran himself that he would prioritize those issues in the Senate, but he hasn't put forth specifics. He continued to say the VA is a broken system. And building more VA clinics isn't the answer. Building VA clinics we can't fill isn't the answer. He said private health care programs can do a better job of taking care of veterans and wants vets to have more community care options. But he didn't say he wanted to completely privatize that system or other federal health care programs like Medicare, Tester is the chairman of the Senate Veterans Affairs Committee. He said the VA isn't perfect, but it's come a long way, and he's worked to improve it. What other health care issues are you hearing about from voters? I recently talked to a voter in Missoula at a Tester campaign event about Medicare. Joyce Westerber says Medicare Advantage is an example of a private federal health care program that isn't working. For those who don't know, Medicare Advantage are insurance plans run by private companies that seniors can choose over traditional Medicare. About 77,000 Montanans are enrolled in those plans according to KFF, a non-partisan health policy research group. That's about 30% of Montana's Medicare eligible population. That's actually a lot lower compared to many states, but the private insurers are quickly growing enrollment rates in rural states, quadrupling since 2010. That's because they offer cheap or $0 premiums, which is enticing for healthy seniors. But Westerber says the private companies contracted by Medicare put up barriers to care. The problem is there's all these pre-authorizations that are required. Before you get the care that you need and your doctor or other care providers feel you need. People like Westerber say profit motives need to stay out of federal health care programs. I'm sure there are other health care issues on the mind of voters, but that's all we have time for today. Erin, thanks for talking this over. Thanks for having me.