One of every five Montanans too young for Medicare has no health insurance. What would happen if Medicaid coverage is offered to the 69,000 lowest income, uninsured Montanans?
- New federal dollars would flow into the state.
- New jobs would be created, mostly in health care but also in services and supplies to health care providers.
- Workers in these new jobs would pay taxes and spend their money in communities all across the state.
The estimate of 69,000 Montanans comes from two sources. First the Bureau of Business and Economic Research at the University of Montana conducted a detailed survey of Montana households in 2011. Data from that survey is in a BBER report presented in January to state insurance commissioner Monica Lindeen. Likewise, the U.S. Census Bureau recently estimated that 68,259 uninsured Montanans are under 138 percent of poverty level, which is the maximum income that the federal government will cover with Medicaid starting next year -- in states that choose to cover their residents.
For three years, the U.S. government will pay 100 percent of the Medicaid care costs for these newly eligible enrollees. After that, states would gradually be required to pay part of the care costs until in 2020 and future years, states would pay 10 percent and the federal government would pay 90 percent, under the federal health reform law.
Most low-income Montana kids already are eligible for Medicaid or the Children's Health Insurance Plan through the Healthy Montana Kids program. Forty percent of births in Montana are covered by Medicaid. About 60 percent of the elders in Montana nursing homes are Medicaid patients. Folks who have been certified as disabled by Social Security also qualify for Medicaid. Parents of young children whose income is a fraction of poverty level also may qualify for Medicaid.
Workers left out
The people left out for now are able-bodied non-pregnant adults between the ages of 19 and 64. Most of these Montanans are working in lower paying jobs. If they had Medicaid, an important sector of Montana's workforce would become healthier and more productive with fewer days lost to sickness.
No place in Montana has more at stake in the Medicaid debate than Yellowstone County. In the state's largest medical center and largest population center, Medicaid expansion would be a boon to both individuals and the area economy. Extrapolating from BBER statewide data, the Montana Budget and Policy Center estimates that 7,245 Yellowstone County residents would become eligible for Medicaid and that covering more Montanans would boost Medicaid spending in our county by $56 million annually while creating 1,450 jobs.
Small wonder that leaders of Big Sky Economic Development and Billings Chamber of Commerce are voicing their support for Medicaid expansion.
Montana hospitals and other health care providers are pushing for expansion because as the federal health care law covers more Americans with Medicaid, it will reduce payments to health care providers. In particular, hospitals will see decreases in Medicare's disproportionate share payments that now help compensate facilities that treat a lot of indigent patients. If Montana doesn't expand its Medicaid program, health care providers in our state will still still have their payments cut.
Although much focus of the Medicaid debate is on covering more Americans, just as important is the opportunity to reform the health care system.
"We've got to reform our system and do it better because it costs too much," said Cindy Stergar, health policy adviser to Gov. Steve Bullock.
Bullock has said he supports a Medicaid reform and expansion bill that House Minority Leader Chuck Hunter of Helena will introduce.
Neither Bullock nor Stergar revealed details of the bill in recent interviews with The Gazette. But Stergar said it will focus on principles such as integration and coordination of care, patient-centered care and accountability.
She is encouraged that the U.S. Department of Health and Human Services recently has started saying it wants to hear Montana's ideas for Medicaid reform.
Those ideas ought to include:
-- Incentives for both providers and patients to use care appropriately.
-- To address concerns about financial sustainability, the state could start by offering the newly eligible the minimum Medicaid benefits allowed and requiring affordable co-pays for those who can pay something.
The Republican governor of Arizona has given her support to Medicaid expansion, but her state also included a "circuit breaker" that says the expansion would end if the state's share of costs rises to 20 percent. Cost conscious Montana lawmakers might consider a similar trigger.
Meanwhile, Montana has the opportunity to offer health coverage to 69,000 residents, to boost its economy with an estimated 11,000 new jobs that would add up to $477 million per year in labor income, according to the BBER.
That's an offer too good to refuse. We call on lawmakers to consider the full impact of Medicaid reform and expansion. We call on Bullock to get his proposal before the Legislature when members return from transmittal break and to work with them to get a good plan for Montana. Lawmakers who want to boost Montana's economy won't find a better opportunity this year than Medicaid.