Gazette opinion: Consider options to cover Montana’s uninsured

2012-07-25T00:10:00Z Gazette opinion: Consider options to cover Montana’s uninsured The Billings Gazette
July 25, 2012 12:10 am

Two out of every five babies born in Montana are born to mothers who have low income and no insurance other than Medicaid.

With controversy raging over possible expansion of Medicaid, it’s important for Montanans to know how our state program operates now.

Let’s start with the youngest Medicaid enrollees, the babies.

In Montana, a pregnant woman in a two-person household can be covered by Medicaid if her income is as much as $22,695 annually.

However, once her baby is born, that mother (now in a household of three) can only keep her Medicaid coverage if her income is below $10,499 annually.

Childless, nondisabled adults between the ages of 19 and 64 cannot get Montana Medicaid coverage -- even if their income is zero. So most low-income Montana women don’t qualify unless they are pregnant.

In 2006, 4,571 Montana births were covered by Medicaid, according to the Montana Department of Public Health and Human Services. In 2010, that number had grown to 4,648. At the same time, the total number of babies born in the state decreased from 12,499 to 12,058. This trend suggests that the proportion of Montana women of child-bearing age without health insurance has increased.

Yet women only get coverage when they are pregnant. That makes no sense for individuals or for the state. Women and men with health coverage are more likely to maintain good health, get preventive care and effectively manage health problems. For women especially, being healthy before conception is an important factor for healthy pregnancy and healthy babies.

Uninsured women tend to have higher-risk pregnancies. A baby born with health problems that could have been prevented can require tens of thousands -- if not hundreds of thousands -- of dollars in specialized medical care. Montana and federal taxpayers pay that bill. The voter-approved program Healthy Montana Kids covers children of poor and lower middle income families even while the state denies coverage to their parents.

The 2011 Legislature rejected proposals for Medicaid to cover more Montanans. Even many Montanans eligible for Medicaid don’t use it. The program requires a lot of paperwork, financial eligibility must be verified frequently, many health care providers refuse Medicaid patients or limit the number they see. It’s easier for many folks to go without and use a hospital emergency room when a problem becomes unbearable.

Fortunately for the needy, all of Montana’s general hospitals are nonprofit organizations committed to providing care regardless of the patient’s ability to pay.

However, somebody has to pay. That somebody is all of us who pay taxes, pay for our own care, our own insurance or employees’ insurance.

The cost shift from uninsured patients added $2,100 to the average Montana family insurance premium in 2009, according to the Center for American Progress.

More than a dozen years ago, when the federal government launched the Children’s Health Insurance Program and states could expand Medicaid to cover more uninsured children, Montana found another way. Montana CHIP, which is now part of Healthy Montana Kids, was set up much like private insurance with the state paying premiums and families having little or no co-pay. Health care providers across the state negotiated discounts with the program to make sure Montana children could access care. The program continues today with more than 21,000 children enrolled and is administered by Blue Cross Blue Shield of Montana.

Since the Supreme Court ruled that Medicaid expansion is optional for states, Montana leaders ought to negotiate with the federal government for flexibility. Maybe the state can set up an adult program similar to CHIP. Perhaps, the state could do a pilot program enrolling some low-income adults in private insurance plans with low out-of-pocket costs and the state paying the premiums.

Most Montana Medicaid spending is on elderly and disabled people. Montanan’s uninsured are predominantly young adults who will cost much less per person than the Medicaid population already covered.

The Supreme Court’s “optional” ruling may open another door to expanding coverage and reducing some of the cost shift/emergency room dependence that plagues our present Medicaid system.

Copyright 2014 The Billings Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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