HELENA — The biggest supporters of Medicaid expansion in Montana – besides those who might get the coverage – are Montana’s medical community, including hospitals, clinics, physicians, nurses and other providers.
They’d benefit financially, as hundreds of millions in federal funds would pour into the state, to pay medical bills for some 70,000 Montanans now without insurance.
But hospital executives and physicians insist that money is not their primary reason for supporting the expansion.
The most important objective is getting more people covered with insurance, because people with insurance don’t delay needed care and are healthier and happier, they say.
“It’s very clear that health improves (if you’re covered),” says Tom Roberts, a Missoula physician and head of the Western Montana Clinic. “There really should be no argument about that. … They get better care by far than they would without insurance.”
Nonetheless, money is a factor, as hospitals stand to get paid for services they now often have to write off, because they generally can’t turn away those who show up for emergency care.
“If there is coverage and some reimbursement, it’s a better situation than we have now, where’s it almost all written off,” says Nicholas Wolter, CEO of Billings Clinic, the state’s largest hospital.
At Marcus Daly Memorial Hospital in Hamilton, CEO John Bartos says the hospital will write off $10 million to $11 million in bad debt and charity care this fiscal year, or 5 percent of its net revenue.
Those costs get shifted to people who can pay their bills, such as those with private health insurance, he says.
Bartos and other hospital executives say revenue from Medicaid expansion will reduce that cost shift, which he called a “silent tax” on paying customers.
Yet hospital executives also say while Medicaid expansion would produce more revenue, hospitals are seeing other payments cut by national health care reform, and that the Medicaid would bring in more customers whose payments may barely cover costs.
“I hope (expansion) reduces our costs, but there are a lot of questions that are yet to be answered,” says Steve Carlson, CEO at Community Medical Center in Missoula. “For us, as we look at the economic implications of expanding Medicaid, it’s likely a push for us.”
Of course, not everyone in the medical community is behind Medicaid expansion.
Paul Gorsuch, a neurosurgeon from Great Falls, and several other physicians submitted letters to a House committee last week saying they oppose it.
In an interview, Gorsuch said Medicaid is rife with problems, and that expanding it is likely to make them worse.
Medicaid pays physicians at rates often below the cost of services they provide, he says, and Medicaid patients rarely contribute any of their own money, so the care is seen as free, he says.
Patients who “have a little financial skin in the game” are more serious about taking care of their health, he says: “People underestimate how big a role that is in getting healthy.”
Gorsuch also says if 70,000 patients are added to Medicaid, able to get “free” care, they will overwhelm a system already short on primary-care physicians, making it harder for all patients to get in to see available physicians. The result will be de facto rationing of care, he predicts.
Roberts, however, doesn’t buy that argument. He says many of the patients covered by a Medicaid expansion are already in the system, seeing doctors and going to the hospital.
“Do you want to provide care to them and get paid for it, or do you want to provide for them and not get paid?” he asks.
And, under Medicaid, covered patients would get acute care earlier and avoid more serious disease, Roberts adds.
He also says that Medicaid reimbursement rates for physicians, clinics and hospitals sometimes come close to meeting costs – but, again, that money isn’t the main reason he and most in the medical community support the expansion.
“We believe health care should be a right,” says Carlson, the CEO for Community Medical Center. “We also think from a societal and economic position, we are better off investing in preventive care for these individuals, as opposed to waiting until we have a clinical train wreck that is going to be significantly more costly to treat.”