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Geraldine Custer


On behalf of Montana health care providers, 70,000 uninsured, low-income citizens and their families, thanks to the 54 representatives who voted to keep hope alive for affordable health care.

Among representatives whose districts include parts of Yellowstone County, nine voted to make all very low-income Montanans eligible for government-subsidized health care. We commend these lawmakers for voting to help the state by providing health care access to the needy among us. Thanks to:

Tom Berry, Virginia Court, Geraldine Custer, Jessica Karjala, Kathy Kelker, Margie MacDonald, Kelly McCarthy, Carolyn Pease-Lopez and Tom Richmond. That’s six Democrats and three Republicans joining to do the right thing for the health and future of this state.

Eight Yellowstone County Republicans voted against Senate Bill 405, the Montana Health and Economic Livelihood Partnership Act.

Next steps for HELP

Although this compromise health care bill cleared its highest hurdle last week, Montana Medicaid expansion isn’t a done deal yet. After a final vote in the House, the bill must go back to the Senate to get approval for an amendment that added a $2 million appropriation. That money would go mostly to the Department of Labor and Industry for services to help enrollees get better jobs.

Gov. Steve Bullock should sign the HELP Act soon after it hits his desk.

Then Montana officials will have to get waivers from the U.S. Department of Health and Human Services to allow the new Montana plan to collect premiums from enrollees. Federal officials haven’t publicly agreed to make that exception, but have said they want to work with the state. The lead sponsor for SB405, Sen. Ed Buttrey, R-Great Falls, has been communicating with HHS.

The bill requires the state to contract with a private company to administer the health care benefits and premium collection, so a contract will have to be bid and awarded.

Next comes the challenge of educating tens of thousands of people who haven’t had insurance about how to enroll in Medicaid. Don’t look for 70,000 or even half that number to hurriedly sign up.

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The first to enroll will likely be people with serious illness who are paying out of pocket or foregoing recommended treatment for lack of money. Also, the state would be able to transition seriously mentally ill people from a state funded program with very limited benefits to the expanded Medicaid program, which would provide physical and mental care with the federal government paying 100 percent. Some enrollees would have copays.

Montana clinics, hospitals and organizations working with low-income individuals will have to step up to spread the word. Outreach was critical when Montana expanded its children’s coverage through Healthy Montana Kids years ago. Even with lots of publicity, enrollment took time.

Community benefits

Expanded coverage would empower low-income Montanans to take better care of their health so they can work and reduce their risk of serious illness.

SB405 would reduce charity care and bad debt for Montana health care providers who treat low income and uninsured patients. That will help hospitals and clinics hold the line on charges for all their patients. Or they may be better able to make needed investments in deferred maintenance or services critical to the community they serve. In communities where the health center is subsidized by local taxes, a reduction in uncompensated patient care would give local taxpayers a break. Many of Montana’s hospitals operate on thin or negative margins.

Strong bipartisan House and Senate majorities moved our state closer to closing the insurance gap. Let’s stick together and get this health care deal done for the people of Montana.

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Opinion Editor

Opinion editor for The Billings Gazette.