For two decades, Montana has provided health care to thousands of its children at low cost or no cost to their low-income families in a program managed by a private company. Once the state determines a child is eligible, his coverage works pretty much like private insurance, allowing access to high-quality care at hospitals and clinics across Montana.
It’s time to use that successful model to start covering low-income parents who now remain uninsured.
Montana Medicaid pays the bills for about 60 percent of the elderly and disabled nursing home residents in our state. Yet many of the low-wage workers who provide that 24/7 care cannot afford insurance for themselves.
Adults with mental illnesses get caught in this conundrum: They lose jobs because they are ill, so they have no health insurance. They can’t get insurance because they have no job and no money. Returning to health and employment can be nearly impossible. Meanwhile, these folks deteriorate until they have emergencies, sometimes even life-threatening problems, and repeatedly wind up in hospitals that provide care regardless of ability to pay.
Four out of every 10 women who gave birth at Billings hospitals last year had no health coverage except for Medicaid. Most of these low-income moms didn’t even qualify for Medicaid until after they became pregnant, and most lost Medicaid a month after their babies were born. This system fails to support healthy pregnancies and healthy babies.
Montana is a relatively low-wage state that has an unusually high percentage of workers toiling at more than one job. Many Montana jobs are seasonal with annual periods of unemployment. Most Montana businesses have fewer than a dozen workers. Small business owners often find employee health coverage unaffordable, even though they want their workers to have coverage.
For all of these reasons, Montana should offer health coverage to all very low-income residents.
Uncompensated care grows
People without health insurance tend to go without the routine and preventive care that keeps minor problems from becoming major. Those festering health problems become a financial burden for the rest of us, because every one of Montana’s community hospitals and public or nonprofit clinics across our state care for patients in need regardless of ability to pay. The cost of that care — delivered late and often in the most expensive setting of emergency departments — is shifted to those who have insurance and those who support tax levies for their local health facilities. In 2003 Montana hospitals reported uncompensated care charges (charity and bad debt) totaling $115 million. In 2013, their total uncompensated care had tripled to $399 million.
The 2015 Legislature has a great opportunity to improve the quality of life for up to 70,000 Montanans by expanding federally funded health care. Covering these low-income parents, workers, mentally ill and other impoverished Montanans will benefit their families, their employers and their communities. Montana’s health care system will become more efficient, more focused on preventive care and personal responsibility through health improvement projects already in place that would add more folks to initiatives such a patient-centered medical homes.
House Bill 249, proposed by Gov. Steve Bullock and sponsored by Rep. Pat Noonan, D-Ramsay, is the best vehicle for delivering the coverage that tens of thousands of Montanans need. These are folks living on income of less than $1,334 a month. They cannot afford insurance. Consider: Montana taxpayers spend $887 per month on health insurance premiums for each state employee and for each of the 150 lawmakers who chooses to be on the state health plan throughout his term.
Montana lawmakers and state employees deserve good health coverage. So do their low-income neighbors.
We call on all Montana lawmakers to make the pragmatic, compassionate decision to support HB249.