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Montana hospitals are worried the latest Senate Republican plan to repeal the Affordable Care Act will harm the working poor and seniors.

Speaking on Wednesday with U.S. Sen. Jon Tester, D-Mont., members of the Montana Hospital Association said the GOP’s plan to replace ACA subsidies with block grants will likely mean steep cuts for Montana health programs like Medicaid, which was expanded in 2016 to provide health care to an additional 70,000 working poor people under the Affordable Care Act.

“One of the things that is a concern to us is the understanding that we would be doing away with the current Medicaid expansion and moving to a block grant mechanism,” said Randall Gibb, Billings Clinic CEO. “We understand the money would be pooled together and there would be preferred treatment for states that did not undergo Medicaid expansion. As a state, we would actually be losing resources.”

Block grants enable the federal government to pass money onto states with few specific terms attached for how the money must be spent. Republicans supporting the latest ACA repeal bill, authored by Sens. Lindsey Graham, of South Carolina, and Bill Cassidy, of Louisiana, say block grants will allow states to decide how the federal money will be spent.

A vote on the bill is expected by month’s end.

Montana Republican Sen. Steve Daines told The Gazette this week that the freedom to make spending decisions is exactly what Montana needs to deal with challenges of subsidized health care. Daines said Montana will likely receive more federal health care money through per capita cap or block grants than it does through ACA.

Dick Brown of the Montana Hospital Association sees a different outcome under block grants than the one presented by Daines.

With few strings attached for what block money can be spent on, there’s a possibility that a cash-strapped Montana won’t spend the money on health care, Brown said. Another concern for MHA is that the Graham-Cassidy bill terms out in 2026, after which there’s no assurance of continued federal funding.

Daines has said the bill’s expiration date is set for 2026 because all federal spending is done in 10-year cycles.

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Montana hospitals would rather the Senate focus on fixing ACA than on repealing it, Brown said.

“The Graham-Cassidy bill will jeopardize many lives that are covered today,” Brown said. “We urge the Senate to oppose this bill and instead protect the health coverage of vulnerable Montanans.”

The true fiscal consequences of Graham-Cassidy haven’t been calculated by the Congressional Budget Office, which gives the official score on legislation. In the CBO’s absence, outside groups are offering opposing views of what the bill might mean for individual states.

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Avalere Health Analysis estimates a $215 billion cut in federal health care funding to states through 2026 and a $4 trillion cut over 20 years. However, not all states would see immediate cuts, according to Avalere. Avalere projects no change for Montana before 2026, but by 2027 the state would see a $1 billion reduction. By 2036, the state would see a cut of $11 billion.

AARP Public Policy Institute projected Wednesday that Graham-Cassidy would cut $7.5 billion from Montana Medicaid by 2036.

Medicaid is most often associated with subsidized care for the poor and the disabled, but the program has a significant impact on seniors living long-term in nursing homes, said Jason Cronk, Immanuel Lutheran Communities executive director. Immanuel provides residential, rehabilitative and assisted living in Kalispell.

Seniors make up a significant portion of Montana’s population, Cronk said, with 25 percent of Montanans being 65 or older in the next five to six years. Medicaid will play a major role in making nursing homes affordable for many of those seniors.

Tester said he is concerned that while big hospitals might be able to survive the cuts under Graham-Cassidy, rural hospitals won’t.

“This dangerous bill will raise rates, kick hardworking folks off their health plans, and shutter rural hospitals,” Tester said.

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