As he starts his third term in the U.S. Senate next year, Sen. Jon Tester said problems with health care access and affordability lead his to-do list, along with working on veterans' issues, infrastructure and education, all with an eye toward the needs of a rural state.
Tester is Montana’s senior senator and the only Democrat in the state’s congressional delegation. He said that in the short term — with a divided Congress as a result of Democrats taking control of the House in this year's midterm elections — he sees a list of wins for both sides of the aisle on health care.
Over and over through the campaign, Tester said he heard from Montanans concerned about the high cost of health care and what would happen if protection was lost for coverage of pre-existing conditions.
Montana voters ranked health care as the most important issue facing the country, according to polling done by the Associated Press. And while voters thought more warmly about how President Donald Trump has handled the economy, immigration, trade and Supreme Court nominations, the poll showed an apparent disapproval of how he deals with health care.
Tester said he plans to put together a list of half a dozen things to champion for rural America, issues he thinks will find some sort of bipartisan traction in an increasingly hyper-partisan environment.
Over the course of Trump's presidency, though Republicans had control of both the White House and Congress, the party failed to deliver its long-promised repeal of the Affordable Care Act.
But a multitude of events and Trump executive orders have altered the country's health care system in a way critics say have led to uncertainty for patients, insurers and hospitals.
They include everything from a lapse in funding for health centers that serve 17 communities around the state, the end of payments that helped offset the costs of health insurance for low-income Montanans who buy coverage on the federal marketplace, as well as the end of the individual mandate.
Tester, who voted for the ACA in 2010, has long said it needs to be improved. But he’s also said while the current system isn’t perfect, it’s kept the state’s rural hospitals and clinics afloat, and those facilities need some form of reliability from the federal government.
“There’s a lot of things wrong with our health care system right now,” Tester said in an interview earlier this month. “First of all, we’ve got to get certainty to hospitals.”
Rural hospitals are vital to the communities in Montana they serve, said Aaron Wernham, chief executive officer of the Montana Healthcare Foundation. But the facilities face hard economic realities in serving small, sometimes remote communities. They received a boost from Medicaid expansion, a provision of the ACA, after it passed in Montana in 2015. In the last three years, uncompensated care at hospitals has dropped $100 million.
“This isn’t a fluke. We know from national data that hospitals in expansion states are six times less likely to close than hospitals in states that did not expand Medicaid,” Wernham said. “Making sure the people that come in your door have coverage and a way to pay for services is essential.”
In Montana, about 22 percent of the population is covered by Medicaid and 18 percent by Medicare, just shy of the total who get coverage through their employer. Medicaid expansion covers more than 96,600 adults.
Concern over the continued existence of the massive programs was used as a campaign tactic across the country this midterm. Tester said he wants to see reassurances that coverage and benefits won’t be rolled back.
Tester called it “unthinkable that we’re going to tell these people they no longer have health coverage."
At a more granular level, Tester wants to see measures to bring transparency to prescription drug prices (“Who the hell’d vote against that?” he asked), specifically making prescription drug companies turn over their formulas to generic manufacturers so they can produce less-expensive versions of drugs. Tester also wants Medicare to be able to negotiate drug costs, and to pass legislation for physician residency programs that better serve states like Montana.
Wernham said residency programs are a critical part of the challenge bringing doctors to rural communities, where recruiting can be difficult.
“It’s tough getting doctors,” Wernham said. “Doctors have a very high propensity for staying where they train.”
Tester advocated for a legislative approach that picks away at health care issues, not a big omnibus package of reforms. He thinks that even in a highly polarized political environment, there would be wins for both parties.
“There’s three or four things that are really good bipartisan wins that would help people and help lower costs for health care,” Tester said. “So do them and see if it’s done the kind of good we anticipate it’s going to do, and if it does, take the next step. … These are easy things, by the way.”
The care for veterans in Montana, a state that has the highest percentage in the nation of those who have served, played a big role in Tester's campaign. Tester campaigned in part on the bills he's brought to fix the beleaguered U.S. Department of Veterans Affairs. But for now he's in a holding pattern to see how one in particular, the MISSION Act, will reshape the troubled agency.
The set of reforms is not fully implemented until July, but Tester said he's holding the VA's "feet to the fire" to make sure it's rolled out properly.
Tester said earlier this month he had concerns the agency was “behind the eight ball a little bit” on implementing the act, which is meant to improve access to health care for veterans. Tester also said the jury is still out on Secretary Robert Wilkie, who took over the massive department a little more than 100 days ago.
“I think he’s a no-BS kind of guy. I have had a number of conversations with him. If he thinks I’m being unfair, he’ll push back. I like that. He’s been in 100 days. I’m a big believer in him. … He’s got to be successful, he has no choice here. We cannot continue to bounce out secretaries in the VA’s case,” Tester said.
Tester added he will “help (Wilkie) in any way I can possibly help him, but I’m also going to make sure he’s doing the job right.”
One of the the things Tester is watching is the push to connect veterans with care at private providers in their communities instead of at VA centers. That was among the provisions of the CHOICE Act meant to let veterans see doctors when they couldn't get appointments at the VA.
Tester said Wilkie supports the community care program, but it will be important to monitor so that it doesn't hollow out the VA.
“It's an interesting line to walk,” Tester said, adding he doesn't want to see community care turn into an effort to privatize the VA through not hiring enough doctors and letting the agency wither.
Tester also said he’s “incredibly concerned” about the lack of urgency filling empty doctor positions in Montana.
“If we can’t get people who can hire doctors and nurses in the VA in Montana, then we need to hire different people,” Tester said.
Jim Porter, the chaplain with the Veterans of Foreign Wars in Montana, said Wednesday that like many veterans in the state, he gets good care at the VA. But he wants to make sure he can keep seeing his doctor at Fort Harrison and not someone he doesn’t know as well at a clinic closer to his home in Belt.
“I have absolutely no complaints about the care and attention and everything else that I get from the VA. They have been very good to me, they really have,” Porter said.
But then he talked about an issue that illustrates when it come to the VA, it can be a bit like plugging a leak in a boat only to have another spring open.
Porter drives to Fort Harrison in Helena from Belt for appointments several times a year. He tries to schedule several on the same day to save the VA time and money on his transportation. Porter said the VA used to cover the cost of a motel room when he had an appointment scheduled before 9 a.m., but the agency recently told him he lived too close for that.
“I myself am struggling to rent a hotel room because I’m not going to leave Belt at 5 o’clock in the morning with the wild game crossing the road and in winter time, it’s not going to happen,” Porter said. “I guess the only thing I’m asking is if he could push the VA to kind of retract that,” Porter said.
Holding power accountable
In a speech to supporters after the race was called in his favor, Tester said Congress needs “to hold people accountable for their actions, and that will be done.”
As Democrats take power of the House in January after historic wins in the midterm and promise to bring investigations into the Trump administration, Tester said his post-election statement wasn’t just about the president.
“Quite frankly it is not Congress’ role to be a part of the executive branch. Congress’ role is to hold the executive branch accountable. And I’m not just talking about the president when I say this. If the VA secretary isn’t doing his job, we have to bring them in and we have to ask them why,” Tester said.
Unlike the House, the Senate did not flip party control, instead seeing Republicans pick up seats. Tester said he’s been frustrated by the inability to get hearings in a GOP-dominated Senate, using as an example a problem that greatly affects a state like Montana: the number of missing and murdered indigenous women.
“I want to have a hearing. I can’t get a hearing in (the Committee on) Indian Affairs. (They say) we’ll do a roundtable discussion. Screw that. We need to have a hearing. I want the FBI and BIA, get them in front of that committee and hold them accountable. There’s a tendency by some of the committees not to do that," Tester said.
While Tester is just coming off his Senate win, Democrats nationally are already looking to 2020. The list of presidential possibles who might challenge Trump keeps growing, and includes Montana’s own Gov. Steve Bullock.
As Democrats look to craft a message for 2020, discussion of what type of candidate should lead the party and where that candidate should fall on the scale from progressive to more moderate, Tester thinks the conversation should shift away from spectrum within the party or partisanship at all.
“We should be looking for things we can do that are wins for the people,” Tester said. “The truth is those are wins. Democrats should be for that, Republicans should be for that. The most progressive of the progressives should be for that and the folks who are the most regressive of the regressive should be for that."