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Deadline passes, many remain without health coverage

LAKE COUNTY – Last week the Obama administration extended the deadline to mid-April for people not quite finished registering for healthcare under new law, but that won’t help an estimated 70,000 Montanans who find themselves without coverage because of the state legislature’s decision not expand Medicaid in its last session.

March 17 saw the launch of a ballot initiative that would allow citizens to vote in favor of or against the expansion of Medicaid coverage to some of the state’s lowest income individuals, but state officials are wary of how effective the initiative actually is. Ultimately, the state legislature will have the final say. It must approve funding for the measure in 2015 if it is passed. The legislature had the opportunity to expand the program in 2013, but the measure to bring the issue to the floor failed by a single vote that was later determined to be accidentally miscast by a Democratic legislator.

Hanging in the balance of the political struggle is Keith Edmonson. The Big Arm resident will turn 53 this week. He’s an African American male with a long family history of cancer, diabetes, heart failure, stroke and high blood pressure. Edmonson said he was wary of the healthcare law when it was first passed because it mandated insurance coverage. 

“I was torn on certain aspects of it,” Edmonson said. “I didn’t want government to tell you what to do … I never liked being told ‘you have to.’” 

The self-confessed news junkie had seen media coverage of the issue, but Edmonson wanted to know firsthand what the bill actually said. 

“You have to read it,” he said. “If you don’t read it, all you’re going to do is take the advice of someone that you’re having lunch or breakfast with at the deli. You’re going to take someone’s word. Just because you trust them doesn’t mean they know what they are talking about.” 

Edmonson found parts of the bill that were simple to understand, and parts that were difficult to comprehend. He agreed with some of the legislation and disagreed with others. He liked the part where the government helped the poor receive coverage. 

“It made sense to me because there’s a lot of people I know that need help,” Edmonson said. 

As the rollout progressed, Edmonson watched his home state of Colorado and his adopted state of Montana take entirely different paths for Medicaid expansion. 

“I realized I’m in trouble,” Edmonson said. Once enrollment opened, Edmonson filled out the forms to see what coverage he might be eligible for. The process was time consuming. 

“To get done (with the application) and it say that I’m qualified for Medicaid, and I fit the criteria but Montana does not offer it, that hurt,” Edmonson said. 

The part that smarted the most for Edmonson was that the federal government would have paid all of the cost of expanding Medicaid through 2016. Under the law, states begin to pay part of the cost of the expansion after 2016, but the federal government still bears the brunt of the cost – 90 percent – until 2020. 

Edmonson set out to write his legislators to tell them his thoughts on the expansion matters. He contacted 90 percent of state legislators and all of Montana’s national representation. Some wrote back, others didn’t. The verdict was always the same: Edmonson will have to wait until 2015 to get a verdict. 

“They can talk all they want to about how it’s going to affect something in the long term, but we are in need of immediate care,” Edmonson said. “ … It’s not coming out of Montana’s pocket. It’s free money.” 

Susan Evans is a Democratic contender for Montana House District 93. She agrees that the state should have expanded Medicaid in 2013. 

“I think that it was spiteful and unnecessary for our legislature to vote against this valuable expansion,” Evans said in an email. “Now, more than ever, when too many people are falling through the cracks, it is our responsibility to take care of our elderly, our disabled, our veterans, and our children who may qualify for the expansion.” 

For incumbents who sat in the chamber last session, the decisions aren’t as clear-cut. 

According to Representative Dan Salomon, the bill to expand came in late last session and was shuffled around without legislators being able to fully assess its impact, although most of the legislators agree the issue is a priority. 

“This is a really important thing,” Salomon said. “It’s an issue that needs to be addressed.” 

Several problems exist with the proposal to expand, according to Salomon. One is the payment structure for healthcare providers. The payments have already been lagging and under the proposed expansion those amounts would drop even more. 

“Doctors aren’t going to see Medicaid patients,” Salomon said. “They have that option. If they don’t see patients, it’s not really going to work. We need them to treat these people.” 

Salomon said bills in the past few sessions that dealt with tort reform and other healthcare cost saving measures were vetoed by the governor. He believes both sides are going to have to come to the table willing to compromise in the next session. 

“We’ve both got some good ideas,” Salomon said. “What can we do with it?” 

The outlook for the current expansion plan, called the Healthy Montana Initiative, is grim, according to Salomon. 

“As it stands now, full Medicaid expansion, I don’t think that the state can make it fly,” Salomon said. “I don’t know any Republicans who would vote to fund it in that form. It’s going to be way over $300 million after a couple years. That’s a tax increase.”

The exact price tag of the initiative has been in dispute. 

At a March 20 info session at Salish Kootenai College in Pablo, Commissioner of Securities and Insurance Monica Lindeen touted the savings Medicaid expansion could bring the state. 

Governor Steve Bullock’s office released a fiscal note in February that claimed expanding Medicaid in 2016 would save the state $7.7 million over three years. The state’s Legislative Fiscal Division threw a red flag at that claim on March 12. In a communication with Senator Fred Thomas of Stevensville, an analyst for the division claimed that Bullock’s office counted $107.4 million toward the savings that shouldn’t have been included. If that analysis is correct, the state’s cost of the three-year expansion would amount to $99.7 million.

Republican Representative Greg Hertz and Senator Janna Taylor both referenced the analysis as a factor to consider as the legislature moves forward. 

“Most citizens are not aware of these costs,” Taylor said in an email. “The initiative might pass for that reason alone.” 

One thing Taylor wants to examine before voting on the matter next session is how other states have implemented different kinds of expansion. 

“So far about half of the states have expanded Medicaid,” Taylor said. “We plan to review their successes and problems to see what we should do here in Montana.” 

She and Hertz both said Montana will likely have to seek a waiver from the federal government that allows Montana to tailor an expansion program that fits the state’s needs. 

“Expansion of existing Medicaid is a short-term solution to a long-term problem and will result in putting current Medicaid and Medicare recipients at risk due to possible reductions in existing benefits,” Hertz said in an email. “In order to reform Medicaid, Montana will need to request waivers from the federal government. The federal government’s one size solution does not work. What may work in New York does not always work in rural Montana.” 

Among Hertz’s suggestions for bettering the system are establishing and expanding low-income clinic usage; utilizing home-based care models for long-term patients; using co-pays, penalties and incentives to help patients choose best usage of medical care; and requiring patients to be responsible for following doctors’ directives.

Hertz says he always takes the opinions of his constituents to heart in his decisions and it’s that attitude that Lauren Wittorp is counting on while canvassing for signatures to put the initiative to expand on this year’s ballot. Wittorp is one of many people statewide working toward the 24,000 signatures necessary to bring the measure to a vote. She spoke to a group in Pablo on March 20 about the measure. 

“I think it’s the best we can do right now without calling a special session of the legislature,” she said. 

In Big Arm, Edmonson waited in the coverage purgatory for answers and he encouraged people to learn more about the opportunities to improve coverage, and communicate them to the legislature. 

“Educate yourself on this bill,” Edmonson said. “That way when something goes down, you can at least fight for it when someone asks you.” 

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