By Michael Howell
Governor Steve Bullock came to the Bitterroot Valley last week to tour Marcus Daly Memorial Hospital (MDMH) and discuss implementation of the Health and Economic Livelihood Partnership Act (HELP Act), which made Medicaid health care benefits available to an estimated 70,000 previously ineligible Montana residents beginning on January 1 of this year. Coverage is offered through a private insurance company just like health plans available to other Montanans. The bill also offers new Medicaid members help finding work and getting new job skills.
Bullock told a gathering of hospital administrators, board members, and hospital staff that since registration was opened on November 1, over 22,000 people had already been signed up. That is roughly two thirds of the estimated pool of eligible people in only two months, he said. He said people will continue to be able to sign up throughout the year and he expected the numbers to grow as information about the program gets disseminated.
One person, Amber Moon of Corvallis, who recently applied for Medicaid under the HELP Act, joined the Governor on the tour of the hospital’s maternity ward, physical therapy center and Intensive Care Unit. Afterward she joined him at the discussion table and talked about her experience.
She was diagnosed with thyroid cancer when she was in the eighth grade and got her thyroid removed at a Spokane Hospital. This was followed by two years of radiation therapy. The cancer was beaten but, without a thyroid, she had to take expensive medication to keep her body functioning. She said when she turned 18 she was no longer covered by insurance. She started avoiding going to the doctors for checkups and examinations and quit buying her medicine. Her health deteriorated and last October she was admitted to the hospital.
“Which put me thousands of dollars in debt and I almost died,” said Moon. The doctor told her he was surprised that she was not comatose and that without any treatment she would probably only have lived for a year.
“But miraculously I made it,” said Moon. “And now with Medicaid I can get the medicine I need and get my life back on track.”
Bullock brought along a letter of confirmation of Medicaid coverage and personally handed it to Moon.
MDMH CEO John Bartos thanked the Governor for taking leadership in getting the HELP Act through the legislature. He said the Bitterroot Valley was a beautiful place to live and the income level of people here runs the spectrum from the very rich to the very poor. But, according to the last census, the average household income in the valley was from $42,000 to $45,000 per year.
“It’s a struggle for many to keep a roof over their heads and food on the table,” said Bartos. “They can’t afford to buy insurance.” He said 65% of the hospital’s business is either Medicaid or Medicare.
Bartos said that low income people who don’t have insurance still get sick but they put off getting any help until it is so serious they end up in the Emergency Room. He said a lot of people even believe that going to the Emergency Room is free. But it is not. The hospital faces about $7 to $8 million in bad debt annually and spends another one to two million dollars in charity.
Bartos said by enlisting more eligible people into the Medicaid program it makes it possible for them to get the kind of preventative care that can keep them out of the ER, one of the most expensive forms of care.
“We need to have care administered in a family care setting,” said Bartos. “That’s where it should occur, not in the Emergency Room. I see it as a benefit to the patients, the hospital, society and the government.” He said the hospital was just learning about the new regulations related to Medicaid expansion. He said they were endorsing it and would be monitoring the results.
The Governor’s Health Policy Advisor, Tara Keazey, said that the HELP Act also established a connection between the Department of Health and Human Services and the Department of Labor and new registrants to Medicaid are also being referred to the Department of Labor for information about jobs, job training and other work related services. So far, she said, the Department of Labor has helped over 500 people through these referrals.
Bartos said that Marcus Daly Memorial was not the only hospital in the state saddled with millions of dollars annually in bad debt.
“If you look around you’ll see that hospitals are closing around the state,” he said.
The Governor noted that the health care industry is Montana’s biggest employer and that hospitals play a key role in the state’s rural economy. Marcus Daly Memorial Hospital is the biggest employer in Ravalli County. He said having a hospital is a key attribute in attracting new businesses.
“Candidly,” he said, “if this hospital wasn’t here you wouldn’t have all the other businesses you have in this area.”
Some concern was expressed about the possibility that more people being able to afford health care might create a shortage of health care professionals.
Lieutenant Governor Mike Cooney, who did not attend the hospital tour, did say, during the governor’s monthly rural telephone conference with newspapers around the state, that the Department of Labor’s “Apprenticeship” program was designed to address that possibility. He said it offers Main Street businesses a tax credit over a span of five years if they participate in the program. The program provides on-the-job training so that people can “earn while they learn” a profession. He said it was an option for high school graduates who do not want to spend four years in college getting a degree. Instead, they can go to work right away in a field they are attracted to and end up with nationally recognized accreditation in their chosen occupation. He said the program goes far beyond the typical construction related trades and includes training for jobs as diverse as beekeeper, computer operator, chef, bookbinder, dental assistant, fire fighter, furniture finisher, gunsmith, and many, many more.
In order to be eligible for the expanded Medicaid program an individual must be earning 138% of the federal poverty level or less. That works out to roughly $16,000 a year for one person or $33,000 for a family of four. Additionally, to be eligible, individuals must be Montana residents of 19 to 64 years of age not enrolled or qualified for Medicare and not pregnant when applying for coverage.
There are several ways to apply: Over the phone at the Federal Marketplace at 1-800-318-2596; online at healthcare.gov or apply.mt.gov; by mail; or in person at community health centers or at local offices of public assistance.