Hospital leaders back Medicaid expansion

While expansion of Medicaid remains a contentious issue for many Montanans, Flathead Valley hospital administrators don’t hold back when they say it is overdue for the Big Sky State.

Two bills currently in the Montana Legislature look at expanding Medicaid, which serves the poor, the disabled and those considered “most vulnerable.” 

Jason Spring, chief executive officer of North Valley Hospital, said the push to expand the program is overdue.

“It’s frustrating that we are paying for the Affordable Car Act and that money is going to other states,” he said. “There’s a whole group of the working poor who can’t afford health care, and because they are able-bodied they can’t get Medicaid either.”

One measure, House Bill 249, based on Gov. Steve Bullock’s Medicaid expansion plan, would expand coverage to 70,000 Montanans, many of them “able-bodied” adults who earn up to 138 percent of the federal poverty level, matching 28 states that elected to expand Medicaid. 

This Healthy Montana Plan is sponsored by Rep. Pat Noonan, D-Butte and is modeled after the Montana Healthy Kids Plan.

The other bill currently in Helena is the Republican-sponsored House Bill 455 that would cover far fewer Montanans and very few “able-bodied” adults. HB 455 would cover some additional parents of children receiving Medicaid and would attempt to extend coverage to military veterans earning up to 100 percent of the poverty line, with 400 slots for disabled people awaiting Medicaid-funded treatment programs.

Spring was clear which bill he supports.

“Without a doubt, the governor’s bill is better,” he said. “The bill to cover 10,000 to 12,000 people is paid for fully by the state. It’s going to cost the state a lot more money. If you tell me we couldn’t have the governor’s bill, I’d take the other one, but it makes no sense to pay more money and leave out 50,000 to 60,000 people.”

Tony Patterson, the chief administrative officer and general counsel at Kalispell Regional Healthcare, takes a more cautious approach.

“We are committed not to expand Medicaid for expansion’s sake. We also want it to be effective,” he said. “That’s why we want these standards and pilot programs which would measure the effectiveness. We want to sit down and look at each bill and hopefully meld the best of these to get us further ahead.”

Only about a third of Medicaid as it currently stands is paid for by Montana. The rest of the money come from the federal government. Republicans see the governor’s bill as a costly, unnecessary move. 

Rep. Nancy Ballance, R-Hamilton is the sponsor of HB 455 and decries the Democratic bill as covering able-bodied adults, not those considered “most vulnerable.”

For the hospitals, the main thing is getting people healthy.

“We are in the business of providing health care to those who need it,” Patterson said. “Just in economic or business terms, some of those eligible for expansion are unable to pay for health care or pay a smaller amount. Looking at Medicaid helps provide for these people, and where we now get zero, we would get something.”

Kalispell Regional Healthcare gave $7,997,643 in charity care last year and incurred $5,332,828 in bad debt. 

The numbers for North Valley Hospital were $2.6 million and $3 million, respectively.

From a purely business standpoint, the expansion of Medicaid would get the hospital paid more frequently, particularly reducing the charity care amount.

“We call it charity care if you make less than 400 percent of the federal poverty guidelines,” Spring said. “When patients aren’t able to afford health care, they choose not to get care at all until they show up to the emergency room.”

Spring said taxpayers and those who pay insurance are already footing the bill for emergency-room visits, and that’s only when a person is in dire need.

Patterson agreed a different approach is needed.

“You see in some preliminary studies about the expansion that visits actually go up,” he said. “Critics say, ‘Well, they are using more resources,’ but you want to get these people well. If we are focusing on wellness and prevention, that’s what we like to see.”

It’s cheaper to go to a primary-care physician than to end up in the emergency room. By taking an active approach to health, which might consist of more doctor visits, the theory hospital administrators have is that taxpayers will actually save money and keep people at a higher level of health.

“We have to treat these patients,” Spring said. “We aren’t going to kick them out if they can’t pay. We can’t even ask if they can pay until we stabilize them. We are taking care of these patients anyway — why not cover them? We could avoid some really expensive stays. We are being double-taxed and still not covering these people.”

Both administrators said their institutions support expansion but would be willing to consider other options if the Legislature presented them. 

The House bills will face their first hearings in front of the House Human Services Committee on Friday.

Reporter Ryan Murray may be reached at 758-4436 or by email at rmurray@dailyinterlake.com.