Mother’s Day: What Moms need is health care

We hope moms and moms-to-be around the state had a wonderful Mother’s Day.

Because we love our moms and we are a female-led organization, our team spent time looking into how the House GOP bill to repeal and replace the Affordable Care Act (ACA) might affect women, and moms specifically.

The ACA changed the landscape for women’s health insurance coverage. As we await the Senate’s version of a bill, it is crucial to understand the particular damage that ACA repeal poses for women’s health and economic security.

We know that much attention has been given to the provision of the AHCA that allows states to waive the “essential health benefits” coverage for individual market plans. Which basically means that pregnancy, c-sections, or injuries from domestic violence are included as pre-existing conditions and subject moms and women to significantly higher premiums.

However the issue of fundamentally changing Medicaid is equally as detrimental to moms in our state and country. As it stands, the House health bill would have devastating consequences for the nearly 40 million women across the country who rely on Medicaid. In Montana, 129,200 women are enrolled in Medicaid and 35% of births are financed by Medicaid.

The House-passed bill would slash Medicaid by more than $800 billion over ten years by effectively eliminating Medicaid expansion to low-income adults and imposing a “per capita cap” on the program.

Women would bear a disproportionate impact of these cuts because they are not only the majority of Medicaid beneficiaries, but are also the primary utilizers of family planning and maternity care, benefits that could be eliminated with devastating federal cuts to Medicaid.

In addition, Medicaid expansion gave many women not raising children access to coverage and offered continuous coverage to new mothers who had qualified while pregnant but would not have qualified after their pregnancy. Ending the expansion would take these benefits away.

There are a few other benefits the ACA gave women that could be lost with repeal. One is breastfeeding. The ACA covers lactation support and counseling, equipment and supplies, such as pumps, and infrastructure, such as pump rooms and break time. The other is access to birth control which provides health benefits for women and children, improves women’s ability to control whether and when they have a child, and fosters women’s ability to participate in education and the workforce on an equal footing with men. The ACA was a total game-changer when it comes to access to birth control for women because it removed the cost barriers. Women no longer have to pay out-of-pocket costs or choose between paying for birth control and paying for other necessities, like groceries and utilities.

The ACA and Medicaid have been hugely beneficial for women’s health. With the potential repeal hanging above us, women – and mom’s – have a lot to lose. While the future is uncertain, we want to make sure that women and moms continue to have access to affordable health care. We encourage all moms, women, and the men in their lives to contact our Montana Senators and tell them to reject any health bill that causes people to lose coverage, caps or cuts Medicaid, ends the Medicaid expansion, or takes away critical protections.

Wonky Word: Healthy Montana Kids & CHIP

This week is Children’s Mental Health Week and today is National School Nurse Day. So we thought today would be a great day to recap CHIP and the Healthy Montana Kids (HMK) for our wonky words this week.

In 1997, the federal government established the Children’s Health Insurance Program (CHIP). The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. CHIP provides health coverage to eligible children, through both Medicaid and separate CHIP programs. It is administered by states and funded jointly by states and the federal government. Since states have flexibility to design their own program within Federal guidelines, benefits vary by state. Unfortunately, in the late ‘90s, there was a waiting list for children who were eligible but not enough funding.

Then in 2008, a group submitted a ballot initiative – Healthy Montana Kids I-155 – to the voters. The idea was to expand CHIP by using premium taxes paid by insurance companies to make health insurance available to more children. It raised the ceiling of eligibility to families earning up to 250% of the federal poverty level (FPL) (what is now approximately $51,000 for a family of three) with the goal of covering an additional 30,000 children. The initiative passed in all 56 counties and received 70% of the statewide vote.

Shortly thereafter, the 2009 Montana Legislature enacted the Healthy Montana Kids program. It brings CHIP and Children’s Medicaid under one umbrella with only one application process. Children below 143% of the FPL qualify for Medicaid and children between 143%-261% qualify for CHIP.

What makes HMK so unique – and what makes the Healthy Montana Plan unique – is that it competitively contracts with an insurer to administer healthcare through a private provider network at negotiated rates. This kind of contract is known as a “third party administrator,” or TPA. The TPA for HMK is Blue Cross Blue Shield of Montana and this contract grants access to care through the contractor’s extensive provider network. The contractor processes the claims and issues fee payments to providers on behalf of the state. Montana reimburses the contractor for those claims on a fee-for-service basis.

Healthy Montana Kids covers more than 120,000 children in our state. This means regular check ups, dental care, vision, and help when there is an emergency. The Medicaid Access and CHIP Reauthorization Act (MACRA) extended CHIP funding with no programmatic changes through September 30, 2017. That means legislative action will be required to extend federal funding past September, which is just 4 months away. When we talk about health care, we need to make sure we talk about CHIP reauthorization too. Kids with coverage help keep medical costs down for all of us, and kids with coverage are healthier. Healthier kids mean they do better in school, which will lead to a more educated work force.

The New House Health Care Plan Makes a Bad Bill Even Worse

While Montana still is without a congressional representative, the House is poised to vote on a bill tomorrow, which could result in 259,000 Montanans either losing their coverage or facing increased out-of-pocket costs for health insurance.

Press reports have indicated House leadership continues to try to cobble together votes to repeal ACA, and we could see a vote on a newer version of the GOP plan as early as tomorrow or Saturday. The revised version does nothing to address the 24 million Americans who will lose coverage or the cut of over $800 billion in federal Medicaid dollars. Instead, the amended GOP plan makes a bad bill even worse, in three ways:

  • Gutting protections for Montanans with pre-existing conditions: The new proposal would allow states to eliminate protections for those with pre-existing condition. Insurance companies would now have the power to deny coverage based on pre-existing conditions except in states that choose to prohibit it. 426,400 Montanans have pre-existing conditions and risk losing the coverage they desperately need.
  • Eliminating coverage for services, like maternity care, mental and substance use treatment, and prescription drugs: The new version of the GOP plan would also allow states to waive Essential Health Benefits standards that require plans to cover services such as mental health and substance use treatment. It would also do away with guaranteed maternity care coverage, effectively allowing plans to charge women more for insurance than men.
  • Reinstate annual and lifetime limits on health care: The ACA prohibits plans from limits on coverage that are Essential Health Benefits. If states are allowed to eliminate the Essential Health Benefit standards, plans could likely place caps on coverage for those services, such as emergency services, impatient care, and prescription drugs. Before ACA, over 330,000 Montanans – most with employer coverage – faced lifetime limits on health services. The new, worse GOP plan could put in place these same practices, which means even those Montanans who can afford coverage could be one major illness away from bankruptcy.

This new bill is in no way a compromise or an improvement. Instead, it only further exacerbates the problems it would create for millions of Americans. This flawed proposal would: shift of over $3 billion in Medicaid costs to the state, end Montana’s bipartisan plan to expand Medicaid covering over 71,000 Montanans, and raise premiums and health care costs on tens of thousands of Montana families. D.C. politicians must take note – the GOP plan is a dangerous move that is wrong for Montana.

 

Indian Country Suicide Prevention Receives Attention and Investment

Maybe it’s our relative isolation and inability to easily access sufficient mental and behavior healthcare. Or maybe it’s the elevation or the sigma we often associate with depression. Whatever the reason, Montana has had one of the highest suicide rates in the country for almost forty years.

According to a report by the Montana Department of Health and Human Services, Montana ranked first in the nation for suicides in 2014. Nationally, whites have the highest rate of suicide, followed by American Indians. In Montana, this trend is reversed. Between 2014 and 2015, the American Indian suicide rate was 35.5 (per 100,000 people) compared to 28.1 for whites.

The same report notes that American Indian youth ages 11-17 are especially at risk. In fact, they are almost four times more likely to die by suicide than their white counterparts in Montana. Further, youth suicidal risk assessments for 2015 also show that American Indian youth living in urban areas are more likely than reservation-residing American Indian youth to seriously consider, plan, and attempt suicide.

We know that suicide has been a major public health concern in Montana for years, and particularly in Indian Country. This is why we applaud the legislature’s recent passage of House Bill 118, which invests $1 million in statewide suicide prevention efforts. Of this, $250,000 goes expressly to implement the action steps outlined in the Montana Native Youth Suicide Reduction Plan (MNYSRP). The Indian-owned consulting firm, Kauffman & Associates, in collaboration with both reservation and urban-based tribal communities in Montana, as well as the five urban Indian Health organizations created MNYSRP. MNYSRP came about as a result of an initiative developed by Governor Bullock in 2015, which was funded through the 64th Montana Legislative session.

An official bill signing has been scheduled for Tuesday, April 25, 2017 at 3pm.

Montana Budget Not Ready for Prime-Time

With less than two weeks remaining in the legislative session, the state budget is far from ready for the governor’s signature. Last week, legislative fiscal division released its updated status sheet. Factoring in the current spending bills, tax bills, current revenue estimate, and the budget, the legislature is leaving the state with a mere $162 million in projected ending fund balance. That current level is $138 million below the long-standing precedent for a $300 million ending fund balance. Perhaps even more shocking, it’s $38 million below some Republicans’ counter-proposal for a much lower $200 million ending fund balance.

Thus far, the legislature has:

  • Failed to support nearly all of the governor’s tax fairness measures that would raise needed general fund revenue and provide a pathway for a balanced solution to the recent revenue downturn;
  • Left significant cuts to the budget, particularly in the areas of higher education and social service programs for our seniors and Montanans with disabilities;
  • Passed a myriad of new spending bills that risk leaving an insufficient ending fund balance for dealing with an economic downturn or lower-than-expected revenues; and
  • Increased the revenue estimate simply as a mechanism for balancing the budget.

Any one of these problems should cause concern for the governor and any Montanans who care about the budget and the essential services it funds. The combination of the current problems is simply unacceptable and unsustainable.

The legislature has so far failed to make the difficult choices necessary for a responsible budget. As has been true all session, they have two choices: make further cuts to the budget and other spending priorities or raise revenue. MBPC believes only one responsible choice remains: raising revenue. With significant cuts already proposed by the governor and deeper cuts adopted by the legislature, the legislature must, finally, engage in a meaningful conversation about sensible ways to raise revenue. Options include listening to the dozens of health care professionals and organizations who have asked for an increase in the tobacco tax (which not only raises revenue but also is proven to reduce smoking and decrease health costs) or making sure that millionaires in Montana are paying their fair share for the services and infrastructure that make our families and communities stronger.

It may be that legislators are planning to force the governor to make the additional cuts to popular and essential programs. The governor did his job in proposing a responsible budget, one that included both difficult budgetary cuts but also adequate levels of revenue. Legislators were elected to make the same kinds of hard decisions. If they are going to reject every general fund revenue increase, they need to find other solutions for putting a responsible budget on the governor’s desk.

Equal Pay Day and EITC

Now that spring is in the air, 2016 seems like a long time ago. But it took until today – April 4th – for women to finally earn as much money as a man did in 2016. With such a significant pay disparity between men and women, women have to work three months longer into the next year to make the same amount that men make in a single year.

In Montana, women still are paid only about 67 cents for every dollar a man earns in spite of the fact that more women than ever are the primary breadwinner. In about 40 percent of U.S. households with children under age 18, mothers are the sole or primary breadwinner. For female-headed households, it hurts a lot more when women aren’t paid fairly.

The good news is that a state Earned Income Tax Credit (EITC) could help boost the pay of thousands of low income women. The legislature is considering HB391, which would create a state version of the federal EITC, a tax credit paid to working adults. The Center on Budget and Policy Priorities estimates that 22,000 single mothers in Montana would benefit from receiving the EITC.*

But the EITC does far more than just provide a little extra cash for families. Studies show that the EITC has encouraged large numbers of single mothers to increase the amount of hours they work, and reduce their reliance on social safety net programs. In turn, this increase in hours worked leads to higher wage growth down the road, as well as greater Social Security retirement benefits. The EITC’s impact on employment actually doubles the anti-poverty effect of the EITC for families.

Furthermore, the benefits of the EITC for women aren’t purely financial. Research has also shown that it reduces the rate of low-weight and premature births and improves the health indicators of the mothers. In these studies, women who have received increases in their EITC were more likely to receive prenatal care.

For thousands of workers in Montana, a state EITC could have significant impacts for parents and children alike. In total, 80,000 low- and moderate-income families in Montana stand to benefit from this credit. But for 22,000 single mothers, the EITC can provide additional important benefits that will help improve the stability and health of the entire family.

All hard-working Montana families should get the pay they deserve. While we may have a long way to go in order to minimize the disparity in pay between men and women, a state EITC can be a positive step to reduce the harm this gap causes. Our state legislators should enact a state EITC and improve the lives of thousands of working mothers and their children.

 

* CBPP estimates based on data from IRS, unpublished data from the Brookings Metropolitan Policy Program, and CBPP analysis of the Census Bureau’s March 2010-March 2014 Current Population Survey

A Budget Built on a House of Cards?

Today, the legislative fiscal division (LFD) released its weekly general fund status sheet, providing us a glimpse at where we stand with general fund revenue, projected spending, and the resulting ending fund balance. As the legislature takes actions on bills, including HB 2, LFD updates the status sheet to reflect these changes in spending and revenue bills.

This past week, the Senate Finance & Claims Committee took action on HB 2, adding back some of the cuts made in the House. In total, the Committee restored about $10 million in general funds, $32 million in state special revenue, and $12 million in federal funds.

The status sheet answers a big question: is restoration of these cuts sustainable under the current levels of revenue? The answer: no.

As of today, legislative fiscal division estimates an ending fund balance of $154 million at the end of the next biennium. The status sheets factors in SB 354 to raise the tobacco tax, which passed the Senate this week. This measure raises nearly $69 million in general fund revenue, but still needs to pass the House to become a reality. Even factoring passage of SB 354, we are $145 million below the Governor’s requirement of a $300 million ending fund balance. The ending fund balance is important because it is Montana’s only mechanism for protecting against revenue volatility and unexpected emergencies. This is Montana’s savings account.

Those who have been worried about the budget cuts – including cuts to Medicaid services for seniors and people with disabilities, cuts in higher education, and cuts to programs essential for our emergency responders in local communities – still have work to do. Higher education still faces over $11 million in cuts. Just as importantly, the budget still has several important stages to go and cuts can still be reinstated or increased. As it stands now, the budget is built on a house of cards that could collapse at any moment. We need to continue to be diligent in urging policymakers to pass new revenue and update the revenue estimate, to ensure adequate resources to fund programs essential to our communities.

Want to know more about actions taken this past week on the budget? Check out our quick summary here.

Senate Finance & Claims Acts on Budget Bill, Restores Some Cuts

Senate Finance & Claims met on Tuesday to take executive action on HB 2. You can find all the amendments online here (third tab). The Legislative Fiscal Division also updated its budget narrative with actions from Finance & Claims. Here is a quick overview of some of the key actions taken.

Dept. of Public Health and Human Services. The committee restored the $14.9 million legislative cut to senior & long-term care (SLTC) division, which provides Medicaid services to seniors and individuals with disabilities who are living in their homes or in nursing homes. A third of this restoration was a shift in funds from Health Resources Division, which provides Medicaid services. SLTC division is still $11.6 million below the executive budget. The committee also reduced the vacancy savings required by the Department from 8% to 6%.

Office of Commissioner of Higher Education. All in all, the higher education budget is largely in the same spot as it was when it passed out of the House. Legislators moved amendments to restore the deep cuts to the universities, but those amendments failed. To date, higher education is still about $11 million below the executive budget, and university officials are indicating we are likely to see 18 percent increases to tuition if the levels of funding remain where they are now. Despite those persisting cuts to higher education, the funding formula for community colleges was fixed to reflect a slight increase in the state’s share of the formula. 

Office of Public Instruction. Legislators moved an amendment to add an investment for preschool programs, but it failed on a party-line vote. However, the committee did pass amendments to provide an inflationary adjustment for special education funding (albeit smaller than previously proposed), and restored funding for both the Montana Digital Academy and the Data for Achievement payment. However, in total, OPI’s budget was reduced by approximately $13 million over the biennium.

Dept. of Labor & Industry. Department of Labor & Industry saw restorations, including state special revenue funds added back for Jobs for Montana Graduates Program, which provides graduation support and job training for high school students across Montana. The Committee also restored some funds for the Employment Relations Division, which is good news for workplace safety in Montana.

Dept. of Military Affairs. The Committee restored some funds within the Department of Military Affairs, including support for Air National Guard and Army National Guard. However, the Committee did not restore the funds provided to help train local emergency response teams handling hazardous material disasters and cleanup.

What is the Earned Income Credit?

This session, the Montana legislature is considering legislation to create a state earned income credit – the Working Families Credit – to provide assistance for low- and moderate-income working families, modeled after the successful federal Earned Income Tax Credit (EITC). Doing so could help boost incomes for thousands Montana working families. Today we are going to give a little more background on what the EITC is, and how it works.

History

The EITC was first created in the 1970s, but was expanded significantly in the 1980s by President Ronald Reagan, who called it the “best anti-poverty, the best pro-family, the best job creation measure to come out of Congress.” The measure had broad bipartisan support because it improves the lives of low-income families while encouraging work. In 2013, the federal EITC lifted more than 6.2 million people, including 3.2 million children, out of poverty.

How it works

The credit is based on the amount of money that an individual earns, helping to encourage work. The credit begins with the first dollar earned, increasing before reaching a maximum amount where it plateaus, and then tapers off. This model helps to encourage workers to increase their hours and wages, without punishing them for earning too much. The credit also increases with the number of children in a family, maxing out at three children. Low-income workers without children are eligible for a very small credit, but majority of the benefit goes to adults with children.

Figure 1 _EITC. 3-17 (1)

The federal EITC in Montana

In Montana, 80,000 families receive the federal EITC, with an average amount of $2,168. Rural counties especially benefit from the credit – 21 percent of federal households in rural counties receive the EITC, compared to 17 percent in the rest of the state. In 2014, the federal EITC brought in $173 million into Montana’s economy.

State EITCs across the nation

Because the EITC has been so successful at reducing poverty and encouraging work, 26 states and D.C. have enacted state versions set at a percent of the federal credit. The state credit helps to further support for low-income working families.

Montana’s families would likewise benefit from the Montana Working Families Credit. Two bills are making their way through the process – HB 391 and SB 156. Our legislature should act now to help improve the incomes of working families across the state.

House Appropriations Passes Budget But Leaves Devastating Cuts

Following two lengthy days of hearings, the House Appropriations Committee made amendments to HB 2 on Thursday and Friday and passed it out of committee. The full House of Representatives will begin debate on HB 2 later this week. While the Committee passed several amendments to partially restore some funds, the budget still includes devastating cuts to programs critical to Montana’s students, seniors, and our most vulnerable communities.

To recap, legislative leaders began the budgetary process in January, by adopting cuts in the governor’s proposed budget and then taking additional deep cuts to nearly every state agency. Subcommittees worked through January and February and added back some funds. However, most of those additions simply reflect present law adjustments, or the amount of funds needed to continue existing services into the next biennium, and did not restore the deep cuts to the underlying programs.

Areas facing the deepest cuts include senior and long-term care, which provides Medicaid services to seniors and Montanans with disabilities, and higher education, with major cuts to Montana’s colleges and universities.

Here is an update on what happened in House Appropriations last week:

  • The deep cuts to Senior & Long-Term Care (SLTC) largely remain. While the Committee passed an amendment to add back some (but not all) federal funds, it did not add general fund dollars. This action is meaningless. In other words, if the legislature fails to appropriate state general fund dollars, Montana will not receive the federal matching funds. Therefore, SLTC continues to face a budget hole of $53 million in total funds below the present law budget. The Committee considered amendments to: fully restore legislative cuts to SLTC; pare back the current 8% vacancy savings; provide an increase to direct care worker wages; and restore funds for respite services for family caregivers. All of these amendments failed. The committee did add back about $200,000 in funds for independent living contracts within the Disability & Employment Transition Division.
  • Deep cuts to higher education remain, even with the additional $11.6 million in higher education funding, but this represents only 1/3 of the cuts below a present law budget. Of this $11.6 million, about $9 million will go to the MUS units (MSU, UM, and satellite colleges and universities). With this restoration, community colleges received of $1.7 million, and Tribal colleges received $81,000. Amendments to add back additional funds for the university units, funds for the Montana Seed Lab, and funding for the Governor’s Best and Brightest Scholarship fund, all failed to pass. Prior to full Committee action last week, the higher education budget sat about $30 million below present law budget. This includes the $23 million in cuts taken in early action, as well as a $7.8 million present law adjustment that the Subcommittee did not take. Again, simply looking at a comparison of present law budget with legislative action so far, the Committee action last week restored about one-third of the total $30 million in cuts below the present law.
  • The Committee restored funding to support child care providers and improvements to quality care. The STARS to Quality program is a voluntary program for child care providers to improve quality of early childhood education and care. Previously, the subcommittee added back the one-time-only funds for STARS to Quality, but made the funding contingent upon the passage of a bill to legalize and tax blackjack. The full Appropriations Committee stripped that contingency language, providing $2.4 million in OTO funds for STARS to Quality.
  • The Committee failed to pass an amendment to restore funds for workplace safety programs. Subcommittee action included cuts to the Employment Relations Division, cutting about $1 million within the workplace safety division. Legislators noted that Montana has ranked as one of the worst states for the number of workplace accidents. This cut will result in greater pressure on the Department of Labor and will likely increase accidents in the workplace. An amendment to restore the funds failed to pass.
  • Efforts to restore funding for Department of Military Affairs failed, including funding to support regional response teams. The early cuts in the session included across-the-board reductions to Department of Military Affairs and cuts to the 6 regional hazardous materials teams with Disaster & Emergency Services, which provides training and assistance to local response teams handling hazardous material. The cut in state funding results in additional loss of federal funds. An amendment to restore these funds failed.
  • The Committee restored funds for the Governor’s airplane.

The full House of Representatives will hear HB 2 later this week, presenting another opportunity to restore these deep cuts, and ensure that our seniors and Montanans with disabilities can continue to receive the services they and their families in need.