Senator Daines continues to misconstrue the impact of Senate GOP health plan

On Wednesday night, Senator Daines held a tele-townhall to discuss the Senate GOP plan with Montanans. There are several instances where his statements don’t necessarily match up with the facts of the Senate GOP plan or its impact on Montana. We know from the Congressional Budget Office – Congress’ own nonpartisan scorekeeper – that approximately 22 million more Americans will be uninsured if the Senate bill goes into effect. An independent analysis provided for the Montana Health Care Foundation shows that Montana would lose over $5 billion in federal Medicaid funds, putting at risk coverage for thousands of low-income Montanans.

Here are some responses to statements made on Wednesday’s tele-townhall.

Eliminating Medicaid expansion will hurt many of those living in deep poverty, as well as, seniors in nursing homes and those living in their own home.

Senator Daines has indicated a couple times that he wants to protect those who Medicaid was originally designed to serve and lists “the very poor”, “the elderly under 65”, and “the disabled.” However, in many cases, those with very low incomes, including low-income seniors, were not eligible under traditional Medicaid, and it was Medicaid expansion that provided access to affordable coverage.

Previous to Medicaid expansion, an individual was generally only eligible for coverage if they had incomes below 50% of the federal poverty line and had children under the age of 18, or had a qualifying disability. Medicaid left out many low-income families who couldn’t access coverage elsewhere. During the debate on Medicaid expansion, we heard from many working parents with very low incomes who did not qualify for Medicaid but could not access affordable health insurance. We heard from many older Montanans who were living in deep poverty (and did not have young children) who did not qualify for Medicaid. Medicaid expansion has provided the life saving coverage for nearly 80,000 Montanans, many of whom Senator Daines has referenced in his examples. The Senate GOP plan will eliminate that coverage in 2021.

The Senate GOP plan will also gut traditional Medicaid, cutting over $5 billion in federal funds for Montana and likely forcing deep cuts to coverage and benefits.

Even if Senator Daines accepts the devastation due to eliminating Medicaid expansion, the additional cuts to traditional Medicaid will also hurt the very populations he has said he wants to protect. Medicaid provides health care coverage for nearly one in every three children in Montana. It provides critical health services for people with disabilities to stay in their homes and live with dignity.

The Senate GOP plan will cap federal funds provided to states to run their Medicaid programs, leaving states on their own to cover increased costs for health services. Federal oversight of Medicaid dollars guarantees that the most vulnerable Americans – like low-income children, seniors, and people with disabilities – continue to get the care they need. Under the Senate GOP proposal, spending on Medicaid would be capped or limited, and if a natural disaster occurred or public health crisis arose (like Zika or the current opioid crisis), the state would only be able to cover as many people as the annual lump sum would allow. Medicaid would no longer be a safety net program, with the federal government providing funding in response to state spending needs. Instead, states would have to come up with money themselves to cover any additional costs, turn people away, or make cuts to the people covered by the program.

Today, over 216,000 Montanans access health services through Medicaid coverage. If the Senate GOP plan becomes law, state policymakers would be left to their own devices to cut coverage for thousands of our most vulnerable neighbors.

The Senate GOP plan will leave thousands of Montanans, particularly those who are living on lower-incomes, sicker, and older, with no affordable option for coverage.

Senator Daines alleges that the Senate plan provides a “place to land” for those with lower incomes who are currently covered under Medicaid expansion, but this is far from true. Under the Senate GOP plan, these individuals would be eligible for tax credits to purchase health insurance on the Marketplace, but families would face greater costs and likely be purchasing insurance that provides less coverage.

Furthermore, many others Montanans accessing health insurance through the ACA marketplace will face greater out-of-pocket costs for worse insurance. Premium increases would be especially large for:

  • People in high-cost (read: rural) states. When looking at a comparison of how individuals in each state would fare, Montanans would, on average, see increased premiums that are the 10th highest in the country. This is because the across-the-board cuts to premium tax credits would disproportionately impact those in areas where health services and premiums are higher.
  • Older people with modest incomes. Older Americans are taking the brunt of the Senate GOP cuts, both through lower tax credits and through higher out-of-pocket costs for insurance. For example, a 60-year-old Montanan with income of $42,000 would see an increase in net premiums (after tax credits) of $5,492 to purchase the silver plan. Total reduction in tax credits is nearly $10,000.

Many of those who weren’t buying insurance in 2014 are now eligible for affordable coverage through Medicaid, but the Senate GOP plan would take away that coverage.

Senator Daines mentioned that approximately 35,000 Montanans paid the individual shared responsibility payment, and that roughly 14,000 of those are living on incomes below $25,000. It is important to note that this data is from 2014, before Montana expanded Medicaid. Prior to Medicaid expansion, those living under the poverty line (less than $12,000 for an individual, or less than $20,000 for a family of three) were stuck in the “Medicaid gap”, where they were not eligible for tax credits but also not eligible for traditional Medicaid. Montana’s bipartisan Medicaid expansion changed all that. Without access to Medicaid, lower-income families would be forced to buy insurance on the marketplace with less assistance and would be accessing less comprehensive insurance with greater out-of-pocket expense. In short, many of these Montanans would be back to where they were in 2014: with no insurance.

Montana’s bipartisan Medicaid expansion plan has saved the state millions of dollars and has provided a major lifeline for many of Montana’s rural hospitals.

 Senator Daines mentioned that the state is seeing greater enrollment in Medicaid expansion than previously projected and therefore increased costs. Without a doubt, Medicaid expansion has been a success.

Under the ACA, the federal government provides federal funding at 90% of the cost of coverage – a higher federal match than traditional Medicaid and federal highway dollars. This new coverage has also meant major savings for the state and for many hospitals and clinics that face high uncompensated care costs. In its first year, Medicaid expansion has saved the state of Montana over $22 million. Montana will continue to see savings. What would make Medicaid expansion untenable is the current Senate efforts to cut the federal match, putting at risk coverage for thousands of Montanans.

The massive cuts to Medicaid coverage will not help the ongoing opioid epidemic in the state – actually, it could get a lot worse.  

Since 2015, Medicaid has become our state’s primary payer for substance use disorder (SUD) treatment services and a critical
tool in combatting alcoholism, methamphetamine use, opioid abuse and overdose, and the myriad social consequences of addiction. In fact, since the passage of Medicaid expansion, Montana has seen a 67% increase in federal dollars going toward SUD treatment. Eliminating Medicaid expansion and cutting Medicaid dollars will make it more difficult for Montanans to access the treatment they need and could further devastate our families and communities.

These are important facts for Senator Daines and Montanans to know as the Senate continues to negotiate a potential bill that could rip health coverage away from tens of thousands of Montanans. Montanans made their voices heard this week during the tele-townhall, and we need to keep sharing our stories and concerns about what this bill would mean for Montana families.

Myth Busting: What is really at stake with Medicaid and AHCA

Last week there were two articles quoting Senator Daines on health care and the continued effort in the Senate to repeal and replace the Affordable Care Act: Senator Daines Urged To Protect Medicaid and Daines and Tester weigh in on status of ‘Obamacare’ repeal in U.S. Senate. Some of the statements made about Medicaid were inaccurate, and we want to provide additional context on how Medicaid works and its importance to accessing health services in Montana.

MYTH #1: The original Medicaid program focused on those in deep poverty and seniors below the age of 65.

FACT: In fact, before passage of ACA, Medicaid left out many low-income individuals, including most seniors living in poverty. Montana’s bipartisan Medicaid expansion provides health coverage to those exact populations.

Before the Affordable Care Act and Montana passed Medicaid expansion, Medicaid did not cover the very poor unless they were disabled or had children under the age of 18-years-old. This left tens of thousands of Montanans below the poverty line uninsured. Additionally, Medicaid did not take care of older adults who were under 65 unless they qualified due to a disability, meaning that low-income seniors between 50-64 often did not qualify for Medicaid.

Montana’s bipartisan Medicaid Expansion plan has provided access to health care coverage to nearly 80,000 low-income Montanans, including seniors, adults, and others.

 

MYTH #2: Congress should give states more flexibility to administer their Medicaid programs.

FACT: States already have significant flexibility in how they run their Medicaid program, and cuts to federal Medicaid funding will only make it harder for states to provide access to coverage and benefits.

In exchange for the federal funds, states must meet federal standards that reflect the program’s role covering a low-income population with limited resources and often complex health needs. The federal standards largely focus on requiring states to cover certain groups, such as poor children and pregnant women, as well as certain core benefits.

However, states can choose to cover additional groups, offer enhanced benefits, and already have wide latitude over many aspects of the program, particularly how they pay providers and structure their delivery systems. States can use Section 1115 waiver authority to vary from the federal standards and state options to address different priorities and emerging issues.

The programs across states vary widely in terms of who is eligible, what benefits are covered, what premiums and cost sharing are charged, and how providers are paid and care is delivered.

 

MYTH #3: Medicaid expansion can be protected if the phase out of the higher federal match occurs over several years.

FACT: Any phase-out of the higher federal match for Medicaid expansion will end Medicaid expansion in Montana.

The House-passed AHCA eliminates the higher match of federal funds for those who would be newly enrolled after 2019. The Senate is considering a longer phase-out, but to be clear: this has the same effect. CBO estimates that more than two-thirds of those enrolled in the Medicaid expansion would fall off the program within two years and that fewer than 5 percent would remain on Medicaid after six years. For those who see their income drop after phase out, the state would not receive the higher match and would most likely no longer be able to afford to continue to provide Medicaid to this population.

 

MYTH #4: Medicaid creates a disincentive to individuals to seek employment or employment opportunities with higher wages.

FACT: Among adults with Medicaid coverage—those most likely to be in the workforce—nearly 8 in 10 live in working families, and a majority are working themselves.

Nearly half of working Medicaid enrollees are employed by small businesses, and many work in low-wage industries that do not offer employer-paid insurance. Since the majority of Medicaid expansion enrollees are low-wage workers, Medicaid expansion prevents them from falling into the coverage gap; it helps them cope with high turnover in the low-wage labor market.

Medicaid expansion and the tax credits and subsidies under ACA provide a smoother transition to private Marketplace coverage. This has been particularly important for Montanans living in rural communities, accessing Medicaid and insurance on the marketplace at a greater rate. When their earnings rise or they get a new job, they can transition to employer coverage or the ACA marketplaces. Under ACA, the tax credits and subsidies provide significant support to lower costs for marketplace coverage. And families have the security of knowing that Medicaid will be there for them again if they lose their job, see their hours cut, or face financial crisis. Additionally, when they no longer qualify for Medicaid but live at 139% of the poverty rate, individuals can currently qualify for a tax subsidy to help pay the health insurance premium.

By eliminating Medicaid expansion and cutting tax credits for low-income families, the AHCA (and likely any iteration from the Senate) will create a situation where many families may have to choose between employment and keeping health insurance. For example, a family who earns $20,000 in Montana will see their premium paid after tax credit rise by 295% for a total of $3,690. That is the equivalent of 15% of that family’s income.

Thank You for a Great 2015

With only two days left in the year, we decided to take a look back and remember what a great year 2015 was.

Together, in 2015, we:

  • Passed Medicaid expansion providing tens of thousands of Montanan access to affordable health care.
  • Defeated dozens of irresponsible tax cuts that would have drained our state of critical resources needed to invest in our communities.
  • Released cutting edge research on paid family leave, tribal colleges, earned income tax credit, and more.
  • Formed two new partnerships with the Women’s Foundation of Montana and the Montana Health Care Foundation.
  • Made real progress toward establishing a Montana earned income tax credit to help working families make ends meet.
  • And much, much more.

It really was a year to be proud of, and we wanted to take a second to say thank you. Whether you wrote a letter to the editor, called your legislator, talked to your friends about Medicaid expansion, donated to MBPC, or simply became more informed by reading our blog, you helped make 2015 one where the lives of our low-income neighbors will be a little bit better.

Unfortunately, 2015 is also the year we say goodbye to our long time staff member, Laura John. Laura has served as the State Tribal Policy Specialist, and her perspective and dedication was critical to our work. We will miss Laura, but we wish her all the best as she begins her next adventure.

MBPC is committed to continuing the groundbreaking work Laura started, and we know she leaves big shoes to fill.

We wish you and your family a fun and safe New Years. We look to next year when we will work on issues like paid family and medical leave, EITC, affordable childcare, pre-Kindergarten, and so much more. Together we can accomplish great things in 2016.

Medicaid Expansion: The Clock Ran Out

Today, I am writing you to deliver some disappointing news. 

As you know, for nearly two years, the Montana Budget and Policy Center has been working to expand Medicaid to provide health care for 70,000 of our friends and neighbors. For the past few months, we were heavily involved in an incredible grassroots effort to qualify the Healthy Montana Initiative (1-170) for the November ballot. Unfortunately, we now know that we will not have enough signatures to qualify before the deadline of 5:00 pm tomorrow. 

This effort began with little more than $2,000 in the bank, six organizations on a campaign steering committee, supporting groups through the Partnership for Montana’s Future, and a few dozen incredible volunteers. 

We recognized that in order to compete with enormous, dark, outside money, we would have to run a special kind of campaign. It would have to be a grassroots effort that trained volunteers and developed a ground game made up of ordinary Montanans. We acknowledged that the work would not stop in November because the 2015 Legislature would have to fund the initiative.  

We are so grateful to the thousands of supporters in Montana and beyond. As a result of this extraordinary effort, our movement to provide health care for our neighbors has grown. We are proud that the 25,000 signatures gathered for the Healthy Montana Initiative were gathered by more than 300 Montana volunteers, from Rexford to Red Lodge, and represent honest, neighbor-to-neighbor conversations. Hospitals, doctors, and nurses pitched in; they gave money, time, and spoke up for their patients. Our Governor Steve Bullock signed the petition fresh off the presses, and our own Senator Jon Tester helped gather signatures. 

We are sorry this issue won’t appear on the November 2014 ballot. But the momentum and spirit of this movement will continue to grow. What we built together is incredible and important, and that work will prove its value as we move forward. We are 25,000 people stronger than when we started. 

We won’t stop working until 70,000 of our friends and neighbors across our state receive the healthcare they need and deserve. 

Thank you for your support of the Center and this incredible effort.

Sincerely,

Sarah Cobler Leow, Executive Director and the team at the Montana Budget and Policy Center

Welcome to “Charted Territory”

MT road sign

Welcome to Charted Territory, the new blog from the Montana Budget and Policy Center.

Montana is at a crossroads. We face many challenges – reducing poverty, growing our economy, creating jobs, and ensuring access to health care. There are so many possible directions we could turn that sometimes it feels like we are lost in uncharted territory.

We aim to give Montanans a map to these crucial issues, using accurate information and clear, non-partisan analysis to provide timely commentary. Here, you will find straightforward talk about events and decisions that impact the lives of Montanans, and our nation as a whole. We’ll discuss trends in the Montana economy, the role that state and local taxes play in building strong communities and a vibrant economy, the difference that safety net programs make in helping families meet basic needs and giving them opportunities to move up the economic ladder, and much more. Of course, we’ll throw in a few charts along the way.

Any journey is more pleasant with companions, and we want you to share your thoughts and comments with us along the way. Check back often. You can also find us on Facebook and Twitter, and get regular updates through e-mail.

We hope you will enjoy the journey with us as we venture into Charted Territory.