Missoulian – May 30, 2017
The American Health Care Act, approved by the U.S. House at the start of this month, would result in the loss of health insurance coverage for tens of thousands of Montanans, according to a report recently released by the Montana Budget and Policy Center.
People who live in rural areas are at the highest risk for loss of coverage and increased costs, and could see their premiums rise by more than $10,000 annually in some places, the report says. That’s because of two main provisions in the bill — cuts to the Medicaid program that provides insurance to the poor and a change from subsidies to tax credits that will increase costs for people who buy insurance on a marketplace.
The legislation is the U.S. House Republicans’ plan to carry out their long-promised “repeal and replace” of the Affordable Care Act, former President Barack Obama’s landmark health care bill that was meant to lower the number of people without insurance by expanding health insurance coverage and reducing its cost.
Then-candidate and now Congressman-elect Republican Greg Gianforte is accused of assaulting a journalist who asked him about his stance on the bill in light of the Congressional Budget Office’s assessment of the legislation.
Gianforte, who was elected by a six-point margin a day later in the race against Democrat Rob Quist, had not delivered a consistent assessment of the bill.
After the U.S. House passed the AHCA at the start of May, Gianforte told members of the Montana media he couldn’t support a bill that didn’t preserve rural access to health care, keep coverage for those with pre-existing conditions and lower premiums. Days later he told potential donors on a telephone call that he was “thankful” for the bill.
Gianforte did not speak with a reporter Tuesday, but his press secretary Shane Scanlon said Gianforte would not have voted for the bill either on May 4 when it passed the House or now that it has a CBO score.
The AHCA would drastically overhaul the Medicaid program, cutting $834 billion nationally.
More than 240,000 Montanans are covered under Medicaid, including 77,000 that gained insurance after the state in 2015 chose to expand the program to those earning up to 138 percent of the federal poverty level. Nearly half of those covered are children.
“The House-passed bill fundamentally changes the way that Medicaid works moving forward,” said Heather O’Loughlin, co-director of the Montana Budget and Policy center. “It’s a wholesale restructuring of the financing mechanism of Medicaid that would in the long run shift considerable costs onto the state.”
At the end of April, the Montana Legislature wrapped up a session in which the state’s budget was cut 4 percent from the last biennium to deal with a drop in revenues from natural resource extraction taxes.
Those who live in rural areas have benefited the most from tax credits and subsidies provided in the Affordable Care Act, also known as Obamacare, that helped offset the cost of purchasing insurance through marketplaces. Nearly three-quarters of Montanans who buy insurance on the marketplace live in rural areas, in part because a greater share of those who live in these areas don’t have access to employer-provided health insurance.
The ACA’s tax credits and subsidies take into account factors such as geographic area and income level. The Montana Budget and Policy Center’s report estimates that costs for rural areas could grow to be more on par with those in urban areas.
For example, a 27-year-old in Yellowstone County, population 155,634, could pay $70 more a year in insurance premiums, but someone the same age in Chouteau County, population 5,813, would see their rates jump $730.
The center said the change would be “the most devastating for older Montanans wanting to stay in their rural hometowns.” Premiums for a 60-year-old in Yellowstone County could jump $10,670 — from $2,480 to $13,150 — while a person the same age living in Chouteau County would see rates go up $13,170, from $2,480 to $15,650.
Montana has not seen a representative vote on the American Health Care Act since Ryan Zinke vacated his seat in the House to become Secretary of the Interior before the bill was introduced.
U.S. Sen. Jon Tester, a Democrat, has spoken out passionately against the bill, previously saying “the House is forcing seniors to pay more, jeopardizing health care for Montana women and failing to address the rising costs that are draining pocketbooks.”
Republican U.S. Sen. Steve Daines said Tuesday “Obamacare is in a death spiral. We must keep working to make health care more affordable.”
Daines’ office emphasized the bill will change as it goes through the Senate.