Tester Hosts Roundtable on Potential ACA Repeal

The Western News – January 10, 2017

Healthcare in Libby is unique compared to other Montana towns. Libby’s largest combined employer is the medical field and Libby has a large percentage of people on Medicaid such as the amphibole asbestos victims. All of this would be impacted by a repeal seemingly on the horizon of the controversial Affordable Care Act.

In this time, a healthcare roundtable attended by a U.S. Senator could go on for days.

The healthcare roundtable, hosting people on multiple points of the Libby medical profession spectrum, met at the Northwest Community Health Center on Wednesday to discuss the current situation with U.S. Senator Jon Tester.

Tester’s stance on the Affordable Care Act that he repeated through the roundtable was to move forward instead of backwards. A full repeal without a replacement plan, he said, could have a huge negative impact, and lawmakers have yet to define a plan.

“I think promises have been made, I think talking points were issued and there really wasn’t any understanding of what was going on,” Tester said at the roundtable. “The leadership has made promises and I think they’re going to move forward. I personally think it will be devastating if there isn’t a replacement. It’s a big concern because healthcare, you guys (in the medical field) probably know this better than anyone living here, is a huge part of your economy because it impacts everybody almost without exception. If it’s not done right and we take a step backward on affordability and we take a step back on access, you could literally have people dying in the streets.”

If congress repeals the Affordable Care Act, 142,000 Montanans could lose their health coverage, according to a new report from the Montana Budget and Policy Center.

The NWCHC has seen a 30 percent patient increase since 2010, according to NWCHC’s Marie Clemmons, 35 percent of all the patients at the clinic are on Medicaid, 25 percent are on Medicare and an additional 18 percent are self-pay.

And the NWCHC serves a huge chunk of Lincoln County’s population. By the end of next year, the NWCHC anticipates that they’ll be serving 7,500 patients with the additional Troy facility. They serve 400 under-65 years of age Medicare recipients and 40 percent of those have a chronic condition. On top of those numbers, they also serve 450 veterans who would have to go to Spokane or Kalispell to receive care.

A small portion of the rise in patients, Clemmons said, has to do with people that before just paid out-of-pocket and switched to Medicare. A larger majority of the increase has been people in the community who have never had health insurance before and now they’re getting their healthcare needs done.

“In Libby we have the most hardworking people who just didn’t even qualify for a subsidy,” Clemmons said. “They fell in that gap for so long. So, when Medicaid expansion happened, these people were grateful. These were hardworking people who really didn’t have access before. To have that go away now, I feel like we’re turning the clock back five years.”

CHCs are also facing their funding cut in October of next year and they’re going to transfer their funding into the ACA. That’s going to be an essential need, Clemmons said, especially if they face declines in insurance coverage funding.

“When we look at what does repeal mean, really at the end of the day it’s devastating to the patients, but it’s really just as devastating to our organizations,” Clemmons said. “It’s jobs, it’s access to care, it’s life changing for a lot of our community members. We have a hard time living in limbo, but the thought of a complete repeal could be devastating. Economically — not that Libby needs another economic hit — but to the community members because we don’t have a lot of change going on here that’s providing them health insurance. The health center will continue to do everything it absolutely can to provide primary-care access, but we can’t provide all.”

Kate Matthews of the CHC said, “Six months ago, we were having some amazing conversations around value-based pay and payment reform and super exciting stuff that I honestly didn’t feel like we were going to get to it in a lifetime and now I feel like we’re back to barely holding on because we don’t know what the outcome is going to be. So, that’s a scary place to live when you’re doing this work for people who really need it.”

NHSC, or the National Health Service Corps, is part of the ACA too and that’s going to be a critical component that they need to keep. Clemmons said that she doesn’t think in 15 years they’ve had a provider come through the organization who was not an NHSC recipient.

“We need to preserve that program. It’s huge to places in rural Montana,” Clemmons said.

Through the expansion, they’re also seeing people that are changing their lives for the better once and for all through one-time expenditures that have lasting effects. Clemmons gave as an example, one of their patients who came into the clinic legally deaf but got procedures so they could hear. Those one-time expenditures have costs in the short term, however.

Those costs, Joe Chopyak said, will eventually go down, but they won’t see the numbers for many years.

“Since access has become available people can have things done that they’ve been waiting years and years for,” Chopyak said. “Our demand went up so there’s a cost associated with that.”

On top of those issues, another topic of discussion at the roundtable was the rise in prescription drug costs.

With the deductibles being high, the out-of-pocket expenses are also increasing, and Tester said that people at insurance companies have told him that’s because of specialty and infusion drug costs — the common last-ditch effort for people to get better.

In one year, Chopyak said, a person could spend $60,000 on a prescription drug to treat a condition like arthritis.

“It’s so defeating to know that you got this big deductable and you get there and you need some sort of medication, you’re probably not going to get it,’ Dr. Brad Black said. “A majority of our population are on respiratory drugs and those are very beneficial to our population and they quit taking it because of the exorbitant costs. The pharmacy costs, to me, is the biggest crisis.”

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