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What The Supreme Court's Obamacare Decision Means For Montana

U.S. Supreme Court
Flickr user: Marty Stone (CC-BY-NC-2)
U.S. Supreme Court

The Supreme Court’s decision to uphold the Affordable Care Act’s subsidies for people to buy health insurance means nothing really changes in Montana’s health insurance market. And that’s pretty big news.

"I think it’s a big deal for the state of Montana."

That’s Dick Brown, president of Montana’s Hospital Association. Brown says hospitals feel a lot better now, knowing that the health care law is settled, at least for the time being.

"The uncertainty is what really creates a lot of issues for hospitals, as they’re planning for their communities and the needs of those communities in the future."

Reaction to the court’s decision from Montana’s Congressional delegation fell along a spectrum, with Democrat Jon Tester saying, "the Affordable Care Act is not perfect, but dismantling it without a plan to fix it is reckless, and today the Supreme Court recognized that."

Congressman Ryan Zinke, a Republican, stopped short of calling for Obamacare to be repealed. The written statement Zinke  issued immediately after the decision said, "taking care of our neighbors and staying healthy should not be a partisan issue." Zinke called for President Obama and Congressional Democrats to, "come to the table," and  "work together on health care solutions that truly lower costs, expand coverage, and protect the doctor-patient relationship."

Obamacare's a poorly written law that is failing the American people. And I'm gonna continue working to repeal this failed law and replace it with Montana-driven solutions that will increase access to affordable care for all Montanans and put patients first. - Sen. Daines

Republican Senator Steve Daines offered the harshest assessment of the federal health care law.

"Obamacare's a poorly written law that is failing the American people. And I'm gonna continue working to repeal this failed law and replace it with Montana-driven solutions that will increase access to affordable care for all Montanans and put patients first."

But the law’s defenders say it’s not failing. Christina Goe is an attorney for Montana’s state insurance commissioner.

"Today, more Montanans have access to health care than ever before. Our uninsured rate has been significantly reduced," Goe said.

The subsidies that the Supreme Court upheld are a big reason Montana’s uninsured rate has dropped significantly. And more Montanans with health insurance saves everybody money, says Montana Hospital Association President Dick Brown. That’s because hospitals have to charge people with insurance more, to cover the un-compensated care they provide to people without insurance.

According to Brown, "the uncompensated care goes into the hundreds of millions of dollars across the state."

So, more people with health insurance should mean that hospitals can start charging less, which should mean that insurance companies can lower their rates, or at least not raise them as much as they would have.

But, more people with health insurance should help Montana’s rural hospitals keep their doors open. Of the 60 total hospitals in Montana, 48 are rural, and many are barely hanging on.

"Montana only has two or three hospitals that are considered for-profit. The others are all community not-for-profit facilities. The rural hospitals do have zero, none, or negative margins. Probably about a third of the critical access, the rural hospitals, have some form of a local tax levy, subsidy, that does support that facility on an annual basis," says Brown.

Whitney: For hospitals like those, do these subsidies mean that they might be a little bit closer to breaking even? For local taxpayers who are supporting hospitals, is there the potential for them to see a little relief?

Brown: I think potentially it is. I mean, it's really a numbers game. You take a lot of our rural communities, they're serving a few thousand people, so it will impact them to the tune of maybe a few dozen more people maybe that'll have coverage, so yes, it'll eventually hit that bottom line. And hopefully over time that decreases the burden of local taxpayers with the level of subsidies they're providing.

Brown says Montana’s hospitals will also be made healthier because the state legislature in April passed Medicaid expansion. He says that should add about 50,000 more people to the ranks of those in Montana with health coverage, in addition to the 42,000 or so who are buying subsidized individual policies now.
And the subsidies to buy coverage are significant.

While insurance premiums vary based on age, location, whether a person smokes and the level of coverage they choose to buy, a typical rate for a 40 year old is about $280 a month. The average subsidy in Montana is $230 a month. The Supreme Court’s decision means that those subsidies will remain in place in Montana.

Eric Whitney is NPR's Mountain West/Great Plains Bureau Chief, and was the former news director for Montana Public Radio.
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