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Montana politics, elections and legislative news

Montana's Uninsured Rate Steady, Medicaid Expansion Beneficial, New Studies Say

The percentages of Americans and Montanans without health insurance 2009-2016
Montana Healthcare Foundation
The percentages of Americans and Montanans without health insurance 2009-2016

A report being released today says Montana’s uninsured rate is staying steady at about half of what it was before Medicaid expansion started in 2016. It says just under eight percent of Montanans now lack health insurance.

And, one of the studies outlines what it says are clear benefits to the state as voters and state lawmakers are considering whether to end Medicaid expansion.

“Since we’ve got two full years under our belts, we thought this was a good time to take a look.” says Aaron Wernham, CEO of the Montana Healthcare Foundation, which commissioned the studies, performed by the consulting company Manatt Health.

When Montana lawmakers chose to expand Medicaid in 2015, they did it as a pilot. They’ll have to choose whether to continue it in next year’s legislative session.

Expansion meant that Montana now offers Medicaid health coverage to nearly anyone with an income below about $16,000 a year. Previously it was only available to children, pregnant women, some parents and the disabled.

The federal government pays 90 percent or more of expansion costs, but Montana will soon need to come up with more than $100 million a year to continue expansion.

The Montana Healthcare Foundation’s Wernham says the state will end up saving more than it spends. Since 2016, Wernham says, “the state’s saved more than $36 million in state General Fund expenditures that we would have had to spend had we not expanded Medicaid.”

An April study by the Foundation and a University of Montana economist found that, longer term, Medicaid expansion will pay for itself in Montana. That’s because the hundreds of millions of dollars the federal government is sending the state for expansion will result in lots of new jobs and tax revenue.

Wernham says a lot of the federal money is going to Montana’s hospitals. More people with Medicaid coverage means fewer unpaid hospital bills, to the tune of $138 million over the last two years.

“Nationally on that point, we’ve also had some recent studies that we looked at that show that hospitals in Medicaid expansion states are about six time less likely to close for a financial problem, than in an expansion state like Montana.”

Montana’s Medicaid expansion is unusual among the states, because it requires many of its 94,000 recipients to pay premiums, like people with private sector health coverage do. And they can lose their coverage if they fail to pay.

“The other thing that we found in the study is that many people are paying,” Wernham says. “So far the state has collected more than $7.4 million in premiums from Medicaid recipients to date.”

Also unusual in Montana is that people getting expanded Medicaid coverage are offered help finding jobs, or better jobs than the ones they already have. Conservative state lawmakers wanted to require expansion recipients to work, but the Obama administration wouldn’t allow that. Still, Wernham says, the new study offers important evidence that Montana’s compromise employment assistance program is effective.

“As opposed to what we’ve seen in many other states’ low-income populations, Montana’s low income population appears to be getting back to work,” Wernham says.

The study says that more than 22,000 Montanans have received job training, or help looking for or getting jobs through Medicaid expansion, and that among those who were unemployed, nearly 80 percent got jobs. It says more than 70% who were working when they got help are now making more money.

The study also says Medicaid expansion is making a difference when it comes to one of the state’s most intractable problems: People struggling with addiction and substance use disorders. It says that Medicaid expansion has increased funding for that by five times.

All this information is timely, Wernham says.

“The state is going to have to make a decision.

“We need to base policy decisions on good data,”he says, “and the Foundation really exists to help strengthen our health system, so we thought it was very important to do what we could to provide answers to some of the obvious questions about this program; Is it covering people? How are they using the coverage? What is it costing the state? What is it saving the state?

Whether to continue Medicaid expansion will be one of the biggest issues in Montana’s 2019 legislative session. And that decision could be influenced by voters directly if proponents of a ballot initiative to fund Medicaid expansion by increasing Montana’s tobacco tax are successful this fall.

You can find copies of the Healthcare Foundation’s new studies here:

The Montana Healthcare foundation has provided funding for health coverage on MTPR.

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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