The bill would implement Medicaid work requirements and make people confirm their eligibility more often. The Montana Health Care Foundation estimates 31,000 Montanans would lose coverage because they would be unable to navigate the new paperwork requirements.
The Senate version also caps state taxes on Medicaid providers. States use that money to draw down more federal funding. Senate rules officials have thrown out that provision for now, but Republicans may bring it back.
Bob Olson with the Montana Hospital Association says the state’s Medicaid tax is below the Senate’s cap. But that could be problematic for the state as health care costs rise.
Olson says hospitals will feel a more immediate financial pinch as Montanans lose coverage.
“People still have to be treated. If they’re uninsured, that doesn’t mean the costs aren’t real. They have to be covered somehow, some other way,” Olson says.
The Montana Health Care Foundation estimates the state would lose $5.4 billion in federal Medicaid dollars over the next decade.
Olson says hospitals could ask local taxpayers to help, but that might be a hard ask with skyrocketing property taxes. The more likely solution for hospitals is cutting services.
“If they had to stop offering them, the whole community loses them, not just people on Medicaid or used to be on Medicaid,” Olson says.
Carrie Cochran-McClain with the National Rural Health Association says birthing services and cancer treatment are the most common services to be cut.
She points out that 11% of Montana’s hospitals are considered financially vulnerable and cutting services might not be enough.
“As you apply more pressure to those folks, they’re either going to have to make hard decisions or ultimately close their doors,” Cochran-McClain says.
Republicans are considering a $15 billion fund to shield hospitals from the impact of the bill. But hospital associations say that’s not enough.
If hospitals close many Montanans might find themselves health care deserts.
