GREAT FALLS — If the Republican plan to repeal and replace the Affordable Care Act passes, Shyla Patera may have to move out of her home.

The 48-year-old Great Falls resident was born with cerebral palsy and relies on Medicaid coverage for home health services.

“I do need the Medicaid support to survive and if this bill passes, I’ve got to have you help me convince private insurance that staying in my home is important,” Patera told U.S. Sen. Jon Tester Saturday night at a town hall meeting here on health care.

“I’m worried about keeping a job that I love as an advocate for people with disabilities. I’m already planning for retirement. If this bill passes, I’m afraid I’m not going to get that choice. We deserve a system that works.”

Nearly a hundred Montanans concerned about the Better Care Reconciliation Act, the Republican legislation working its way through Congress, filled a room here on a warm summer night to ask Montana's senior senator what he’s doing to protect them.

Senate Republicans released a draft of their version of the bill, which had been worked on behind closed doors without public input, on Tuesday. Democrats including Tester, who has long been an opponent of the legislation, offered immediate strong opposition. The bill is the Republican Party's long-promised effort to do away with former President Barack Obama's landmark health care legislation.

In Montana, much of the concern about the bill has focused on Medicaid coverage. 

“This Medicaid thing is going to hit rural states in a big way,” Tester told the crowd. “Rural states like Montana get pounded.”

About 216,600 Montanans are insured under Medicaid. Nearly half of those are children, about 96,850. The program also covers about 19,000 adults with disabilities, like Patera.

Clay Preble, 12, is one of the children covered by Medicaid. He was adopted at 8 after living in an abusive home.

“He’s had a number of medical problems, and he’ll need coverage going forward,” said Jennifer Preble, his mom. “He is the face to this problem. His coverage needs to be protected and so does the coverage for kids like him.”

An analysis by Manatt Health commissioned by the Montana Healthcare Foundation estimates that under a per capita cap in the House version of the bill, the state would have to cut Medicaid program spending by $888 million between 2020 and 2026.

John Goodnow, CEO of Benefis Health System in Great Falls, said there’s no way Montana can make up the difference.

“Whenever you hear the federal government say block grants, think cuts. Montana is having a real budgetary struggle right now. The chances of Montana being able to pick up what would be cut from the federal level is about zero,” he said. “You would have tons of people in Montana without coverage.”

In 2016 under a provision of the Affordable Care Act, Montana chose to expand Medicaid coverage to those in the state who earn up to 138 percent of the federal poverty level. More than 79,000 Montanans are covered under expansion.

Under the Senate bill, Medicaid expansion would be eliminated by lowering  the share of money the federal government pays for the program. The Senate bill slows the reduction of the federal match, but Montana is one of eight states where if the federal match drops below rates set in the Affordable Care Act, expansion would end immediately.

Goodnow said that change will kick about 79,000 Montanans off their insurance.

“If this goes through, Montana cannot afford to keep Medicaid expansion. … This is a bad news deal. I am 100 percent against this bill, not for what it does to the hospital; we’ll adapt, we always do, but for what it does to all the people it takes coverage from. That’s my concern.”

Tester told those in attendance that he expects the Senate will vote on the bill this week. While he said he couldn't predict if it would pass, a group that about five Republicans, enough to kill the legislation, have said they don’t support the bill.

Montana’s other senator, Republican Steve Daines, has not said whether or not he will vote for the bill, saying he needs to hear from constituents. Daines is holding a telephone town hall Wednesday night.

“This (health care) is a sixth of the economy. It affects everyone’s life at some point or another and to not have an open discussion on this for months is not the right way to go,” Tester said.

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State Bureau reporter for The Independent Record.

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