Working as a pediatrician taking care of children, I am in daily contact with the victims of the Medicaid gap. They are often the parents of children on Medicaid and the working poor who have been disenfranchised during this whole process.
For the uninitiated, I will explain the Medicaid Gap. Subsidies to help acquire insurance through the Affordable Care Act were not addressed for people who are within 100 percent of Federal Poverty Line ($11,500 a year). This was because they were ostensibly going to get covered under Medicaid expansion. Since that did not happen in the state of Montana, these unfortunate people have no recourse. They do not make enough money to be able to afford health insurance on the open market without any subsidy.
So what is going on in our Legislature to address this problem? There are currently two bills under consideration:
1. Healthy Montana Plan/the Bullock bill (House Bill 249)
As per this bill the number of Montanans covered will be approximately 70,000. These include parents of children on Medicaid, veterans and childless adults who earn less than 138 percent of the Federal Poverty Line. The federal government will give the state of Montana money to cover 90 percent of the cost (90/10 federal match).
2. The Ballance bill (House Bill 455)
The number of Montanans covered under this is 12,000 to 15,000; Parents of children on Medicaid who fall in the coverage gap of 40-100 percent of Federal Poverty Line and veterans. The federal government will pay us 65 percent of the cost (the 65/35 traditional Medicaid waiver).
You don’t have to be a genius to know which bill is best for Montana and Montana’s working poor. Ask any parent of a child on Medicaid (like I have been doing) and they will all invariably favor the Bullock bill.
However this discussion/debate has been hijacked by the tea party Republicans who are holding us Montanans hostage to their ideology and in the process doing nothing to alleviate the suffering of the working poor.
They have cited a multitude of erroneous reasons as to why we should not support the Bullock bill:
1. "We do not want federal monies”
This is the craziest thing I have heard. The reason there is federal money is that Montanans like all other citizens of this great country pay federal taxes. It is now our turn to reap its benefits. Why are tea party Republicans trying to reduce the national debt on the backs of Montana’s working poor?
2. “Doctors do not accept Medicaid”
All hospitals and hospital owned physician practices accept Medicaid. Also the majority (more than 60 percent) of independent physician practices in Montana accepts Medicaid patients (figure courtesy The Montana Medical Association).
The citizens of Montana are being bombarded by misinformation and what is even more disturbing is that no one is challenging obviously incorrect information. Take for example the opinion piece "'Healthy Montana Plan’ won’t help most vulnerable" (web headline: "Money for nothing and Medicaid for free") on the Feb. 9 Opinion page penned by Mr. Zachary Lahn.
Mr. Lahn makes bold statements such as ”Multiple studies have shown that Medicaid recipients often have deplorable health outcomes -- in some instances, worse than if they had no health insurance at all." Mr. Lahn, show me those studies.
His statement regarding the National Center for Health statistics saying one in three Medicaid patients will be turned away by doctors’ offices is blatantly untrue for Montana as I have elaborated earlier.
He then goes on onto quote another study saying that even for those (Medicaid patients), who can find a doctor, they have the longest hospital stays, the highest total hospital costs and the highest risk of death. Therefore Mr. Lahn is reluctant to push another 70,000 poor working Montanans into this “second class health care system."
Mr. Lahn’s logic is flawed. These patients have higher health care costs due to various other reasons, for example, the consequences of untreated hypertension and diabetes, untreated because they previously had no health insurance. They sometimes live in less than optimal housing due to their circumstances, putting them at extra risk of respiratory ailments. They do not get appropriate cancer screenings and eventually get diagnosed with advanced cancer when they finally get on Medicaid. These factors lead to a worse outcome. Saying that being on Medicaid places people at high risk is ridiculous. It’s like saying outcomes for Medicare patients are always bad, they all invariably die!
Mr. Lahn wants to pursue policies that allow individuals to choose the health care most fitting their needs. The working poor in Montana have chosen, they do want Medicaid expansion. The sad truth is nobody is listening to them. There is too much white noise from the tea party Republicans.
It is to time for the people of Montana to stands up and do the right thing. Call your local elected representatives immediately, tell them to support the sensible choice-House Bill 249 (A.K.A the Bullock bill).
Dr. Augustine is a board certified pediatrician who has been working at the Helena Pediatric Clinic for the last 10 years.