Last week at the state Capitol, the Joint Select Committee on Healthcare met with some hospital CEOs to discuss Medicaid and Medicaid expansion. Our thanks to the CEOs from St. Peter’s in Helena, St. James in Butte and the for-profit Community Medical Center in Missoula for attendance at this important meeting. Six of the CEOs from the largest hospitals had "prior commitments." There has been some talk in having another meeting so all of them could be in attendance. Stay tuned.
The committee was comprised of four legislators from the Montana House and four from the Senate of both parties. We asked questions about patient care, hospital board set-up and what the communities see as real needs -- an assessment required of hospitals by IRS regulations.
The following is a short synopsis of what we learned:
• After expansion was passed into law, uncompensated care by hospitals has declined, in some cases from 7.3 percent of total hospital care down to 1.6 percent.
• One CEO felt the state health clinics were taking patient base away and made it harder for them financially. A 2017 Legislative Audit expressed concerns about the management and oversight of these clinics which were created by Gov. Schweitzer in 2012 and has cost the taxpayers $26 million in the first 5 years.
• Because of a significant commitment by taxpayers we’ve seen nearly 100,000 people added to the Medicaid expansion system. The Butte CEO said that 63 percent of Butte businesses have at least one person on Medicaid. It would be wonderful if our state’s economy allowed them to be paid enough to remove them from this need.
• Attendees shared concerns about the difficulty of recruiting doctors in a state with a small and often isolated population base. Innovative solutions such as doctor sharing and specialty doctors having certain days to see patients have been successful to address these concerns.
• There was also discussion about eliminating waste through better vendor contracts, a daily focus on floor staffing and closing programs that are not cost effective. These are exactly the types of things small businesses do in Montana to make sure they remain healthy.
The most recent Montana Single Audit report showed almost $1 billion federal dollars going to Medicaid in 2016. The number climbed to $1.4 billion in 2017 after Medicaid expansion passed. These numbers don’t even show the state’s share.
Montana legislators have an obligation to our constituents to craft policies that are thoughtful and sustainable. One lawyer suggested we didn’t have "standing" to request that CEOs come to a legislative meeting. Legislators, however, appropriate billions of the people’s money and if needed have subpoena power to call people to the legislature to thoroughly vet ideas, spending and what is most helpful for vulnerable populations.
This was a friendly meeting where legislators were able to sit with hospital CEOs at the same table and have a thoughtful, honest talk about our neediest Montanans being served and the money it takes to do it.
We hope you will check out the leg.mt.gov website and go to the archives to listen to the meeting. Everyone can learn something when we have civil conversations about serious matters.
Sen. Dee Brown, R-Hungry Horse, represents Senate District 2 and is the chair of the Joint Healthcare Committee. Sen. Al Olszewski, R-Kalispell, represents Senate District 6.