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Daily Archives: January 6, 2015

Medicaid’s Western Push Hits Montana

The Affordable Care Act is on the move in Western states, with the governors of Utah, Wyoming and Montana all working to hammer out deals with the Obama administration to expand Medicaid in ways tailored to each state. But getting the federal stamp of approval is just the first hurdle – the governors also have to sell it to their legislatures who have their own ideas of how expansion should go.

The latest case-in-point is Montana, where the governor and the legislature have competing proposals about how much federal Medicaid expansion cash the state should try to pull down.

Montana's hospital association is backing Governor Steve Bullock's Medicaid expansion plan. Most are small, " critical access hospitals (25 beds or fewer) like this one in the town of Anaconda. (Photo by Eric Whitney/Montana Public Radio)

Montana’s hospital association is backing Governor Steve Bullock’s Medicaid expansion plan. Most are small, ” critical access hospitals (25 beds or fewer) like this one in the town of Anaconda. (Photo by Eric Whitney/Montana Public Radio)

Montana’s GOP-dominated legislature, which meets every other year, rejected Democratic Governor Steve Bullock’s 2013 attempts to expand Medicaid and set up a state-based insurance exchange. This year Bullock has a different Medicaid expansion proposal that aims to reduce the Treasure State’s 17 percent uninsured rate. It would use federal dollars to contract with a third party administrator to process claims and run a provider network. So far Republican leaders are not embracing it any more than they did his 2013 plan.

The alternative “Healthy Montana Family Plan”  that nine Republican state lawmakers released last week rejects Bullock and the White House’s argument that Medicaid should be offered to anyone making less than 138 percent of the federal poverty level (FPL), or $16,105 a year. That’s an estimated 70,000 people in this sparsely populated state with just over 1 million total residents.

Instead, the plan would extend Medicaid to only some people making less than 100 percent of FPL or $11,670. The idea is to “keep it targeted toward what it’s intended to do,” said plan co-author Sen. Fred Thomas, “take care of our most vulnerable citizens…disabled persons, low income seniors, low income parents, children.”

“Able-bodied people should be able to go out and get a job,” incoming Republican House Speaker Austin Knudsen told the Billings Gazette.

Thomas, an insurance agent by trade, says that extending Medicaid to non-disabled adults who don’t have children is “a disincentive to work.”

This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News. It can be republished for free. (details)logo npr

Of people who make too little to qualify for subsidies, Thomas says, “Anyone that’s in that predicament, we’re gonna encourage them to get another job, get the extra hours, and qualify for the exchange, by bumping their income up a little bit.”

He points out that, under the Affordable Care Act, low income people who make at least 100 percent of FPL qualify for premium subsides through healthcare.gov, which makes health coverage “pretty economical,” or nearly free.

The plan he co-authored says, “Policymakers could employ income tax credits in certain circumstances to boost incomes of those without Medicaid access above 100 percent FPL in order to take advantage of sliding-scale exchange subsidies.”

The Montana State Legislature (Photo Courtesy of the Montana State Legislature)

That reliance on subsidies could hit a snag if the Supreme Court decides in June that it is illegal for those tax subsidies to flow to states that are using healthcare.gov rather than setting up their own exchanges.

The Montana Republican health plan also echoes policies advocated by former Obama administration Medicaid and Medicare leader Don Berwick. It calls for risk-based contracts for providers, and for rewarding them based on “metrics that focus on health outcomes, patient satisfaction and cost containment,” what Berwick calls the “triple aim.” The health law enacted many of those rewards and penalties for hospitals that treat Medicare patients.

This story is part of a reporting partnership that includes Montana Public Radio, NPR and Kaiser Health News.

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Viewpoints: Republicans’ Tough Choices; ‘Mortal Threat’ To Medicaid; ‘Whiny’ Harvard Professors

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State Highlights: Blue Shield Of California, Sutter Health Contract Dispute Stems From Cost Issues; Maine Gov. Spent Big In Medicaid Fight

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CDC Reports Flu Activity Widespread In 43 States

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Health Providers Collect Increasing Amounts Of Data But It Doesn’t Always Lead To Better Care

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VA Protocols For Monitoring Depression Are Faulted

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Seniors In Traditional Medicare Are Moving To Private Advantage Plans, Study Finds

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Study: Hospital Quality Reporting May Help Control Prices

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In Industry Battle Over Hepatitis C Drugs, CVS Sticks With Sovaldi And Harvoni

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Harvard Professors Protest Higher Deductibles

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