Tester in town to talk about health care

by Quinn Schwartz, Sidney Herald

With great change often comes great uncertainty.

President Donald Trump ran his 2016 political campaign with the promise of a significant “shakeup” in Washington, and now with new plans and legislations swirling around our nation’s capital, some of these uncertainties are beginning to emerge around the country.

One of the biggest is what will happen to healthcare with the formal repeal of the Affordable Care Act (ACA). Sen. Jon Tester, D-Mont. paid a visit to Sidney Medical Center Monday for a sit-down with healthcare department heads from all over eastern Montana to discuss their concerns.

“I’ve had a number of discussions like these with docs, patients and administrators around Montana,” Tester said. “The goal is to see what is and what isn’t working with ACA. We know we’re looking at a full repeal, and now we hear that there will be a replacement, but what that is remains to be seen.”

Audrey Stromberg of Roosevelt Medical Center in Culbertson said

Eastern Montana has experienced a sharp increase in the number of its insured residents, but the amount of bad debt patients are facing remains steady according to Audrey Stromberg of Roosevelt Medical Center in Culbertson.

“We’ve basically seen a flip-flop from 12 percent uninsured to 5 percent medicaid, to 5 percent uninsured to 12 percent medicaid on our hospital side,” she said. “The payments might be affordable, but some people have $6-$8,000 deductibles before copays that they just can’t pay out of pocket.”

The switch from fee-for-service care to value-based care was one of the biggest challenges for healthcare in eastern Montana under ACA, members of the panel said.

Fee-for-service care plan reimburses providers for each visit, treatment or test they might receive, whereas with a value-based plan providers are reimbursed through bundled payments for all services needed to treat a specific condition. The goal of value-based care is to provide high-quality care without duplicating services, but the system works most efficiently under a high-volume patient population and therefore designed with larger, urban populations in mind. As a result, low-volume hospitals like the Sidney Health Center could lose a significant amount of funding, panel members said.

“What we’re going to start seeing is a battle between big places and little places to see who gets that money,” Stromberg said. “We need to talk to the people on the front lines to see what makes sense in small places, because if it works for us then it will most likely make sense in the big places too.”

Another concern voiced in the meeting was the financial support given to Indian Health Services (IHS) opposed to funding given to non-IHS facilities that also treat native Americans.

“IHS clinics are getting 100 percent funding from the federal government, but if we see a Native American who is on Medicaid, we only get $120,” Peggy Norgaard, CEO of the Wolf Point and Poplar hospital said. “I don’t understand why they can’t apply that 100 percent to non-IHS clinics that are caring for Native Americans. I think something has really got to be done there.”

The meeting concluded with a discussion on how mental health and chemical dependency treatment could be affected by the ACA repeal. The ACA covers many mental health procedures and therapies, but the sector remains perpetually underfunded and now may risk being eliminated completely under the repeal.

“Just because someone has access, doesn’t mean there is enough money in the system for it to operate fully,” Jim Novelli, the executive director for Eastern Montana Community and Mental Health Center said.

“We really need to consider how the state is going to use its medicaid dollars in these rural areas and how they are going to reimburse for mental health,” he added. “A person’s chance of a full mental health recovery is significantly better when their physical well-being is taken care of. If we start ripping away the system so these people can’t get the physical health they need, it will be much harder for them to recover.”

Sen. Tester plans to hold roughly 50 meetings similar to Monday’s in hopes to hear as many concerns as possible to put forth a mutually beneficial plan for rural and more urban Montanans.

“There are parts of the ACA I like, and parts that definitely need to be changed,” Stromberg said. “I just want to see whatever system we have work.”