Tester hears ACA repeal concerns in Billings

A day after Congress moved one step closer to repealing the Affordable Care Act, U.S. Sen. Jon Tester, D-Mont., met with health care representatives in Billings to hear their thoughts about the impact that action might have.

Tester has been holding a series of health care roundtables around the state, including one in Roundup on Friday and three on Saturday in Billings, Bozeman and Butte. More than 30 health care providers, administrators and community members met with Tester Saturday morning at Billings Clinic, most telling him what the ACA has accomplished.

Uncertainty filled the air during the hour-long conversation, as participants wondered whether the repeal would be paired with a replacement piece. National news reports have said that Republican leaders intend to come up with a such a plan.

“If there is a replacement, I have not seen it,” Tester told the group. “I’ve asked, and quite frankly, I haven’t seen a replacement from anybody.”

Tester told others around the table he wanted to hear “the good, the bad, the ugly – everything” about the ACA.

“If we have a replacement, what should that replacement look like?” he asked. “What’s working with the ACA, what’s not working?”

Scot Gudger, vice president of St. Vincent Physicians, said with more people insured through the ACA, including those covered through the expanded Medicaid, they are able to seek less expensive primary care. Without it, patients are more likely to wait until their only option is the costly emergency room or intensive care unit.

“The bill for charity care is compounded if we are forced back to a system where people don’t have access to primary care,” Gudger said.

Mike Foster, regional director of advocacy at St. Vincent Healthcare, said if what the ACA provides is taken away, “especially for the poor and vulnerable, that’s a very deep and high concern for us.”

“We’re hoping whatever happens, there’s a good bridge, where people do not lose their coverage,” Foster said. “We’re talking about access here and also quality of life.”

Dr. Tersh McCracken, who specializes in obstetrics and gynecology at Billings Clinic, met a couple of months ago with a ranch woman in her early 60s who didn’t have health insurance and had put off seeking treatment. By the time he diagnosed her cancer, it was no longer treatable.

Another, even more personal example, McCracken said, involved his 13-year-old nephew who was diagnosed with leukemia this fall. Three months into treatment, his insurance company changed.

Penny Ronning of Billings said she was diagnosed with brain cancer two years ago.

“Without the Affordable Care Act i would not be walking,” she said. “Because I had insurance for the first time, I am here today, able to walk, to do what I can.”

“Thank goodness for the pre-existing clause in the ACA so he’s insurable,” McCracken said. “Otherwise he wouldn’t have been.”

Dr. Randall Gibb, interim CEO at Billings Clinic added that with Montana’s aging population, in five years there will be more people than ever accessing health care. That is compounded by a shortage of medical professionals, the exorbitant cost of technology and increasing drug costs.

“We have a really good opportunity as a community and a nation,” Gibb said. “The ACA was certainly a good start, but we need to find ways to strengthen it to address all the concerns,” Gibb said.

Dr. Jonathan Gilbert, chief medical officer for the Billings area office of Indian Health Service (IHS), said the loss of the ACA would be a devastating blow to the Indian tribes of Montana. Since Medicaid expansion in December 2015, more than 8,500 Native Americans in Montana have enrolled, a 21 percent increase.

Many other aspects of the ACA have benefited the tribes and their members, Gilbert said, including the permanence of Indian Health Care Improvement Act. With the repeal, Congress would once again have to annually approve the act, something it hadn’t done for several years before the ACA’s passage.

Jace Killsback, president of the Northern Cheyenne Tribe, added that certain waivers and exemptions have allowed tribal members to access quality healthcare, something not possible in the past with the chronic underfunding of the IHS.

Tester was challenged on his vote Wednesday on a budget resolution designed to cut medication prices by allowing cheaper, identical versions of prescription drugs to be imported from other countries, including Canada.

Tester, one of 13 Senate Democrats who voted no, which helped defeat the bill, said he was concerned with the safety of the imported drugs. Tester said he relied on the expertise of Secretary Sylvia Burwell, head of Health and Human Services, who said the drugs can’t be tracked well enough to assure their purity.

“If you want to give me the authority to be able to determine if they can be re-imported, that’s a different story,” he said. “But that’s not what the amendment did.”

After the roundtable, Tester was asked what he sees as the big takeaways from all of the listening sessions. One, he said, is the success of the Medicaid expansion in boosting individual health and reducing hospital charity care and bad debt. The repeal would eliminate the expansion.

Tester has also gotten feedback on how mental health care would be impacted with the repeal, as well as preventative services.

“There’s a lot of the preventive services the ACA affords and we get some $7 million in the state of Montana that has its impacts,” he said.

Regarding impacts on rural communities, Tester said smaller medical centers in the midst of setting their budgets are living with uncertainty.

“They’re concerned the model is going to change and they may not be able to offer the same services that they’ve been offering their communities,” Tester said. “And potentially they could close down.”

Tester said, on the negative side of the ACA, he’s heard a lot about high premiums and a lack of subsidies and higher deductibles that are hurting a lot of middle-class families.

“And that it does need to be fixed, it needs to be addressed, there’s no ifs, ands and buts about it,” he said.

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