Parts of Senate bill tailored to Montana needs

U.S. Sen. Jon Tester has a perspective on health insurance that few, if any, of his 99 colleagues can claim. For a time early in their marriage, as new parents, Tester and his wife, Sharla, couldn’t afford health insurance. So they went without, kept working on their Big Sandy farm and prayed that they and the baby stayed healthy.

Tester recounted that experience in a speech he delivered Monday in the Senate.

“My story is one of the thousands of real Montana families that were forced to wing it, rather than depend on a health care system that works,” he said. Tester then continued with stories of Montanans who were forced to sell their homes, sell pieces or all of the family ranch or take bankruptcy to pay enormous medical bills to obtain lifesaving cancer treatment.

In a telephone interview this week from Washington, Tester said that making health care affordable and holding insurance providers accountable are key features of the bill the Senate is scheduled to take a final vote on this morning. He said it will also stabilize Medicare and help small-business employees.

Tester acknowledges there are parts of the bill he doesn’t like. “I’m not crazy about taxing benefits,” he said. But on balance, the bill has more good points than bad, he said.

Rural benefits

Parts of the Senate bill have distinctly rural benefits, thanks to Tester, Sen. Max Baucus and their North Dakota counterparts, Sens. Byron Dorgan and Kent Conrad. So what’s in the legislation for Montana?

• The Montana Public Health Association on Tuesday applauded Tester for including language in the Senate bill that would ensure that at least 20 percent of certain preventive-health grants are available to rural communities.
• The Senate bill would mandate that employers with more than 50 workers to eventually offer health care coverage to employees. However, many Montana businesses are smaller than that, so they won’t be subject to the mandate.
• On the other hand, the Senate bill offers six years of annual tax credits to employers with fewer than 25 workers who offer health coverage.
• A proposed boost in Medicare hospital and physician payments in North Dakota, South Dakota, Montana and Wyoming would increase North Dakota Medicare reimbursements by $650 million over 10 years, according to a news release from Conrad’s office.

Starting in October, this amendment would adjust the wage index that is a component of all pre-set Medicare hospital reimbursements. Hospitals in Billings, Missoula, Great Falls, Havre, Bozeman, Miles City, Butte, Helena and Kalispell are paid less than the national average wage index; this amendment would boost them up to average. Montana’s 47 other hospitals already are reimbursed according to actual costs under Medicare’s Critical Access Hospital program and aren’t subject to the pre-set fee schedule. The same amendment would increase Medicare  rates for physicians in the four states starting in January 2011 by adjusting a geographic differential in their payment formula.

Status quo doesn’t work

The U.S. Census Bureau estimates that 150,000 Montanans lacked health insurance before the financial system meltdown of 2008. The University of Montana’s Bureau of Economic Research estimated that 35,000 children were among the state’s uninsured citizens last year. A 2005 Montana survey found that 77 percent of Montana’s uninsured population was employed, and also that 59 percent of businesses with fewer than 10 employees weren’t offering health insurance to their workers.

The status quo isn’t acceptable. Legislative measures that effectively cover the uninsured by making the individual and small group market affordable will benefit Montana. If the Senate votes final approval this morning, the next challenge for Tester and Baucus, who is expected to be a conference negotiator, will be to retain the good parts of that bill as it is combined with the House bill in conference committee.