Missoulian, Nov. 18, on Montana’s legislators needing to reauthorize Medicaid expansion:
Montana legislators met in Helena this past week to attend orientation for the 2019 session that will begin in just a few short weeks, and to determine leadership for the House and Senate. At the same time, Gov. Steve Bullock released his budget proposal for the 2021 biennium, a plan that calls for maintaining the Montana Health and Economic Livelihood Partnerships (HELP) Act that expands Medicaid in Montana.
Thus the stage is set for the start of the 66th legislative session on Jan. 7, 2019. One of the biggest challenges facing lawmakers in the new year will be ensuring that Montana’s most vulnerable are able to receive the care they need to lead long, healthy lives. This means renewing the enormously successful Medicaid expansion program.
Unfortunately, some state legislators already have hinted at their intention to severely reform Medicaid expansion, or see it end altogether. This would be a tragic mistake.
Medicaid expansion has helped tens of thousands of low-income Montanans since it took effect in January 2016, thanks to a bill narrowly passed by the 2015 Legislature. At last count, more than 96,000 Montanans were enrolled, helping to slash the state’s uninsured rate by nearly half.
Who are these folks? Medicaid applicants must make less than 138 percent of the federal poverty level: $16,643 for a single person or $33,948 for a family of four. Montana’s program requires enrollees to pay 2 percent of this meager income in premiums.
More than 70 percent are families with children. According to the Henry J. Kaiser Foundation, 61 percent of children with special health care needs are covered by Medicaid in Montana, and 67 percent of adult enrollees are working in Montana. Medicaid covers 3 of every 5 nursing home residents, and 1 of every 2 individuals with a disability.
But some Republican legislators suspect there must be freeloaders in the group and want to push workforce requirements as a condition of enrollment. Already, there are bill draft requests in line to generally revise Medicaid expansion.
Montana’s Medicaid program already includes assistance for those interested in job training and career counseling, and Gov. Bullock’s budget proposal summary notes that Montana is the only state in the nation to have boosted, by 9 percent, labor market participation among non-disabled enrollees.
However, there remain other barriers to employment, including lack of transportation or child care. Not surprisingly, the enrollment rate tends to be higher in counties with higher unemployment rates and higher numbers of people living in poverty. For these folks, Medicaid enrollment ensures they are able to continue to receive health services until they are able to overcome those barriers and land a good-paying job.
Removing that access would be cruel. It would also be harmful to Montana’s health.
Multiple studies show that Medicaid expansion has had a strong positive effect on more than just individual health outcomes. According to an April 2018 report by the Bureau of Business and Economic Research at the University of Montana, Medicaid expansion can be directly linked to substantial gains in jobs and personal income through increased economic activity; it even reduces debt and crime rates.
Medicaid expansion spurs the economy, actually resulting in a net savings for Montana taxpayers. Under Medicaid expansion, the federal government pays a greater portion of the costs for a number of folks who were previously covered primarily by state dollars, resulting in a general fund savings of $58 million so far, according to an October report by the Montana Budget and Policy Center.
As the report notes, “during its first two years, Medicaid expansion spending totaled $802 million” - with the state responsible for picking up only 5 percent of the total costs, and the federal government covering the rest. By 2020, if Medicaid expansion remains in place, the state’s share will increase to 10 percent, or about $60 million a year.
Initiative 185 would have raised up to $26 million per fiscal year to help pay for Medicaid expansion through a $2 per pack increase on cigarettes. It also would have helped reduce health care costs by reducing the number of tobacco users in Montana. Unfortunately, I-185 failed to gain enough votes to become law after major tobacco corporations spent a huge amount of money - more than $17 million - to defeat the proposal, which was backed by a number of Montana health organizations.
A number of state legislators opposed the measure as well, some signaling their intention to restrict the requirements for Medicaid expansion in order to reduce the number of people who qualify. But I-185 would not have prevented lawmakers from making reforms to the program; it simply would have provided that the program be maintained instead of sunsetting in June 2019, which is what will happen if legislators cannot agree on a plan to keep it going.
Any reforms should be viewed with an extremely critical eye, because Montana’s Medicaid expansion is working extremely well, just as it is. It’s true that the number of people enrolled is higher than originally expected, but Montanans should take this as good assurance that people who have long needed health care are finally able to get it.
Bullock’s proposed budget summary notes that Montana’s uninsured rate is now at 7 percent; it was 20 percent as recently as 2013. Rural communities have seen the costs associated with uncompensated care reduced by nearly 50 percent, and Medicaid expansion has kept hospitals open in states that adopted it.
The budget proposal provides a good starting framework for discussion. It’s up to the 2019 Legislature to reauthorize Medicaid expansion so it can continue improving Montana’s health.
Editorial: https://bit.ly/2A4lVy5
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Billings Gazette, Nov. 18, on seeking justice for Indian women:
Missing and murdered Native American women deserve justice.
That, in brief, is the urgency behind Savanna’s Act - legislation that has been awaiting action in the U.S. House and U.S. Senate for an entire year.
The Senate bill, which is co-sponsored by Sen. Jon Tester, D-Montana, was unanimously approved by the Senate Indian Affairs Committee Nov. 14. Tester, one of the original bill sponsors, is a member of that committee as are Republican Sens. Steve Daines of Montana and John Barrasso of Wyoming. There was no partisan division in the vote on S.1942. But we must ask: Why did it take so long?
“We need Savanna’s Act to improve information sharing between law enforcement agencies, establish better response protocols and put an end to these crimes committed across Indian Country,” Tester said in a press release.
The bill spells out the terrible danger that engulfs Native American and Alaska Native women and girls more often than other U.S. women:
- On some reservations, Indian women are murdered at more than 10 times the national average.
- American Indians and Alaska Natives are at least twice as likely to experience rape or sexual assault crimes - compared to all other races.
- More than 84 percent of Native American and Alaska Native women have experienced violence in their lifetime.
- Homicide is the third leading cause of death among American Indian and Alaska Native women between 10 and 24 years old.
U.S. attorneys declined to prosecute nearly 52 percent of violent crimes that occur in Indian country, according to a 2010 report from the General Accountability Office. Investigation into these cases of missing women is hindered by a lack of training, equipment or funding and a lack of interagency cooperation, the bill states, continuing: “The complicated jurisdictional scheme that exists in Indian country has a significant negative impact on the ability to provide public safety to Indian communities.”
The act aims to clarify the responsibilities of federal, state, tribal, and local governments. That includes increasing coordination and communication among federal, state, tribal, and local law enforcement agencies. It is intended to empower effective response to cases of missing and murdered Indians and to increase the collection of data related to missing and murdered Indian women.
Savanna’s Act is named for a young Native woman, Savanna LaFountaine-Greywind, who was murdered last year in North Dakota when she was eight months pregnant.
In December 2017, the Senate Indian Affairs Committee unanimously approved the Survive Act. It still awaits Senate floor action. Tester is a sponsor of the Survive Act, which sets aside 5 percent of the Crime Victims Fund to provide an additional $150 million that tribes could use to assist survivors of violent crimes. The Survive Act can support domestic violence shelters, medical care, counseling, legal assistance and services, and child and elder abuse prevention.
In Montana, home to seven Indian reservations, we have seen horrendous crimes committed against Native women. Both Daines and Tester have supported resolutions recognizing May 5 as the National Day of Awareness for Missing and Murdered Native Women and Girls. May 5 is the birthday of Hanna Harris, a young member of the Northern Cheyenne Tribe who was murdered in July 2013.
The Senate Committee vote for Savannah’s Act Wednesday was a hopeful step, but the hope will disappear when the lame duck Congress adjourns.
We urge Tester and Daines to talk with their Senate colleagues about passing both Savanna’s Act and the Survive Act very soon. Members of the Senate Indian Affairs Committee should be leaders in persuading Majority Leader Mitch McConnell to bring these lifesaving measures to the Senate floor to become part of the year-end legislation that the House and Senate agree to send to President Donald Trump.
Don’t force Native American women to wait even longer for justice.
Editorial: https://bit.ly/2FB1S0g
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Bozeman Daily Chronicle, Nov. 20, on indoor vaping ban being the right call:
Last month the Gallatin City-County Health Board voted to ban vaping indoors. It was a split decision, but the ayes prevailed. And so they should have. It was the right thing to do.
Vaping devices, or electronic cigarettes, have only been on the market for about 15 years. Their popularity has been increasing exponentially, but not without a good deal of controversy.
Most health care professionals acknowledge that vaping is less harmful than smoking tobacco. But that doesn’t mean they are safe. And there has been little research on the effects of inhaling secondhand nicotine-infused vapor. Until more is known, non-vapers should not have to be exposed to those vapors in public places.
What’s most troubling about the growing popularity of vaping is the favor it is finding among youth. The recent Youth Risk Behavior Survey found that 7 percent of Gallatin County middle-schoolers and 25 percent of high schoolers had used a vaping device within the previous 30 days.
While smoking has been steadily declining among youth, vaping offers a different opportunity to become addicted to nicotine. And there are genuine fears that many kids who start out vaping will end up smoking tobacco. The ban on indoor vaping won’t eliminate that trend, but by making the practice less convenient - and subject to legal discipline when done indoors - may help discourage teens from taking up the habit.
Some, particularly vaping shop owners, have spoken out against the ban, arguing that sampling vaping products within their stores is an important part of their businesses. But, as one health board member pointed out, you can buy e-cigarettes in convenience stores and you can’t try them out before you purchase them there. The same is true for other products, such as beer and wine. Those products are purchased without sampling them beforehand.
Gallatin County joins 10 other Montana counties that have banned indoor vaping. And the health board is applauded for doing so. These products will continue to be available to adults who want to use them, including those who find they are helpful in quitting a tobacco habit.
But now those who don’t want to be exposed to secondhand vapor in public establishments don’t have to be.
Editorial: https://bit.ly/2KmYOU3
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