Medicaid expansion is a necessary evil

Joe Balyeat recently wrote a Community Forum column about why the Legislature should refuse the expansion of Medicaid in Montana. As a staunch Republican and a board member of a hospital in a small town, I disagree.

Mr. Balyeat's synopsis of the health care program seems to suggest that we should do away with the systems that are in place.

Regardless of what Mr. Balyeat believes and regardless of whether he and I agree on policies, Mr. Obama is the president and his health care plan is in place for at least four more years. The feds are allocating funds to states for their participation in this expanded Medicaid plan. The funds are out there to be used, but only if states accept the expansion.

I am a board member at Pondera Medical Center, which is classified as a critical access hospital. People seek medical attention at our small hospital, and we are required by laws in place to furnish medical attention to all who present themselves to our emergency room, urgent care, patient clinic or hospital with no prejudice as to their race, creed or ability to pay. There is no other recourse for most of the hospitals in Montana but to furnish this care. Without Medicaid, every CAH in the state knows that we will write these visits off to charity care or bad debt.

Charity care and bad debt not only hurt our bottom line, but threaten our ability to continue to exist. Once again, laws already in place impact our policies. Many people are not aware that a CAH, by federal law, is paid 101 percent of total Medicaid charges. At year-end an audit is completed and if the hospital is over-paid, the hospital must return the overage amount within 30 days or face financial penalties.

I'm sure the readers may find this unbelievable but it is true. Hospitals such as Pondera Medical Center must survive on this 1 percent profit margin. Compare this 1 percent with other industries and with for-profit hospitals. The crux of this information is that every small hospital in Montana is on the verge of failing every month if they don't get their expected Medicare/Medicaid payments in a timely manner.

We also read Mr. Balyeat's facts on Medicaid patient success rates. Are we to assume that Medicaid-attached patients shouldn't seek medical attention, as the odds are against them? The new federal health care plan will encourage Medicaid patients to seek medical attention as well as improve their overall health.

I state to Mr. Balyeat that you may not agree with these rules or Obama health care, but it is the payment method that is in place. Until voters change this, we as a small town hospital have to live with what is in place.

Mr. Balyeat noted a shortage of doctors in small towns across Montana. A large number of new doctors who practice at critical access hospitals do so with the knowledge that a portion of their college loans are forgiven with every year of employment at the CAH. This encourages doctors to practice in small towns. Typically a small CAH has to offer higher financial premiums to new doctors to get these services in our small towns.

Our legislators should accept all expansion of state Medicaid from Obamacare. It is a necessary evil to keep our heads above water and allow our small hospitals to stay afloat. Remember, Mr. Balyeat, you may not agree, but don't penalize the employees in Conrad and thousands at other CAHs in Montana. Change the vision by changing the players in the next election.