Democrats have full day in Havre

Democratic legislative leaders spent all day in Havre touring facilities and listening to residents and officials talk on a plethora of topics, with the day starting at a 7 a.m. breakfast session at Northern Montana Hospital and ending at 5 p.m. at Montana State University-Northern.

Senate Minority Whip Cliff Larsen, D-Missoula, and House Minority Leader Chuck Hunter, D-Helena, joined Sen. Greg Jergeson, D-Havre, and Rep. Clarena Brockie, D-Harlem, for a series of tours and meetings to see what is happening on the Hi-Line.

They were joined at several sessions by Democrat Janet Trethewey, both in her capacity as a Havre City Council member and as a retired teacher, union member and candidate for the House district encompassing Havre.

Both Hunter and Larsen agreed with comments made by people throughout the day - the Hi-Line faces many issues radically different than in their cities in southwestern Montana.

A nonpolitical visit in an election year

The visit was touted as a listening and learning session, not a campaign event. The meetings throughout the day did not include discussions of the upcoming election, although Larsen did say during the 7 a.m. breakfast meeting that the Havre area lacking a representative on the House Appropriations Committee had pulled some of the area's clout in the budgeting process.

The last Havre member of the Appropriations Committee, former Rep. John Musgrove, D-Havre, attended the breakfast meeting. That meeting was listed as a visit with local labor representatives, and although many at the meeting were union members, the talk revolved more around education and health care.

Danielle Golie, Hill County director of public health, urged the lawmakers to continue to fund a program that provides help to teens while they are pregnant and in their first two years of motherhood.

Golie said she is adding a second nurse to the program in Hill County, with the intent of increasing work with Rocky Boy's Indian Reservation. The nurses help teach the participants about prenatal care and continue after the mother gives birth, both in helping teach the young mother - and father, if possible - how to care for the child and to help connect them with other resources and agencies.

Golie said that, while the first goal is to try to reduce teen pregnancy, evidence shows the program helps reduce additional pregnancies and to improve the health and wellness of the child and family, including reduced child abuse, reduced crime and improved school and job-readiness for the child.

The Hill County program receives federal and state funding, and, while she said she is working to make it sustainable locally, she asked the lawmakers to support funding it in the future.

Medical issues on the Hi-Line - and everywhere

A later meeting, following tours of the Northern Montana Hospital family medical center being built on the hospital campus and of the new Bullhook Community Medical Center facility being built across from City Hall, was set to talk about medical issues.

One topic was on the impact of unpaid medical bills and about Medicaid expansion.

Northern Montana Hospital President and CEO Dave Henry said the unpaid portion of bills, or uncompensated care, covered by Medicaid and Medicare and Indian Health Service contracted care is part of the reason hospitals have to raise rates more for other patients. The government sets payment for procedures under those programs, with contractual discounts, not hospitals

He said Northern Montana Hospital has only about 14 percent of its bills paid by the patient or through their private insurance. That means that if the hospital raises prices to cover increasing costs, some 85 percent of its patients don't care - their payments don't go up. He also said that hospitals in larger cities, such as Bozeman or Missoula, have a much higher percentage of patients with private pay or private insurance.

That while costs and regulation continue to creep up.

"We get caught in the middle, all of us do, that are providing care," Henry said.

Larson, a former health care administrator and health care consultant, said he completely agreed with Henry about uncompensated care.

"He's not exaggerating," he said.

Hunter asked if Henry would favor a proposal to implement the Affordable Care Act Medicaid expansion by providing subsidies to people who would qualify to buy private insurance through the new insurance exchange.

"Absolutely. No question about it," Henry said.

Nursing home expenses

Ron Gleason, administrator of Northern Montana Care Center at the hospital, said nursing homes face some of the same - and some additional - problems.

One is that, just as the hospital is facing cuts to Medicaid, including sequestration, mean the program in June of last year was paying less for a nursing home stay than it did in July 2009. That means to cover increased costs including wage and salary increases for staff, the center has to raise the prices enough that the private-pay people can cover it. He added that he does not want to raise the prices any more.

"We're about as high as we think we can be," Gleason said.

Along with reduced payments from Medicare and Medicaid, with complex issues about when those programs will pay for care center stays, a lookback period is giving people ways to avoid paying, he said.

He gave an example of a man who took ownership of his mother's property, and power of attorney over her affairs. He applied for Medicaid for his mother, put her in the care center, and kept her there after she was denied Medicaid because of the five-year lookback period for property transfers. But he did not pay most of the bill, Gleason said.

He removed her from the care center - probably taking her to another and starting over - with $60,000 due, Gleason said. He added that that is not uncommon.

State law does not allow the care centers to legally pursue the child of the resident, and since the resident does not have any assets, the care centers cannot get payment from them. Gleason and Henry asked for a modification of a bill that passed last session, allowing the state to take action, to allow care centers to do the same.

The legislators also heard from people who are helping enroll people in the health care expansion and from people who are in between the level of Medicaid eligibility and the health care subsidies. They received a request to back the initiative to expand Medicaid, which was voted down in the last Legislature and Henry said the state hospital association also is backing the initiative.

Education on the Hi-Line

Several discussions included talks on education, including a session focused on both higher education and the K-12 system.

Before that, the last session of the day, the legislators toured Montana State University-Northern College of Technical Sciences facilities. The tour included one building scheduled for replacement, the building that houses the Automotive and Diesel technology programs.

A bonding bill in 2011 that would have paid the full $8.9 million to build a new auto-diesel building was voted down by the Republican majority, which said the state revenue would not meet the expected amount and so refused to add to the state debt.

Last session, the Republican majority said that, because the state had higher revenue than expected, there was no reason to go into debt, and voted to pay for state building projects in cash instead of selling bonds. Northern was required to raise $3 million for the new auto-diesel building.

Dean Greg Kegel gave a tour of the current facility, saying it lacks a heated floor, lacks adequate ventilation, lacks the space to bring in a vehicle and turn it around, and has a barely usable vehicle washing stall. He also pointed out where the university had insulated and walled over the window on the north side of the building due to leaking air.

The legislators heard several times that Northern having to raise $3 million is unrealistic.

Northern Chancellor Jim Limbaugh said he is continuing to follow the legislative mandate and trying to raise the money, but doubts Havre's university can raise the full amount.

Board of Regents Interim Chair Paul Tuss of Havre echoed that - Montana State University or University of Montana would have an easier time, but for Northern the task is extremely difficult.

Tuss also questioned having to raise money for a public building that will be owned by the state.

Tuss and Limbaugh and others at the meeting thanked the legislators for passing legislation allowing a tuition freeze, and a pay increase at universities, but both said the university has to raise its faculty pay.

"Frankly, it's embarrassing," Tuss said.

Brockie, who is dean of students at Aaniiih Nakoda College at Fort Belknap Indian Reservation, talked about challenges facing tribal colleges.

Havre Public Schools Superintendent Andy Carlson talked about education issues, saying many problems are the same - such as paying for infrastructure improvements or replacements - but that each district is unique.

"Part of what we struggle with is when people try to make us all the same," he said.

He talked about a program Havre started called kindergarten prep, where students who are behind in kindergarten requirements are given an extra year to help them catch up. While the program still is too new to show much data, a group of students put into prekindergarten due to deficiencies in language preparation now are ahead of their peers, he said.

Ag and transportation

The legislators also heard from a group of farmers, ranchers and educators about agriculture and transportation.

Highway 2 Association President Bob Sivertson, a former state legislator himself, told the legislators that both of the top industries now in the region - agriculture and energy - are increasing traffic on the highways, railroad and at the ports of entry between Montana and Canada's Alberta and Saskatchewan. He urged support of upgrading the highways and to upgrade the hours and status at the Port of Wild Horse north of Havre.

The agriculture representatives, including Northern Professor Tom Welch, Northern Agriculture Research Center Superintendent Darrin Boss, retired farmer Robert Boettcher, farmer Tom Bangs, and Tiffany Melby, value-added agriculture coordinator for Bear Paw Development Corp., all agreed that agriculture faces challenges, but that this region continues to lead in the agriculture industry.

"We are the envy of the world," Welch said.

Bangs also spoke as a member of the board of the communications cooperative Triangle Communications, saying it is continuing to try to provide fiber-optics for all of its customers with a priority for getting top-level communications to schools in its region.

The group agreed that problems include finding young people to go into ag careers - although youth in the area are doing so - and in finding land. They said capital seems to be more available than it was in the past, although finding financing still is not easy.

"It's getting better," said Northern student Eric Billmayer, adding, "It's still tough."

The group also said that federal programs to help starting farmers, and to help transition land from the Conservation Reserve Program to young farmers, should help the industry.

Bangs also said that if the price of grain drops - projections are it could go from $7 or more a bushel to $5 a bushel - that could severely impact the industry, including finding financing for new or existing operations.

"If that happens it's going to be really dramatic on available capital," he said.