Participation in Montana’s federally facilitated exchange might be described as fairly steady. Big Sky Country exchange-based health insurance enrollment increased 7 percent between 2015 and 2016, but then declined 10 percent in 2017.
Although many carriers left state marketplaces nationwide at the end of 2016, all three of the insurers that offered plans in Montana’s exchange in 2016 continued to do so for 2017 (the CO-OP, Montana Health CO-OP, ceased new enrollments in late December 2016, however, and is not planning to begin new enrollments until open enrollment starts for 2018 coverage, in November 2017).
Historically, Montana’s uninsured rates have weakened its performance in public health rankings. That could change now that the state has expanded Medicaid, however. Medicaid expansion is up 66 percent in Montana since the end of 2013, with most of that gain coming in 2016 after Medicaid expansion took effect. 71,000 people had enrolled in the state’s expanded Medicaid by early 2017.
And of the people who enrolled in expanded Medicaid in 2016, more than 33,600 had received preventive care during the year, thanks to their Medicaid coverage.
Montana health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2015 rated Montana 28th among the 50 states and District of Columbia. That ranking fell one spot to 29th in 2017. The state’s 2017 scoring based on five main dimensions ran the spectrum, from a #5 ranking in the Avoidable Hospital Use & Costs category to 37th place in the Access category. Relatively high uninsured rates among adults (16 percent) and children (7 percent) pulled down the state’s rating. However, the 2017 report is based on 2015 data, which was before the state expanded Medicaid. A future report that utilizes data from 2016 or later, should show a significantly lower uninsured rate, and thus a better access and affordability score.
The most recent edition of America’s Health Rankings (2016) also measured the state’s healthiness and ranked Montana number 23rd of the 50 states—the same rank it held in 2015. The state has seen improvements in measures related to health insurance, number of primary care physicians, and immunizations for adults and children.
For more details on overall public health in Montana, check out the 2016 listing of Key Health Data About Montana, compiled by Trust for America’s Health. A county-by-county analysis is available via the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Has Obamacare helped Montanans?
When Obamacare took effect, Montana opted for a federally facilitated health insurance exchange and opted out of Medicaid expansion. In the first few years, the state’s uninsured rate improved steadily.
A Gallup Well-Being poll released February 4, 2016, showed Montana’s uninsured rate dropped 7.4 percentage points, from 20.7 percent in 2013 to 13.3 percent in 2015.
However, the state expanded Medicaid on January 1, 2016, and has seen its uninsured rates significantly decline in the past year. The percentage of uninsured Montanans has dropped nearly two-thirds in less than three years, and an annual enrollment survey found that approximately 92.6 percent of Montanans had health coverage as of May 2016, with only 7.4 percent remaining uninsured.
“Medicaid expansion is dramatically improving the health of our state, while also saving millions of Montana tax dollars, creating jobs, and investing in our workforce.” said Montana Department of Public Health and Human Services Director Richard Opper in a July 12, 2016, news release.
Medicaid enrollment is available year-round, which means coverage rates continue to fluctuate.
MT health insurance rates, carriers 2017
Those who bought individual health plans through Montana’s exchange for 2017 had access to plans from the same carriers that participated in 2016:
- Blue Cross Blue Shield of Montana
- Mountain Health Cooperative (enrollment ceased as of December 22, 2016; people who had enrolled by that point can keep their coverage throughout 2017, but new enrollments will not begin again until November 1, 2017, when open enrollment begins for 2018 coverage).
BCBSMT enrolled about 55,000 individuals on and off the state’s exchange in 2016. However, rate increases for 2017 may have shifted that market share somewhat. The state determined that BCBSMT’s rate increase for 2017, which averaged more than 55 percent, was not justified. The state does not have the power to block unjustified rate increases, however, so the rate increase took effect January 1, 2017. The higher premiums may have deterred some enrollees from signing up with BCBSMT. However, 84 percent of Montana exchange enrollees receive premium subsidies, which are determined by average benchmark premiums. As benchmark premiums rise, so do subsidies that help lower monthly premium costs.
Montana enrollment in qualified health plans
In November 2013, the Kaiser Family Foundation estimated that the potential market for Montana’s exchange was 152,000 residents and that 97,000 of them would qualify for premium subsidies to offset the cost of coverage. By the end of the 2014 open enrollment period, 36,584 people had finalized their enrollment in qualified health plans through Montana’s exchange, and HHS reported that 85 percent of them had received premium subsidies.
For 2017, there were 52,473 enrollees in qualified health plans through the Montana exchange. 84 percent of them were eligible for premium subsidies that reduce average premiums from $581/month to $176/month.
The Affordable Care Act and Montana
In 2010, Montana’s U.S. Senators, Max Baucus and Jon Tester, voted to approve the health reform law. But Denny Rehberg, Montana’s sole Representative in the U.S. House, voted against the ACA. Baucus and Rehberg are no longer in Congress.
Senator Steve Daines, who replaced Baucus, has voted to repeal Obamacare. The state’s lone House of Representatives seat is currently vacant, after Rep. Ryan Zinke became Secretary of the Interior in the Trump Administration. Republican Greg Gianforte and Democrat Rob Quist are vying to replace Zinke in the House. Gianforte opposes the ACA and wants to repeal it. Quist supports the ACA, but would like to take it a step further, to a single-payer health care system.
At the state level, former Gov. Brian Schweitzer and former Insurance Commissioner Monica Lindeen were supportive of the ACA, but the state legislature was not. Two bills that would have created a state-run exchange failed in Montana in 2011, while a bill banning the creation of a state-run exchange passed. That bill (SB 228) was ultimately vetoed by Schweitzer, but in late 2012 Montana officially announced that it would default to a federally-facilitated exchange run by HHS.
Gov. Steve Bullock took office in 2013 and has supported Obamacare and worked to improve access. On April 29, 2015, he signed Senate Bill 405 into law, which made Montana the 29th state to expand Medicaid. CMS approved a waiver that included deviations from standard Medicare expansion.
Lindeen was term limited in 2016, and was replaced as Insurance Commissioner by Matt Rosendale, who opposes the ACA and wants a more conservative, “free-market,” Montana-based approach to health care reform. In a letter to U.S. Senator Lamar Alexander (R, Tennessee) in March 2017, Rosendale details his proposals (which include the sale of non-ACA-compliant plans in Montana), and noted that his letter supersedes Lindeen’s letter from late 2016.
Montana Medicaid/CHIP enrollment
Before Montana expanded Medicaid, an estimated 40,140 people – 27 percent of the state’s uninsured population – fell into the coverage gap. Those individuals were said to be eligible if the state were to use federal funds to expand coverage under the ACA. Initially, the state did not move forward with Medicaid expansion, which meant there was not financial assistance available for people with incomes below the poverty level who did not qualify for Medicaid under the state’s existing guidelines
On April 29, 2015, Governor Steve Bullock signed an expansion bill into law, and on November 2, 2015, CMS approved Montana’s Medicaid expansion waiver. The state had projected 23,000 enrollees by June 2016.
Sure enough, Montana Medicaid enrollment surged in 2016. The state’s average monthly Medicaid enrollment grew 66 percent from before the ACA to January 2017, from 148,974 to 246,548.
Other ACA provisions in Montana
The Affordable Care Act established a federal loan program to encourage the creation of nonprofit, consumer-run health insurance issuers – called Consumer Operated and Oriented Plans (CO-OPs). By January of 2013, 23 CO-Ops had received loans totaling $1.98 billion, including more than $85 million for the Montana Health CO-OP, which offers coverage in both Montana and Idaho.
By the end of 2016, the majority of ACA CO-OPs had closed; only five remain operational in 2017. Montana Health CO-OP is among them, but ceased enrollment for 2017 as of December 22, 2016. They plan to reopen enrollment on November 1, 2017, when open enrollment begins for 2018 coverage.
Medicare in Montana
Montana Medicare enrollment has typically been higher than the national average – 20 percent of its total population, compared with 17 percent nationwide. However, the state’s Medicare spending is among the lowest in the country at $6,737 per-beneficiary. Nationally, per-beneficiary spending is $8,970.
Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare. It is an option for consumers who seek additional benefits, and 19 percent of all Montana Medicare recipients selected a Medicare Advantage plan instead of Original Medicare in 2016. Of all Montana Medicare enrollees, 45 percent have a stand-alone prescription drug plan.
Montana’s state-based health reform legislation
Here’s a summary of recent state-level bills related to health reform: