Participation in Montana’s federally facilitated exchange might be described as stead. Big Sky Country exchange-based health insurance enrollment increased 7 percent between 2015 and 2016. And, at a time when many carriers are leaving state marketplaces, all three of Montana’s existing exchange carries will sell plans in 2017.
Historically, Montana’s uninsured rates have weakened its performance in public health rankings. That could change as the state embraces Medicaid expansion – in 2016, Medicaid enrollment grew 59 percent – and sees continued enrollment growth through its federally facilitate health insurance exchange.
Will Montana’s attitudes toward providing health coverage and healthcare shift as access improves? This guide takes a look at Montana’s changing health insurance landscape under the Affordable Care Act and its impact on public health.
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. The state’s scoring based on five main dimensions ran the spectrum, from a #5 ranking in the Avoidable Hospital Use & Costs category to 39th place in the Access category. Relatively high uninsured rates among adults (19 percent) and children (9 percent) pulled down the state’s rating. If 85,410 more adults were insured, Montana would improve to the level of the best-performing state.
Take a closer look at Montana’s Scorecard for details on how the rankings are determined.
The most recent edition of America’s Health Rankings (2015) also measured the state’s healthiness and ranked Montana number 23rd of the 50 states—a one-spot slip from 22nd in 2014. 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.
“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 an July 12, 2016, news release.
Medicaid enrollment is available year-round, which means coverage rates continue to fluctuate.
MT health insurance rates, carriers 2017
- Blue Cross Blue Shield of Montana
- Mountain Health Cooperative
BCBSMT enrolls about 55,000 individuals on and off the state’s exchange. However, rate increases for 2017 may encourage people to show around. The state is reviewing proposed hikes, which, as filed, average nearly 50 percent. However, 85 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.
As of March 31, 2016, the Montana exchange’s effectuated enrollment stood at 51,758 – at the end of 2016 open enrollment, enrollment was up 7 percent from 2015. This year, more than 85 percent of Montana enrollees are receiving subsidies that average $306 per 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. Their successor Steve Daines has voted to repeal Obamacare.
At the state level, former Gov. Brian Schweitzer and 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.
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 59 percent from before the ACA to June 2016, from 148,974 to 236,952.
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 August 2016, the majority of ACA CO-OPs had closed or announced plans to do so. As of then, Montana Health CO-OP was among the seven remaining.
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 18 percent of all Montana Medicare recipients have selected a Medicare Advantage plan instead of Original. 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: