- Associated Press - Friday, July 29, 2016

Bozeman Daily Chronicle, July 26, on state lawmakers’ suit against Gov. Steve Bullock:

Three Republican Montana lawmakers, including two local ones, have filed a lawsuit in Gallatin County District Court to force Gov. Steve Bullock’s administration to turn over the income information on some 44,000 households.

What’s wrong with this picture?

Let’s just start with this: Any time you have one branch of state government suing another with the third branch presiding over the dispute, you have an intragovernmental train wreck. Who is going to pay for all of these people on the state payroll to defend a lawsuit brought by state legislators?

Yup. You, the taxpayer.



The three lawmakers, represented by a lawyer who also happens to be a local Republican state representative, want the household income data for people who have enrolled in Medicaid as a result of expanded eligibility requirements made possible by Obamacare.

Bozeman State Reps. Tom Burnett and Art Wittich, and Billings Sen. Roger Webb, along with their attorney, Bozeman Rep. Matthew Monforton, seem to think it’s scandalous that people are signing up for the expanded Medicaid at a rate faster than expected. Initially it was estimated that some 70,000 Montanans would become eligible under the expansion but that perhaps only 25,000 or so would sign up. But so far, 44,114 people have done so.

And, as a result, The Associated Press reported recently that the rate of Montanans without health insurance has plummeted by half from 15 percent to 7.4 percent in just the last year - in part because of the Medicaid expansion. That’s great news. That’s tens of thousands of people who won’t be relying on the wildly inflated costs of emergency rooms for their primary care - costs that won’t have to be picked up by the rest of us when the bills largely go unpaid.

And the Medicaid expansion is 100 percent paid for by the federal government for the first three years and 90 percent paid for after that until 2022. Some states have reported they are coming out ahead on the expansion.

The state Department of Health and Human Services has indicated the agency is working on providing the lawmakers with what they want. But it takes time to black out names, Social Security numbers and other private information from 44,000 records. The agency should continue that effort with haste.

While these are elected lawmakers and should be able to access public information - whatever their motives - continued patience, rather than filing a lawsuit, would have better served the taxpayers.

Editorial: https://bit.ly/2arOkCk

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The Billings Gazette, July 27, on the cost of Montana health care:

While the number of Montanans with health care coverage has grown by 119,000 in the past four years, so have efforts to slow the growth of health care costs.

The Montana state health plan is part of the cost-control campaign.

Early last year, the state health plan was projected to run $12 million short. In fact, the plan covered its costs and was able to add more than $2 million to its reserves for a total turnaround of nearly $15 million, according to the Department of Administration. The department says that was accomplished by:

-Negotiating an 18 percent reduction in administration fees for its employee primary care clinics while promoting use of the clinics to state workers.

-Contracting with Allegiance in Missoula to administer its health plan, saving 24 percent in administrative fees over its previous contract.

-Transferring data services to an internal IT warehouse and increasing contract efficiencies.

‘Transparent Pricing’

Earlier this month, Gov. Steve Bullock and Sheila Hogan, director of the Department of Administration, came to Billings to announce “a new way of reimbursing hospitals for services.” It’s an effort to reduce the disparity in prices the state employee plan pays for hospital services, which Bullock and Hogan predicted will save $25 million over the next two years.

According to Bullock, charges for services have varied by an average of 271 percent between Montana hospitals caring for 33,000 Montanans in the plan - state employees, lawmakers, other elected officials and their families. Bullock cited an example of knee replacement surgery costing $25,000 at one Montana hospital and $100,000 at another.

The new hospital pricing contracts will promote “comparability and cost fairness,” Bullock said.

As previously reported by The Gazette, the state plan spent $185 million last year on employee health care with 48 percent of that going to Montana hospitals.

The new plan is expected to reduce cost variance from 271 percent to about 57 percent this year and about 25 percent next year. “Transparent Pricing” involves rates negotiated with each hospital based on a multiple of what Medicare would have paid the hospital for that service. All these negotiated rates are still more than double what Medicare pays.

Montana’s 10 largest hospitals account for 90 percent of the money the state plan spends on hospital care. Billings Clinic, St. Vincent Healthcare and all the other largest hospitals, except for Benefis in Great Falls, had agreed to participate as of July 8. A majority of the state’s 58 critical access hospitals also had signed on, Hogan said. If a state plan participant’s closest hospital decides not to join Transparent Pricing, the plan will pay the patient’s costs of traveling to a hospital in the plan.

As Dr. Heidi Duncan of Billings Clinic said at the governor’s press conference, hospitals can’t control all their cost drivers. She noted that Billings Clinic has been working hard for eight years to reduce costs and hold down price increases.

Promote quality care

As the largest employer in Montana, the state can and should be a leader in controlling costs, but it must act in a way that promotes excellent care, not “cheap” care. Hospital costs don’t go down, just because a big customer pays less. On the other hand, wide price disparities don’t necessarily reflect differences in actual costs of care.

The pricing of hospital services in America is an arcane and largely unfathomable realm. If the state of Montana can bring a greater measure of transparency and fairness to these prices, all the state’s residents will benefit.

Health care cost control won’t be achieved with just a few changes. The state’s efforts must be ongoing and updated to promote quality as medical needs, knowledge and treatments change.

Editorial: https://bit.ly/2ayqpUb

___

The Independent Record on improving Montana’s forests:

Until it has the full support of Montana’s congressional delegation, the forestry solutions proposed for an area along the Bob Marshall Wilderness Complex probably won’t get much attention from Congress members in other parts of the country.

That’s why it’s so important for Republican Sen. Steve Daines and Rep. Ryan Zinke to join Democratic Sen. Jon Tester in backing the Blackfoot Clearwater Stewardship Project 100 percent.

The grassroots project, which has been in the works for the last 10 years, includes three primary components: Conservation, recreation and restoration.

The conservation portion of the plan includes the designation of about 83,000 acres of official wilderness. All of the wilderness proposed by the project is already managed as wilderness per a 1986 forest plan, so there would be no change to the way these areas are used if the Blackfoot Clearwater Stewardship Project becomes a reality.

The recreation portion would allow snowmobilers to use about 2,000 acres adjacent to the wilderness and ask the Forest Service to conduct a recreation study in the area. Motorized use is currently prohibited in the proposed recreation area, which is also managed as wilderness under the 1986 plan.

The restoration portion of the project includes noxious weed treatment, stream restoration and the removal of fire fuels through commercial thinning in areas adjacent to the proposed wilderness. These efforts not only improve the health of the forest, but also support the timber industry and create jobs for those who make their livelihood from it, which brings money into Montana’s economy.

In our view, the Blackfoot Clearwater Stewardship Project is a win-win-win that offers something for everyone. But the trick will be getting it through Congress.

Tester included the entire package in his Forest Jobs and Recreation Act in 2008, but the bill never made it to a full Senate floor vote. Daines and Zinke have shown some interest in the plan, but it’s going to take a lot more than that to make this happen.

Both Republican members of Montana’s delegation have said they want to focus on improving the health of all forests. We wholeheartedly support them as they work toward this critically important goal - and we believe the Blackfoot Clearwater Stewardship Project would be a good place for them to start.

The plan is not something to put aside until a holistic forestry management solution is found, but a good first step toward bringing that to fruition.

And we hope all three members of our state’s congressional delegation will work together to make that point to their colleagues on Capitol Hill.

Editorial: https://bit.ly/2ag13Z6

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