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At the Libby Cemetery on Tuesday, Marilyn Tavenner, left, administrator of the Centers for Medicare and Medicaid Services, and U.S. Sen. Max Baucus, right, listen as Gayla Benefield of Libby talks about the town's asbestos victims.

LIBBY – Marilyn Tavenner has a picture of Lester Skramstad on her desk in Washington, D.C., even though she’s never met him – not in this life, anyway – and never will.

She came as close as she could Wednesday morning.

Tavenner, barely four months into her tenure as the nation’s top administrator for an $820 billion federal agency, the Centers for Medicare and Medicaid Services, stood at Skramstad’s grave in the Libby Cemetery on a beautiful August morning with U.S. Sen. Max Baucus, D-Mont.

Skramstad is one of an estimated 3,000 victims of asbestos-related illnesses stemming from a vermiculite mine once operated in Libby by W.R. Grace & Co. – and one of more than 400 who have died because of it.

“Max wanted her to meet his friend Les,” said Gayla Benefield, one of Libby’s many asbestos victims, who organized the cemetery portion of Tavenner’s visit. Benefield’s father, Perley Vatland, worked in the mine for 19 years, was diagnosed in 1971 and died in 1974.

Like Skramstad, who died in 2007, Vertland unknowingly dragged the deadly dust home from work with him – as did many of the miners – and infected his family.

Baucus met Skramstad over huckleberry pie and coffee in Benefield’s home in 2000, where about 20 local people “described the awful legacy of W.R. Grace,” according to Baucus’ office. The senator calls his meeting Skramstad a pivotal moment in his decision to champion the cause of Libby victims in the years since.

***

It was Baucus who gave Tavenner the picture of Skramstad in May, Baucus who grilled Tavenner about Medicare holding up other victims’ settlement payments during her confirmation hearings that same month, and Baucus who engineered her first-ever trip to Montana.

“The first time I met Senator Baucus, (Libby) was one of the first things we discussed,” Tavenner said.

Montana’s senior senator, who will not seek a seventh term in 2014, has hauled everyone from White House Cabinet secretaries to the head of the Environmental Protection Agency to Libby so they could see firsthand what happened to this town.

“The U.S. government is so big that things get lost in the shuffle, things get high-centered,” Baucus, chairman of the Senate Committee on Finance, said later at lunch at the Libby Café. “You have to focus on it relentlessly. Libby is a small part of our state, a small part of our country, but it’s a big, big need.

“You have to keep your eye on the ball, keep bugging people about health care, about getting people screened, about getting this cleaned up. These people deserve justice.”

Libby asbestos victims receive health care coverage under Medicare due to a provision Baucus wrote in the Affordable Care Act.

One of Baucus’ goals with Tavenner’s visit is to convince her to expand additional Medicare benefits to victims who have moved out of the area. The pilot program pays for expenses Medicare normally denies, but only victims living in Lincoln and Flathead counties currently qualify.

Libby asbestos victims who no longer live in either county can’t receive the special home care services, special medical equipment, help with travel to get care, special counseling, nutritional supplements and prescription drugs not covered by Medicare drug plans.

The Centers for Medicare and Medicaid Services has the authority to change that.

***

Tavenner indicated the change would come, and within months, not years.

“Certainly before the end of the year,” she said. “I have a feeling the chairman will make sure I do.”

After hearing from Benefield and other asbestos victims and survivors of victims at the cemetery, Tavenner visited the Centers for Asbestos Related Disease Clinic in Libby.

“I’ve heard from the families, now I want to hear the clinical side,” said Tavenner, a nurse by training. “I want to get their feedback. Are they getting what they need?”

Baucus was pleased that a backlog in CMS cases that had held up settlement payments from W.R. Grace for victims has largely vanished in the four months since Tavenner took over.

Medicare had to collect its qualifying expenses from the settlements before victims could be paid.

“What’s tragic is some folks died before they got their payments,” Baucus said, “but the backlog is almost down to zero.”

***

In addition to learning about asbestos-related issues, Tavenner used her day in Libby to visit the Lincoln County Community Health Center and find out how implementation of the Affordable Care Act – better known as “Obamacare” – is working for a rural clinic.

“It’s important for folks in Washington to get out from behind their desks and see what’s working, and what isn’t, on the ground in places like rural Montana,” said Baucus, a primary architect of the legislation.

Montana has 17 community health centers that served 99,000 patients last year, almost half of whom did not have health insurance. The Libby center served 6,000 patients in 2012 according to Baucus’ office, or more than 30 percent of Lincoln County’s total population.

But for many people in this county, of course, health care revolves around asbestos-related disease. Lester Skramstad, Benefield said, spent only two years working in the mine in the 1950s.

In the years after Skramstad was diagnosed, his wife and four of his five children were, too.

Brent Skramstad is buried behind his father’s grave in the Libby Cemetery. He died of asbestos-related disease in 2009, at the age of 51.

When she helped put up white crosses in the cemetery in 2005 to mark the graves of all the people who died because of the vermiculite, Benefield said 265 were needed.

“Now it’d take more than 400,” she said. “My parents’ generation have all died, now we have ones in their 20s coming through and being diagnosed. That’s my grandchildren’s generation – that’s four generations.”

Libby CARD Clinic officials report approximately 40 new cases of asbestos-related disease per month.

That’s why Baucus said he keeps Skramstad’s picture in his office, and gives the same picture to high-ranking federal officials such as Tavenner.

“It reminds me of Libby,” he said, “and it reminds me why we have these jobs.”

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Reporter Vince Devlin can be reached at 1-800-366-7186 or by email at vdevlin@missoulian.com.

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