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The election in November of Republican majorities in the House and Senate and a Republican president means the Affordable Care Act is likely to be repealed when the new Congress convenes in January.

But many Montanans, despite significant criticism of the law known as Obamacare, wonder what the future of affordable health care will look like for thousands of people in this state if it goes away.

In an effort to understand community perspective, Senator Jon Tester met with some of those Montanans, along with about 25 healthcare professionals from various facilities, at Missoula’s Providence St. Patrick Hospital Saturday afternoon for a Missoula Healthcare Roundtable.

Although Tester, a Democrat, started the discussion with introductions, he quickly turned it over to the participants with a single question: How would a potential partial or full repeal of the ACA impact your community?

For Mineral County, a repeal of the ACA without an immediate similar or better healthcare plan could mean the loss of the county’s only hospital, according to Ron Gleason, CEO of Mineral Community Hospital. The hospital treats everyone in Mineral County, which Gleason said has a large low-income and veteran population, and is operating with a minimum staff.

Gleason said the hospital will be closing its assisted living center in February and a repeal of the ACA would mean a loss of even more funding. If Mineral Community Hospital closed, Gleason said there wouldn’t be another health center for miles, and much of the population would move or be left without care.

“A big problem with Washington, D.C. right now is that they don’t understand where we live,” Gleason said, as much of the room, including Tester, nodded. “They think Buffalo, New York is rural. They don’t understand the distance and the time it takes to get to a hospital here if these smaller facilities go away.”

While Montanans across the state could be affected by a total or partial repeal of the ACA, the most common topic of discussion at Saturday’s roundtable was the impact it could have on rural Montana.

Rural Community Health Centers, which serve more than 100,000 people, could face the loss of 70 percent of their funding. Tester said Lincoln County alone could lose up to $2.5 million a year in asbestos-related disease screening and support.

Ken Burd, a Granite County Hospital board member, said the loss of the ACA would set off a series of unintentional events that would eventually cripple rural America. Rural America, Burd said, depends on blue collar, industrial jobs and recreational outdoor activity, both of which are injury prone. Without affordable emergency care, people will stop working industrial jobs and move away from rural America.

“So this would have larger impacts socially and economically than I think people are looking at now,” Burd said. 

Maria Stoppler, the CEO and director of nursing at the Granite County Medical Center, agreed. When people in rural places can’t afford care, they simply stop treating their chronic illnesses until the issues become emergencies and are more difficult to treat.

Human Resources Director at the Western Montana Mental Health Center Karen Harrison jumped into the conversation, adding that when people who can’t afford health care are injured, they’ll look for other ways to cover the cost. In rural areas, this is usually worker’s compensation. When an area’s rate of workers comp rises, Harrison said, fewer employers choose to locate there and the area’s economy is negatively affected.

Still, Tester said, many people think the ACA doesn’t, and won’t, affect them. Montana’s rate of 7 percent uninsured would surely jump if the ACA was repealed, according to Tester, and nearly 152,000 Montanans with pre-existing conditions would be at risk for losing insurance coverage. In addition, 44,000 would lose tax credits that lower the cost of healthcare.

One community member, who wouldn’t give his name, said he suffered a heart attack last Friday, and without the ACA, he wouldn’t have been able to afford care and probably wouldn’t have survived. Now he’s worried he won’t have insurance if he has another attack.

Still, even with the concern surrounding the loss of the ACA, the group agreed it could be improved.

Mary Jane Nealon, the director of innovation at Partnership Health Center, said the law’s worst area concerns the people of the middle class, whose insurance deductibles are increasing, yet they don’t qualify for Medicaid or Medicare.

“Anybody in healthcare will tell you that the ACA could be better,” Nealon said before the room laughed and nodded. “But we can’t just do away with it.”

Community member Rita Agin said her family is middle class, and since the ACA was passed, her insurance rates have nearly tripled. Agin said she has two kids, and the rising rates are crippling her ability to care for her own family.

“What about me and my family?” Agin asked the group, nearly all of whom nodded with her. “I don’t want to have to be poor to pay for healthcare.”

Tester nodded and said that issue, along with many others, will have to be worked out within the ACA if it isn’t repealed. For now, Tester promised to use these stories and concerns to convince Congress to keep the ACA, simply because of the impact it’s loss would have on the U.S. population as a whole.

“Something that concerns me is that people think if we repeal the ACA, our insurance rates will go down,” Tester said. “That’s not happening. So we need be putting out good information because when people have good information, they make good decisions.” 

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