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The Healthy Montana Act – House Bill 249, which aims to expand Medicaid in the state — has been introduced in the legislature and is worthy of citizen support. This act is important because Montana has a significant gap in access to health care for all citizens. The gap impacts 70,000 Montanans who have no health coverage. These are people living below 138 percent of the federal poverty line, not eligible for a subsidy yet earning too little to afford coverage through the exchange. This number includes 9,500 veterans and their families, 15,000 seniors and 20,000 American Indians. Nearly two-thirds are working people who cannot afford health care and are not covered by their employer.

The loss of revenue to our state is enormous. Each day the state loses $1.84 million in revenue. Expansion would bring $5.4 billion federal dollars back into Montana between July 2015-2021. This can result in 12,000 new, much-needed jobs, mostly in the health care field, and generate $138 million in labor productivity. The net result would be increased tax revenues due to increased employment, and sharp decreases in the cost of un-compensated care, which will benefit all our communities. Doctors, nurse practitioners and hospitals treat thousands of low-income people who can’t pay for their care. Uncompensated care costs providers as well as our local communities millions of dollars. In fact, many small rural hospitals in Montana are already at risk of closing due to the cost of uncompensated care.

The real issue, however, is the health care gap that exists for people who are unable to seek treatment for acute or chronic illnesses, or receive preventive health care which is vital to keeping health care costs down. When hard-working low- and middle-income citizens in the state delay or avoid health care due to lack of coverage, it results in serious and more complicated health problems that lead eventually to more expensive care.

Uncompensated health care, including nutrition therapy, results from countless physical and mental illnesses. Diseases such as diabetes, cancer, Crohn’s disease, chronic kidney disease, heart disease and uncontrolled obesity are just a small sampling of illnesses that deserve intervention. The need is greater among low-income seniors who are dealing with chronic disease, or are unable to eat well due to complications of their illness or a limited food budget. These seniors are at great risk of malnutrition, leading to long hospitalizations that the health care facility has to pay and that ultimately impacts the community.

Just two examples of the 70,000 Montanans who would be eligible for coverage include Mike (name has been changed), a 53-year-old heavy equipment operator, smoker and moderate drinker who developed a throat problem which he ignored until the situation worsened. After seeing two physicians, he was diagnosed with Stage IV cancer of the esophagus. Radiation and chemotherapy were given and this 6-feet-3-inch man now weighs 122 pounds. He is surviving on donated nutrition formulas through a feeding tube.

Also Mary (name has also been changed), a 61-year-old lady with hypertension and elevated blood lipids secondary to obesity, was in increasingly poor health. Due to lack of health insurance, she did not seek nutrition therapy, which could have addressed her problems earlier. She now has a stage of congestive heart failure that shows serious blood flow deficiencies in the heart. She is currently receiving home care services and faced with a much worsened health status. In both cases, bills are mounting to the providers, and eventually the community bears the cost.

The Healthy Montana Act would provide coverage for these and many other Montanans, likely preventing many health issues before they grow out of control. In addition, Medicaid expansion would cover treatment for mental illness – a widely unrecognized health problem in our state with one of the highest suicide rates in the country.

The Montana Academy of Nutrition and Dietetics joins the many health care organizations throughout the state in strongly supporting for HB 249 to expand Medicaid in Montana.

We urge all readers to contact members of the House Health and Human Services Committee to voice your strong support of the Healthy Montana Act – HB 249. It is very simple to do. Send an email to, or call 406-444-4800. 

Minkie Medora and Katie Bark are registered dietitians and members of the Montana Academy of Nutrition and Dietetics.

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