Medicaid Expansion Has Saved Lives and Rural Hospitals in Montana

The evidence is in: the Medicaid expansion championed by Governor Bullock and Montana Democrats in the Legislature has not only saved lives, but it has saved rural hospitals in our state.

Lives first. Research by the National Bureau of Economic Research shows that over 15,000 died unnecessarily between 2014-17 because their states refused to accept Medicaid expansion. Mother Jones reports on the study:

“Since there are about 3.7 million individuals who meet our sample criteria living in expansion states, our results indicate that approximately 4,800 fewer deaths occurred per year among this population, or roughly 19,200 fewer deaths over the first four years alone,” the researchers wrote. “Or, put differently, as there are approximately 3 million individuals meeting this sample criteria in non-expansion states, failure to expand in these states likely resulted in 15,600 additional deaths over this four year period that could have been avoided if the states had opted to expand coverage.”

And now to the hospitals.

New reporting from Gatehouse News shows that rural hospitals across the country are in crisis and that those in states that rejected Medicaid expansion are much more likely to close:

  • Rural America is in the midst of a deep and prolonged crisis that resulted in 106 hospital closures since 2010. Nearly 700 more are on shaky ground, and nearly 200 are on the verge of collapse right now, according to reports from Massachusetts consulting firm iVantage Health Analytics and the Sheps Center for Health Services Research at the University of North Carolina in Chapel Hill.
  • Hospitals faring the worst are mainly in states that refused to expand Medicaid.  Those states account for 77 of the 106 closures over the past decade. They also are home to a greater percentage of money losing facilities and lower collective profit margins.

Kansas illustrates the crisis Montana could have faced if Republicans got their way. The report notes that between 2011 and 2017, two out of three rural hospitals there lost money and five were forced to close.

And anyone who has lived in a rural area understands just how devastating it would be for a community to lose its hospital:

“A hospital closure is a frightening thing for a small town,” said Patti Davis, president of the Oklahoma Hospital Association. “It places lives in jeopardy and has a domino effect on the community. Health care professionals leave, pharmacies can’t stay open, nursing homes have to close and residents are forced to rely on ambulances to take them to the next closest facility in their most vulnerable hours.”

While Montana Republicans bray about socialism and argue they are defending “Montana values,” Montana Democrats–joined by a few sensible and courageous Republicans in the Legislature–fought to save lives and the rural hospitals that are vital economic and health drivers in their communities.

That’s not just good policy; it’s a moral imperative and Democrats should be proud of their efforts to fight for our communities.

If you appreciate an independent voice holding Montana politicians accountable and informing voters, and you can throw a few dollars a month our way, we would certainly appreciate it.

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About the author

Don Pogreba

Don Pogreba has been writing about Montana politics since 2005 and teaching high school English since 2000. He's a former debate coach, and loyal, if often sad, fan of the San Diego Padres and Portland Timbers. He spends far too many hours of his life working at school and on his small business, Big Sky Debate.
His work has appeared in Politico and Rewire.
In the past few years, travel has become a priority, whether it's a road trip to some little town in Montana or a museum of culture in Ísafjörður, Iceland.


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  • The comparison with Kansas is a little misleading. I lived in that state for almost a quarter of a century and I will return there in a few years. My step-daughter works in public health for the State of Kansas and we have discussed the hospital closure issue several times. As she always reminds me, Kansas has 105 counties. On my last visit there, I noticed a closed hospital in a small town, which is sad, but the next nearest hospital is only about half an hour away. Not defending them–I’m truly disappointed and disgusted that they haven’t passed Medicaid expansion. And I feel sorry for the towns losing hospitals–and jobs. Just know that the numbers of hospitals there reflect a somewhat different (geographical) reality than we have in Montana.

  • Good job Dems, Bullock signed the bill that passed sponsored by Republican Rep. Ed Buttrey and Democratic Rep. Mary Caferro, who sponsored a separate bill did not pass. Results matter even if Dems try to mislead voters. Just like Tester claimed getting the Butte Veterans home funded though Danes bill changed the funding priorities so the home got funded. 8 years of Obama and Tester and what did the veterans get?

    • Bill,

      There are a million places where you can lie online, but this isn’t one of them. While Buttrey did write the bill that passed, anyone who can read a roll call vote knows that ME only passed because of Democrats.

      And it’s 100% not true that Daines secured the funding for the Butte Veterans home. That was absolutely done by Jon Tester and you know it.

      • ME passed because Buttrey could write a bill for bipartisan passage.

        Tester or Johnny Isakson and Trump funding support of veterans.

        • Bill, it is obvious that you weren’t paying attention when all of the back and forth over the medicaid expansion bills was taking place.
          And Daines always tries to take credit for things that Tester initiated – like the Butte Veterans’ Home. Trump support of veterans is a joke. He tries to pretend that he is the one who got the Choice Program for Vets – it was signed in 2014! And it was authored by Tester.

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