This week on HealthConnections, Dr. Carole Myers, a professor emeritus in the University of Tennessee College of Nursing, speaks with Montana State Representative Ed Buttrey about the HELP Act implemented in Montana and how that changed the state’s approach to healthcare.
WUOT’s Carole Myers: Medicaid work requirements have been discussed, particularly in association with Medicaid expansion to promote better health outcomes, reduce poverty and manage state expenses. Today, Montana State Representative Ed Buttrey will describe a novel approach that might appeal to Tennessee legislators. What is the genesis of the HELP Act in Montana?
Ed Buttrey: Well, I started the legislature in Montana in 2011 and at that point, the ACA had been passed, and there was a lot of discussion in state legislators as to how to implement it, or even if to implement it in different states across the nation. And coming into the legislature, I saw one side of the aisle, the Democrats basically pushing to pass the ACA as is, just to bring the kind of feds, one size fits all solution into Montana. On the other side of the aisle, the Republicans were saying, make sure that we don't do anything that will kill any efforts to implement anything to do with the ACA. And as a Republican Solutions Caucus member, I was a little bit frustrated that nobody was talking about a solution for Montana to bring the money we were paying into the system back and put it to work. We know that our low income population has the largest need in Montana for both physical and mental healthcare as well as addiction services, and we know that many of our Montana employers were struggling at that point to find and keep a dependable workforce, because ultimately, an unhealthy or addicted worker is not going to contribute to a company's success or even be able to take care of themselves and their families. We decided at that point that we were going to craft a solution that was a partnership between healthcare and economic development. We want to get folks not only healthy and unaddicted, but also provide job training and life skills to help that population succeed financially and ultimately rely less on government social services.
Let's talk a little bit more about the basic features of the HELP Act. What does it look like?
It's a partnership between providing healthcare services, whether they're mental or physical healthcare, providing addiction services, but also identifying barriers to employment or better employment, and utilizing existing state resources to provide aid for folks, to get them into the workplace market, to help our Montana businesses to ultimately become financially successful and to be able to provide more for themselves and rely less on government services.
What are some of the key learnings from your experience and results related to the HELP Act?
Some of the more surprising results were we actually created a budget savings so we're able to give a good return to our taxpayers, because we knew that what the cost of the program would be, but we really needed to measure what the revenues and results were, and we've now got 10 years worth of data showing what's meant for Montana. Not only do we have budget savings for our taxpayers, but we've seen zero closure of our Montana rural hospitals. We've experienced a 30% decrease in our uninsured population. We've had our uncompensated care at hospitals cut more than one half, which means we're not shifting the cost of that care to other payers. We've experienced a reduction in incarceration with this population, which further helps our budget savings, and we've saved Montana businesses the cost of insuring workers to the tune of billions of dollars, and we've helped provide those businesses with a secure and dependable workforce. Another great result was that through our economic development program, we've shown that the membership in our expansion program of those folks, 72% of them work, 6% are in school, 7% are care taking, and there are some about 10% that are ill or disabled and unable to work, but 95% of the folks in our program are contributing back to society, and that's a big deal. And we've shown that the time that a member is on the program before they come off because they've secured their own insurance or gone on the exchange is actually about 22 months. So this adage that people get on the program and never get off simply isn't true in Montana.
What is the future of the HELP Act?
We do have a sunset on our Medicaid expansion plan, so we are going to be addressing this in the upcoming legislative session starting in January.
This transcript has been lightly edited for content.