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Impact of the Affordable Care Act in Montana

Thousands of Montanans have gained coverage, and hundreds of thousands more have had their coverage substantially improved

Today, the U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years. The data show that the uninsured rate in Montana has fallen by 33 percent since the Affordable Care Act (ACA) was enacted in 2010, translating into 58,000 Montanans gaining coverage. And, in addition to residents who would otherwise be uninsured, hundreds of thousands more Montanans with employer, Medicaid, individual market, or Medicare coverage have also benefited from new protections as a result of the law.

“As our nation debates changes to the health care system, it’s important to take stock of where we are today compared to where we were before the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Whether Montanans get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.”

Highlights of today’s data release include:

Employer Coverage: 510,000 people in Montana are covered through employer-sponsored health plans. Since the ACA was enacted in 2010, this group has seen:

  • An end to annual and lifetime limits: Before the ACA, 319,000 Montanans with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all Montanans with employer plans now have coverage that’s there when they need it.
  • Young adults covered until age 26: An estimated 7,000 young adults in Montana have benefited from the ACA provision that allows kids to stay on their parents’ health insurance up to age 26.
  • Free preventive care: Under the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers. This provision benefits 401,717 people in Montana, most of whom have employer coverage.
  • Slower premium growth: Nationally, average family premiums for employer coverage grew 5 percent per year 2010-2016, compared with 8 percent over the previous decade. Family premiums are $3,600 lower today than if growth had matched the pre-ACA decade.
  • Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. Montanans with employer coverage have received $148,722 in insurance refunds since 2012.

Medicaid: 224,048 people in Montana are covered by Medicaid or the Children’s Health Insurance Program, including 120,626 children and 15,939 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.

  • 32,000 Montanans have gained coverage through Medicaid: An estimated 32,000 Montanans have health insurance today because Montana expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health, resulting in an estimated 4,000 more Montanans getting all needed care, 4,600 fewer Montanans struggling to pay medical bills, and 40 avoided deaths each year.
  • Thousands of Montanans with a mental illness or substance use disorder are getting care: Thanks to expansion and improved access to treatment, an estimated 3,000 fewer Montanans are experiencing symptoms of depression.
  • Montana is saving millions in uncompensated care costs: Instead of spending $30 million on uncompensated care, which increases costs for everyone, Montana is getting $140 million in federal support to provide low-income adults with much needed coverage.
  • Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable Montanans could more easily access and maintain coverage.
  • Montana is building on expansion to improve access to care for its American Indian and Alaska Native population: Under the new Medicaid Tribal policy, Montana is able to leverage enhanced federal funding to better serve these populations.

Individual market: 51,758 people in Montana have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:

  • No discrimination based on pre-existing conditions: Up to 426,361 people in Montana have a pre-existing health condition. Before the ACA, these Montanans could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.
  • Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 44,091 moderate- and middle-income Montanans receive tax credits averaging $306 per month to help them get covered through HealthCare.gov.
  • Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of Montana.
  • Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, Montana has received $1 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 21 plans on average.

Medicare: 209,389 people in Montana are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:

  • Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 13,384 Montana seniors are saving $12 million on drugs in 2015, an average of $904 per beneficiary.
  • Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 106,395 Montana seniors, or 65 percent of all Montana seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
  • Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for Montana Medicare beneficiaries dropped 6 percent between 2010 and 2015, which translates into 231 times Montana Medicare beneficiaries avoided an unnecessary return to the hospital in 2015. 
  • More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 4 Accountable Care Organizations (ACOs) in Montana now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.
Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on December 13, 2016
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