美国国家公共电台 NPR Montana Insurers Say Medicaid Cuts Would Drive Up Cost Of Private Health Plans（在线收听）

ROBERT SIEGEL, HOST:

Many of those who support the deep cuts to Medicaid called for in the Republican health care bills say it's simply too expensive. But some health insurers say if Medicaid shrinks, that could lead to higher costs for everyone. Eric Whitney reports from Montana, one of the last states to expand Medicaid under the Affordable Care Act.

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The Republicans who make up two-thirds of Montana's congressional delegation say a big reason they want to repeal the current health care law is because it's causing health insurance markets to, quote, "collapse." But the insurance companies that sell policies here say that's not true in Montana. And they're concerned about GOP repeal and replace plans.

JERRY DWORAK: I don't think that their plan is going to improve health care in the state of Montana.

ERIC WHITNEY, BYLINE: Jerry Dworak is the CEO of Montana Health Co-Op.

DWORAK: I think that just the opposite is going to happen. I really do think a lot of people are going to get hurt.

WHITNEY: The co-op is one of the three insurance companies that's been selling Montanans coverage on healthcare.gov since it started in 2013 with no plans to leave. They say collapse is a real possibility, though, if the deep Medicaid cuts Republican health bills call for actually happen. Todd Lovshin is a vice president at PacificSource insurance. He says Medicaid expansion means Montana hospitals are now getting paid for taking care of more than 70,000 Montanans who got Medicaid in the expansion.

TODD LOVSHIN: All of our hospitals have to take any patient that comes in and serve them. That has to be paid somewhere, right? And if we're not paying that through a Medicaid expansion, those costs have to be borne by someone. And so that will increase the overall cost of medical expenses.

WHITNEY: When hospitals see their unpaid bills stack up, Lovshin says, they'll have to charge patients who have insurance more to stay afloat. John Doran agrees with that analysis. Doran a vice president with Blue Cross and Blue Shield of Montana the state's biggest insurer. Doran says that problems would likely get worse if the individual mandate goes away. That's the requirement to have health insurance the Republican health care bills do away with.

DWORAK: If there's no mandate and there's no incentive for them to buy a health insurance plan, then maybe they won't. And, again, the people who need health care the most and typically have the highest health care costs are the only ones who are in the marketplace. And that results in higher health care costs and consequently higher premiums.

WHITNEY: Montanans have been seeing insurance premiums go up, sometimes by more than 50 percent a year, since healthcare.gov launched in 2013. But the co-op's Jerry Dworak says he thinks prices are now starting to stabilize. And if the health law isn't changed, his company's premiums would only go up 5 percent in 2018. For NPR News, I'm Eric Whitney in Missoula, Mont.

SIEGEL: And that story is part of a reporting partnership of NPR, Montana Public Radio and Kaiser Health News.