If you’re wondering how repealing the Affordable Care Act will impact Montana, Indian country is a good place to look.
To Native healthcare leaders, Obamacare provides a great opportunity to create jobs.
Here at Blackfeet Community Hospital in Browning, they’re hiring billers and coders. Those are the back-office people that keep track of every appointment, test and procedure; and then generate bills and process insurance claims.
Blackfeet Tribal Member Gerald Murray, who has two kids in college to support, started making a living last year doing just that:
"Whatever's not paid, I go through and make sure it's all paid."
Murray learned billing skills through a new curriculum that Blackfeet Community College started to meet growing demand for workers in healthcare administration. He had a job lined up before he even finished school:
"I got a contract before I graduated in April, and then the day of graduation in May it became permanent, so I applied for it," Murray says.
A lot more of these kinds of jobs are becoming available in Indian country now, because as more Native Americans get coverage, the Indian Health Service and tribal health facilities are getting access to a whole new revenue stream. They have a lot more opportunities to bill private insurance companies now that subsidies through Healthcare.gov are making insurance affordable for lower income people.
"Yeah, I'm a revenue enhancement manager, so yeah, it really excites me [laughs]," says Fonda Redfox, who works for the tribally-run Southern Piegan Health Center.
Another big new source of revenue for Redfox’s clinic is the Affordable Care Act’s expansion of Medicaid, which Montana signed onto in 2015. Since then, an estimated 8,000 Montana Native Americans have enrolled in Medicaid, including about 1,100 members of the Blackfeet tribe.
"It's really exciting knowing that so many people are getting on Medicaid to receive services," Redfox says.
An estimated 40 percent of Montana’s Native Americans were uninsured before Obamacare. That was about twice the rate of Montanans in general at the time. The statewide uninsured rate has now dropped to a little over 7 percent.
The Indian Health Service has long been available to any Native Americans in Montana, but it’s not insurance, and it routinely denies people healthcare for any condition that’s not immediately threatening their life or a limb.
So, to people like Mary Lynn Billy-Old Coyote, Obamacare changed the game completely:
"Now you’ve got an opportunity for American Indian people to truly have access to private insurance. You have access to greater networks of providers and specialists, and all the things we generally don’t see you have access to."
Billy-Old Coyote is Montana’s American Indian health director.
"To me, there’s not only opportunity there for healthcare, but there's opportunity to build your entire community, to build jobs," says Billy-Old Coyote.
Back here At Blackfeet Community College, there are training programs for hands-on healthcare work, too. In this class, 23-year-old Leroy Bearmedicine, is working toward certification as an emergency medical technician.
He’s from Missoula, but moved to Browning to take advantage of his tribe’s college courses:
"I'd like to become a registered nurse at some point, maybe even work my way up to flight nurse … something to get the adrenaline going," Bearmedicine says.
Before the election, economists at the University of Montana were expecting the demand for healthcare workers in the state to grow strongly – they projected that Montana would need 7,000 new nurses, doctors and other professionals to take care of both the newly-insured, as well as the state’s rapidly aging population.
The demand for health care will likely remain. What’s unknown at this point, is how many of the people who need it will still have health insurance if Congress and the Trump administration make good on their promise to repeal the Affordable Care Act. The more people with coverage, the more health care jobs Montana will have going forward.