Daines, Sheehy Tight-Lipped on Proposed Medicaid, Marketplace Cuts
As the GOP megabill nears a floor vote, Montana’s senators have ducked questions about how coverage losses could affect constituents
By Mara Silvers, Montana Free Press
When Ron Wiens looks at his hospital’s budget, he doesn’t see much flexibility.
Wiens is the top administrator at Big Sandy Medical Center, a 25-bed critical access hospital about an hour northeast of Great Falls. Many of the hospital’s beds are filled by Medicaid-eligible seniors who need long-term care.
The Medicaid application for one of those patients, he said, has been in limbo for almost three months. That delay stalls the hospital’s Medicaid reimbursement, putting the cost of patient care squarely on Wiens’ bottom line.
Budget strains for Montana hospitals could become more common if the One Big Beautiful Bill Act backed by President Donald Trump becomes law. Tucked inside the roughly 1,000-page reconciliation bill bowling through Congress is a provision to increase Medicaid eligibility reviews to every six months rather than once a year.
“That’s going to be the big bottleneck right there,” Wiens said.
He acknowledged that the health care provisions in the budget bill could be worse for hospitals like his. He’s grateful that Montana isn’t one of the states poised to see a reduction in the percentage of Medicaid costs the federal government covers — typically between 65% and 90% — a prospect that could wreak havoc on the state budget.
But Wiens and other health care providers are wary about how many Montanans will be ensnared in the red tape of new work requirements and tougher eligibility standards. If those restrictions result in the removal of people from Medicaid’s rolls, Wiens expects many of them will keep showing up at his hospital’s doors uninsured.
“It moves a lot of people off of Medicaid and basically into bad debt for us, because they can’t afford their care,” Wiens said. With every uninsured patient the hospital cares for, Wiens’ budget gets a little tighter.
Health policy analysts have estimated that 31,000 Montanans, mostly low-income adults, could lose Medicaid coverage if the congressional budget bill goes into effect as originally drafted by the House of Representatives. Any degree of coverage loss would mean less state and federal reimbursement funds flowing to health care providers. A June review by the National Rural Health Association found that 62% of Montana’s coverage losses would be among rural residents, a higher percentage than any other state.
Members of the U.S. Senate have been deliberating over the One Big Beautiful Bill Act since early June. Since June 9, staff for Montana’s Senators Steve Daines and Tim Sheehy, both Republicans, have not responded to multiple interview requests from Montana Free Press about the legislation’s proposed health care cuts and how those provisions would impact their Montana constituents.
Since he was first elected to Congress in 2012, Daines has voted against the Affordable Care Act and Medicaid expansion on multiple occasions. However, in a June 17 Fox News segment about the health care provisions in the reconciliation bill, Daines posited that reforms proposed by Republicans were intended to “save” the program.
“This is one of the fastest-growing entitlements currently in federal spending. It’s designed to protect those who are most vulnerable. It’s an important safety net, but we’ve got to reform Medicaid if we’re going to save Medicaid,” Daines told host Will Cain. “We’ve got to take able-bodied males who are laying on the couches at home and get them back to work and off of Medicaid … The reforms we have made, we think, are reasonable.”
Hospital administrators from Montana have made multiple trips to D.C. to lobby the state’s delegation on the bill’s potential impacts. Some said they’ve heard Daines and others express support and care about rural health care providers, while maintaining that the federal government needs to curb national spending on Medicaid and other social safety net programs.
“Basically, Senator Daines had this chart that he was showing us that had this skyrocketing cost curve that was from since the pandemic,” recalled Nick Dirkes, the CEO at Frances Mahon Deaconess Hospital in Glasgow. “They were wanting to be kind for the hospitals back home, but also feeling that they had this undeniable need to control spending.”
The cuts would reduce Medicaid spending by as much as $880 billion nationwide. Congressional budget analysts have predicted that those and other provisions would lead to 10.9 million Americans losing health coverage.
The Medicaid cuts are just one part of the GOP strategy for offsetting other aspects of the reconciliation bill. Among other priorities of the Trump administration, the legislation includes the multitrillion-dollar cost of extending tax cuts originally passed under the Trump administration in 2017. The bill also includes billions of dollars in cuts to spending on SNAP, the Supplemental Nutrition Assistance Program, which helps low-income people buy food each month, and reductions for subsidies for health care plans sold through the Affordable Care Act marketplace.
Republicans have been negotiating over methods for winnowing down safety net programs to help pay for tax cuts, some of which are geared toward businesses and higher-income earners who Republicans say will help drive economic development and job growth. Some senators, including Josh Hawley, R-Missouri, have pushed for easing up on Medicaid cuts to try to protect eligible residents from losing coverage through administrative pitfalls. Others, including Senator Susan Collins of Maine and Senator Thom Tillis of North Carolina, both Republicans, have dug in their heels about the provisions they say would hurt rural hospitals.
On Thursday, the Senate parliamentarian advised that several parts of the bill were not compatible with the chamber’s rules for bills that can be passed with a simple majority vote. One of the strategies the parliamentarian ruled against would have restricted provider taxes — a method most states use to maximize reimbursements from the federal government. Without that cost-cutting device in place, and with several other provisions found to fail the Senate’s rules, the bill would require substantial revisions.
Spokespeople for Daines and Sheehy did not respond Thursday to requests for comment about the bill’s next steps. But in a June 26 interview with CBS, Sheehy said the Senate is still aiming to advance the bill in the coming days.
Sheehy emphasized how the legislation will create stability for the business community through extending tax cuts and other provisions to spur research and development. Asked about the bill’s projected impact on rural hospitals, Sheehy endorsed other types of federal health care investments, including reforms to the Veterans Administration, but doubled down on the GOP’s approach to Medicaid reforms in the current bill.
“Let’s not forget also that the Medicaid, Medicare reforms that are primarily being drafted across the Republican conference in no way, in no way, are focused on taking care away from anyone who has earned it, who deserves it, who needs it,” Sheehy told “The Takeout” host Scott MacFarlane. “There’s been a tremendous amount of fraud, waste and abuse. These different types of policies would help get that under control and make sure we’re protecting Medicare and Medicaid for those who truly need it.”
Bob Olsen, the outgoing CEO of the Montana Hospital Association, said the organization has not overtly lobbied Montana’s congressional delegation to vote against the bill because it doesn’t appear to pose an existential threat to Montana’s health care landscape, unlike other states. Montana, for example, relies on provider taxes less than some states’ programs, and doesn’t use state-directed payments to increase rates for services.
But Olsen said that Montana could see dramatic impacts if the state health department rolls out work requirements and other eligibility checks in a way that removes qualified recipients from the rolls — similar to what happened in Arkansas under that state’s experiment with work policies.
“I don’t believe they want to see anybody who’s truly eligible for the program under these requirements to lose their coverage,” Olsen said, summarizing his takeaways from conversations with Daines and Sheehy. “They’re sympathetic to our message. I just don’t think there’s a way to go ahead and legislate these things into place.”
Olsen said the hospital association has not yet appealed to Daines and Sheehy about the proposed changes to federal marketplace plans, such as shortening application windows and eligibility for tax credits that reduce premiums. Those changes, he said, “are not anything to do with waste, fraud or abuse,” but rather “just flat bureaucratic changes to ice people out.”
Olsen said many Montana health care providers are waiting to see how the legislation evolves during ongoing negotiations. As it currently stands, Olsen said, Montana might dodge some of the biggest impacts other states stand to experience. But, he added, the legislation is a far cry from what Congress could do to improve health access and services for Montanans.
“If you come back to the big problem with this — there’s nothing in this bill that improves health coverage, that improves health quality, that rules in or contains cost, or provides better access,” Olsen said. “This bill does essentially the opposite of all of those things.”
Of course they're tight-lipped. They're ashamed of a horrible bill they don't have the spine to oppose. Instead, they'd rather let millions of Americans suffer.