Community Medical Center CEO Dean French is watching the drama unfold in Washington as President Donald Trump has taken it upon himself to undo the infrastructure of the Affordable Care Act, known as Obamacare.

One of the methods he is using is to bring an end to what are called Cost-Sharing Reduction payments. French says what will likely happen in small markets like Missoula is a lack of access to healthcare for the most vulnerable patients.

“The effect on the hospitals is we’re going to have fewer patients actually having insurance,” French said. “That means they will have less access to primary care services to keep them well, and they will probably end up having to come to the hospital when they’re very ill, most likely to the emergency room. Anything that reduces access because there’s no funding is a concern.”

The issue of insurance companies offering policies across state lines is also of concern to French.

“We have a history of having done this before,” he said. “Back in 1983 we had the ability to have insurance across state lines, but there wasn’t anybody minding the ship in terms of what those insurance products were. The best example I could give is that your insurance plan in Montana through Allegiance, Blue Cross or Pacific Source, they all have an in-network agreement with the air ambulance service, so if you get into a car wreck and have to be transported, it’s a covered service, after your co-pay. With the out-of-state companies, there’s no state insurance commissioner to monitor, so you may have a company that says ‘Hey, we’ll pay up to $50 for your air ambulance service", and you think the ride will only cost $50, but we all know that can cost thousands of dollars.”

French offered his advice to people who visit the doctor more often than others, is to make their views known at the next election.

“The best protection, unfortunately, might have to be through the ballot box,” he said. “The trend is to back to individual risk pooling rather than a more collective pooling. The thought process that’s driving all this is that it’s fundamentally unfair if you’re a healthy young person to have to pay higher premiums because you’re in a pool with older or unhealthy Americans or people that require a higher level of medical services. The avenue that’s been opened by the executive orders is a pathway for people to access health insurance based on their individual risk.”

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