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Originally published in The Missoula Current.

Saying that a pandemic leaves nothing hidden, local health officials joined Gov. Steve Bullock in Missoula on Thursday to laud the role Medicaid expansion in Montana has played during the COVID-19 outbreak.

The program also has helped bridge the social gaps that often lead to poor health outcomes by enabling public health clinics to address issues around food security and housing, along with other factors that can weigh heavily on good health.

“Health care not only is fundamental to treatment, but our economic livelihoods in Montana,” said Bullock. “The emergence of COVID-19 has further underscored the importance of removing barriers to affordable care. Medicaid coverage really does lead to those improvements in health status.”

When the 2019 Legislature reauthorized Medicaid expansion, no one predicted the COVID-19 pandemic that would sweep the nation one year later. When the pandemic did arrive, resulting in a public health crisis, the program’s importance took on new meaning.

“People living in Medicaid expansion states like Montana may be in a better position to weather this pandemic than those 14 states that didn’t opt to take up expansion,” Bullock said. “Medicaid expansion will cover the cost of COVID-19 related treatments, as well as continuing to pay for routine medical care. Low-income adults in states that didn’t have Medicaid wouldn’t be eligible for that Medicaid coverage should they contract COVID-19.”

Bullock said the pandemic has placed “extraordinary strain” on healthcare systems across the country. Prior to the crisis, roughly 20% of rural hospitals were at risk of closing. Medicaid has helped keep Montana’s rural hospitals open while states that resisted Medicaid expansion have seen rural hospitals and clinics close.

“If you look at most of those states, they are states that didn’t expand Medicaid,” Bullock said. “This pandemic underscores that in times of good how important health care is. But in times of crisis, both public health crisis and economic crisis, it becomes that much more essential.”

Laurie Francis, executive director at Partnership Health Center in Missoula, said Medicaid expansion has reduced the clinic’s uninsured from 50% to 12% in recent years. It also has given the clinic room to address the wider social disparities that lead to poor health outcomes, such as housing and food insecurity, legal representation and other inequities.

The clinic serves 16,000 unique individuals each year and accepts “all comers” regardless of financial standing. Francis said the pandemic has laid bare the social inequities that have lingered for generations.

“Medicaid expansion has allowed us to think about the structural issues that create or thwart health and well being,” Francis said. “People call them the social determinants of health care, but we would call them the political determinants of health care. We work hard at Partnership to treat all people equally to improve their health while moving upstream.”

Before the pandemic hit, Partnership saw upwards of 1,500 patients a day, and most of those visits took place in person. After the second week of March, however, the number of patient visits dropped dramatically while telehealth visits began to surge.

The state expanded telehealth in March, ensuring patients could access health care without worrying about cost, or placing their personal health at risk by venturing out in public.

“This to me highlights how quickly we pivoted to providing telehealth visits and phone visits and how that enabled us to provide services and care to people and not necessarily worry about a financial model that wasn’t sustainable,” said Dr. James Quirk. “The stuff that happened at the state level impacts our daily operations. These decisions are life saving for some.”

Quirk, who has practiced for 20 years, described health care as a right, not a privilege. He credited Medicaid expansion for extending that right to more people. While working in small towns and urgent care centers, he said patients would often describe the cost of care as a barrier.

Medicaid expansion has helped remove those financial concerns from the equation, he said, especially for the 425,000 Montanans with preexisting conditions.

“Prior to Medicaid expansion, having a rancher or construction worker break down and cry because they have to make a decision about their health and financial well being, or their family’s well being, is not a place I want to be,” said Quirk. “Thanks to Medicaid expansion, we don’t see that as often. It’s not a perfect system, but it helps a lot.”

Missoula business owner Amy Coseo, who was diagnosed with cancer at the age of 38, said Medicaid enabled her to access treatment without waiting or stressing over costs. She’s been in treatment for five years and said the early diagnosis may help save her life.

The pandemic has revealed the “disparities and inequities that have always been there,” she added.

“We look at the stress of a pandemic and the stress of a major diagnosis, and now we add the stress of potentially losing your job and the stress of potentially losing your access to health care,” she said. “When they mention economic hardship, that’s directly tied to access to health care, and it’s directly tied to the health of individual Montanans, which comprise Montana’s communities and comprise Montana as a state, and that’s directly tied to the economic health of our state.”