Government

Gov. Gianforte Unveils Agenda To Improve Health Care

9 November 2022
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Governor Greg Gianforte recently shared elements of his health care agenda for the 2023 legislative session and the year ahead, emphasizing the need to increase access to affordable, high-quality health care.

“Creating greater, and better, access to health care and lowering Montanans’ costs for care are core pillars of our health care agenda for 2023,” Gov. Gianforte said. “I look forward to working with legislators, patients, doctors, providers, and hospital administrators to develop more meaningful, innovative solutions that improve Montanans’ health and their access to care.”

At the Montana College of Osteopathic Medicine, the governor highlighted the importance of recruiting and retaining medical professionals to expand access to care.

“With an increasingly aging population as well as our growing population, demand for health care providers continues to rise in Montana, and our supply can’t keep up. This has been a growing issue that we’ve faced for many years. We’re coming to the table with more solutions in 2023,” the governor said, before outlining his plan to make it easier for qualified health care providers to practice medicine in Montana by reducing unnecessary barriers they face.

“Imagine if you’re a doctor who’s registered to practice medicine in another state and are in good standing there. You move to Montana. You shouldn’t have to jump through burdensome hoops to start treating patients in your community here,” the governor continued. “We must reform our licensure regime to reduce those barriers.”

Addressing the substance use crisis and shortage of mental health providers, Gov. Gianforte highlighted programs his administration has implemented, including the HEART Fund and the Angel Initiative, to increase access to treatment and recovery for those struggling with addiction.

Building on those successes, the governor addressed a plan to improve access to mental health resources, saying, “Montana should enter into a behavioral health compact to reduce barriers that qualified providers face. By taking that step, Montanans will have better access to mental health care.”

He also credited Rocky Vista’s Montana College of Osteopathic Medicine, the first medical school in Montana, as a key part of the solution in meeting the demand for medical professionals.

Acknowledging the federal government has a larger role in lowering health care costs, the governor emphasized the state must do what it can to lower costs, including increasing medical billing transparency.

“What if, before a procedure, you knew what you would pay? What if your provider and your insurer provided you with a cost estimate? We must ensure Montanans have access to important pricing information prior to receiving services,” Gov. Gianforte said. “With greater transparency on costs in advance, Montanans can better make health care decisions that work for them and their families.”

The governor began his remarks by acknowledging Montana’s health care workers and the important work they do.

Last Sunday, a patient entered the Billings Clinic emergency room and attempted suicide before law enforcement intervened.

“What happened Sunday was troubling and traumatic. It’s a reminder that our health care workers are on the frontlines, every day, serving our communities. They see patients, as well as their friends and family, at their most vulnerable, and it takes a toll on them,” the governor said.

“No nurse or doctor or provider should fear for their well-being simply by showing up for work and doing their best to care for patients,”

Future Visions?

9 November 2022
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Federal planning requirements, passed down to local governments, have for a number of decades pursued what’s called “traffic calming” strategies aimed at making driving less desirable and pressuring citizens to abandon their personal vehicles. Often tied to qualifying for federal transportation funds, the federal efforts, have more recently, been elevated, but they have encountered a problem according to Axios Richmond: “While the city considers dramatically rolling back parking requirements to encourage denser, walkable neighborhoods, an unseen force is still quietly demanding developers build big parking decks.” Banks ! Banks almost always require developers to build a minimum number of parking spaces — often well above the requirements set by the city, complain centralized planners. Banks and developers are responding to consumer demands. They are also speculating that it will be a good investment, all the more so, because of the escalating emphasis of most municipal planning and regulators to eliminate the availability of on-street or public parking. The planners worry – even though it is not their money — that in ten years all those parking spaces will be a “financial albatross,” said Axios.

Feds Take Aim at Gig Economy

9 November 2022
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By Casey Harper, The Center Square

The U.S. Department of Labor proposed a new rule in mid-October that would overhaul how independent contractors like freelancers and drivers for ridesharing apps are classified, potentially upending the gig economy that has exploded in growth in recent years.

The DOL said in its rule proposal that it would change how the federal government determines who is a freelancer and who is an employee.

How exactly contractors will be determined remains to be fully worked out, but it is expected that many freelance positions could become classified as regular workers.

“The Department believes that this proposal, if finalized, will provide more consistent guidance to employers as they determine whether workers are economically dependent on the employer for work or are in business for themselves, as well as useful guidance to workers on whether they are correctly classified as employees or independent contractors,” DOL said.

The DOL says the new rule will provide more benefits and protections for workers.

Critics, though, argue this will put major costs on businesses. Small businesses in particular can rely on an assortment of independent contractors to help keep their business afloat before they can afford full time hires.

“The modern workplace is more complex in the wake of the COVID-19 pandemic,” said National Retail Federation Senior Vice President of Government Relations David French “Retailers, along with countless other employers, maintain a wide range of business relationships with independent contractors, including billing, facility maintenance, data analysis, delivery, marketing and other critical services.

Other critics said many workers prefer the freedom and flexibility of contract work, or the “side hustle.”

“The DOL is out-of-touch with the modern economy and how people want to work, as evident by its proposed independent contractor rule,” said Karen Kerrigan, president and CEO of the Small Business Entrepreneurship Council. “Moreover, an independent contractor’s cherished flexibility could be taken away. These are all outcomes that will exacerbate the weakening economy and harm America’s small business ecosystem.”

Many Americans started side businesses that provide services to other businesses during the pandemic. Under this new rule, those business relationships could become illegal.

“More people are starting businesses because they have access to modern tools and platforms that make it simple and affordable,” Kerrigan said. “Overwhelmingly, they want to be their own boss and want control over their own time. The proposed DOL rule is a massive step backwards, as it resurrects an outdated approach that works against flexibility and regulatory certainty.

“The proposed rule will create uncertainty, higher costs and complexity, and snuff out countless innovative ideas and entrepreneurial dreams in their infancy.”

French said the rule would also drive up costs for consumers.

“The current rules clearly define the difference between employees and independent contractors, providing much-needed legal certainty for employers, employees and independent contractors alike,” he said. “The changes being proposed by the Labor Department will significantly increase costs for businesses across all industries, and further drive already rampant inflation.

“This decision will only foster massive confusion, endless litigation, reduced innovation and fewer opportunities for employees and independent contractors alike,” he added.

Equipment Tax Reforms Could Attract Businesses

9 November 2022
Dennis Pyburn
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By David Beasley, The Center Square

Gov. Greg Gianforte’s plan to provide more relief from the state’s business equipment tax could attract more businesses to Montana, according to one small business advocacy group.

The governor said earlier this month that he wants more reforms to the business equipment tax when the legislature convenes next year. In 2021, lawmakers raised the tax exemption from $100,000 to $300,000, which provided 3,400 businesses with tax relief, according to the governor’s office.

“Taxing critical business equipment makes it harder to grow a small business and is a wet blanket on job creation,” Gianforte said in a statement. 

“In 2023, we want to build on that success, further reforming the business equipment tax so small business owners can grow their operations and create more good-paying Montana jobs,” he added.

The price of equipment needed to operate businesses has increased with inflation, according to Ronda Wiggers, Montana state director for the National Federal of Independent Business.

“If you are a store owner who buys cabinets, or a farmer who buys a combine, or you buy freezers and refrigerators for your restaurant, in the state of Montana we tax those,” she told The Center Square. “We put a taxable value on that, and we tax them. Although the taxable value depreciates over time, you don’t just pay it once. You pay it every year. It’s an ongoing tax.”

When the state eliminated the first $100,000 of value from taxation a few years ago, “that took care of a lot of our small businesses,” she said. “Most of the stores, for example, probably don’t have over $100,000 worth of display cases.”

Since local governments obtain revenue from the equipment tax, the state last year covered any losses they might incur from raising the exemption to $300,000, Wiggers said.

Gianforte has not yet detailed what his proposal will be for raising the exemption this year, although there has been some speculation he may support increasing it to $500,000, according to Wiggers. 

A higher exemption could attract more equipment-intensive businesses like in the manufacturing sector, Wiggers noted.

“When you are trying to attract those kinds of businesses to the state, they are looking at the bottom line,” she said. “Having an equipment tax in one state and not having it in another would very much affect something like manufacturing.”

City Plans Rec Facility

9 November 2022
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After five years of planning, the preliminary plans for a multi-use recreation center for Billings have been released.

The proposed $98.7 million facility would be located adjacent to Amend Park at the corner of King Avenue East and South Billings Boulevard, on property that the city acquired through a tax increment finance district. The plans call for a 177,000 square-foot facility that would include an ice sheet for hockey and skating, a leisure and activity swimming pool, a 50-meter competition pool, four sports courts, open fitness and activity areas and an indoor running track.

A facility with that price tag will require multiple sources of funding according to city officials. Besides funds from the South Billings Boulevard Tax Increment District, it will require community contributions and a bond request from the voters.

Funding a project of that size would require cash from multiple sources, including tax increment finance dollars, philanthropic support and most notably a voter-approved bond.

A&E designed the facility after gathering broad community input.

Planning was based on “a statistically valid survey” done in 2019 and repeated this spring to determine the highest priorities of the community.

Projections estimate that the facility would cost $3.4 million to operate annually while bringing in $2.5 million in revenue, a cost recovery rate of about 74%. The $901,000 gap would be filled by the city and would cost the average Billings homeowner roughly $12 to $15 a year.

WWAMI  –  50 Years Educating Montana Medical Students, Providing Montana with Doctors

18 October 2022
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By Anne Cantrell, MSU News Service

Montana State University is celebrating the 50th year of the WWAMI Medical Education Program, which allows students from Montana to pay in-state tuition while earning MD degrees from University of Washington’s top-ranking School of Medicine.

Since WWAMI’s inception at MSU in the fall of 1973, more than 1,000 students from Montana have enrolled, according to the program’s records. More than 350 WWAMI graduates currently serve as physicians in the state of Montana.

“There were two goals at the outset of the WWAMI program,” said Martin Teintze, MSU WWAMI director. “One is to provide an opportunity for Montana students to go a top-notch medical school. The other goal was to provide physicians for the state of Montana.

“The first goal has definitely been met,” Teintze continued. “For the second goal, there are more than 350 physicians practicing in the state that are WWAMI graduates. That’s a significant chunk of physicians in our state.”

In addition to Montana, other states participating in the cooperative medical education program are Washington, Wyoming, Alaska and Idaho. Montana students spend 18 months receiving instruction from MSU professors as well as physicians at Bozeman Health Deaconess Hospital. The next two and a half years are spent doing clinical rotations in a variety of Montana locations, as well as Seattle and other sites in the WWAMI region.

Montana’s first WWAMI class had 10 students. Class size grew to 20 in 1975 and then to 30 students in 2013, with support from the Montana Legislature.

Students complete their first 18 months in Bozeman, which means that two groups totaling 60 Montana students are now educated in the program at MSU each fall.

“There was general agreement when Montana joined WWAMI in 1973 that Montana needed more physicians and this was the way to do it,” Teintze said. “It was also the least expensive way to do it. Building a standalone, Montana University System-run medical school would have been vastly more expensive for the Montana taxpayer.”

Teintze expressed appreciation for Montana lawmakers who supported the state’s joining the program in the 1970s and have increased the number of Montana resident students supported by legislative funding in successive decades. Students who do not end up practicing in Montana within a year after completing their education repay a portion of the subsidy they received from the state.

“We appreciate the ongoing support the program has had from the legislature for the past 50 years,” Teintze said. “It’s a long-term investment in the health of Montanans.”

Montana WWAMI students complete the majority of their clinical training in the state at more than 50 sites under the direction of approximately 650 Montana physicians, Teintze said.

“It has really become a Montana program,” Teintze said.

In the mid 2000s, the University of Washington hired a Montana clinical dean, Jay Erickson, who developed a program called TRUST, which stands for Targeted Rural Under Served Track. The program links 12 WWAMI students in each class to underserved communities. Those students spend a couple of weeks in the community in which they are paired before starting medical school as well as a month between the 1st and 2nd year. Then, in their second year, they spend five months in those communities completing part of their clinical training. There are currently 11 TRUST sites in Montana, from Miles City to Libby and from Dillon to Glasgow.

“The objective is to provide students who are interested in this kind of a work a real experience of what it is like to be a small-town physician, and to make sure they are trained by people who have chosen it as their career path,” Teintze said.

Teintze said TRUST has seen success with its goal of increasing the number of WWAMI graduates now practicing in the state’s rural areas, with alumni of that program now practicing medicine in places like Anaconda, Ronan, Hardin, Havre, Lewistown and Miles City.

“We’re hoping this success will grow,” he said.

Teintze said that, after 50 years in operation, the need for the WWAMI program remains strong.

“The average age of the population in Montana is going up, and therefore the need for medical care is also rising,” he said. “We are also facing a wave of physician retirements at a time when the need for more physicians due to the aging population is increasing, and the situation is even more dire in rural parts of Montana.

“With the time it takes to educate a medical student – four years of medical school, plus three to five years of residency afterwards – we need to be planning now for physicians that we need seven to 10 years from now. The prudent thing is to plan ahead.”

States to Fight for Federal ‘hydrogen hub’

17 October 2022
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The Center Square

Montana, North Dakota, Minnesota, and Wisconsin are joining forces to create a regional clean hybrid hub that will compete with other hubs for federal dollars.

The Biden administration announced last week that it was accepting applications for the $7 billion program for regional hubs funded through President Biden’s Bipartisan Infrastructure Law. The money is part of a larger $8 billion hydrogen hub program, according to a news release from the Biden administration. 

The U.S Department of Energy will select six to ten hubs, according to a news release from Burgum. The four-state collaboration will be called the Heartland Hydrogen Hub. 

The Energy & Environmental Research Center at the University of North Dakota in Grand Forks is leading the effort, which also includes the state’s tribes, according to Burgum’s office. The National Center for Hydrogen Technology is housed at the research center.

According to the memorandum of understanding, other states could join the hub in the future. 

“By bringing together our expertise in agriculture and energy production, we can create a world-class hydrogen hub and do even more as states to feed and fuel the nation and the world,” Burgum said. “We are grateful to these states and their governors for their participation, collaboration and shared interest in American energy production, U.S. energy security, job creation, economic development and environmental stewardship.”

Other states are collaborating on regional hydrogen hubs. Colorado, New Mexico, Wyoming, and Utah formed a regional hub in February. Louisiana, Arkansas and Oklahoma announced a regional hub in March. 

The hydrogen hubs are part of the Biden administration’s plan for a net-zero carbon economy by 2050, according to the Department of Energy. 

Loan Repayments May be Done Through County Tax Collectors

17 October 2022
Evelyn Pyburn
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The City of Billings and Yellowstone County are scrutinizing a proposed lending option for businesses which many believe would be a boost to economic development. Called C-Pace, the program would allow businesses to borrow money from lenders and make repayment as a part of their property tax bill. The loan would be attached to the property rather than the borrower – something like a lien.

Overseeing the program is a Great Falls-based non-profit organization connected to the Montana Department of Commerce called the Montana Facility Finance Authority (MFFA). MFFA has traditionally specialized in serving the medical care industry to finance energy and water-saving measures in the process of remodeling or building new buildings. MFFA aids companies in processing taxes, loans and grants for health care.

MFFA wants to extend their services to other businesses and to utilize the property tax collection system to facilitate repayment of the loans. MFFA would serve as the facilitator that handles the disbursement of the money collected through tax bills to the appropriate financial institution or bank. Delinquencies would be dealt with as part of the total tax bill and in the same way as delinquent taxes.

Implementing C-Pace would necessitate a hearing process and approval of a resolution by county commissioners, but before moving forward the county commissioners are asking their legal advisors to check the fine print to make sure that the county can in no way be held responsible for any defaults.

City of Billings officials are interested in the concept, but are waiting to see if the county moves forward in adopting the program, since the city would be part of any county-wide application.

County Treasurer Sherry Long expressed concern about the idea and has a lot of questions that she believes must be answered before the county adopts it.

During a discussion meeting, a number of people spoke about the potential economic development benefits and encouraged county commissioners to join seven other counties that have already adopted the financing option. They urged the county commissioners to act quickly since there are projects already pending, they said.

CON Limits Health Care Growth in Montana

17 October 2022
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South Carolina is the third worst state to have a baby, writes Dean Clancy, Senior Fellow, Health Care Policy for Americans for Prosperity. The key driver to the problem, he states, is government red tape “that creates artificial shortages for hospitals, obstetrics services, perinatal services, and intensive neonatal car.”

Clancy sites an associate analyst, Thomas Kimbrell, whose data shows that in South Carolina families use neonatal intensive care units (NICU) 30 times more often than what government estimates claim is needed under the state’s “certificate of need” plan.

He goes on to say that State and local “certificate of need” or CON laws are well-named: they’re the biggest “con” in American health care today. For Montanans that’s problematic because Montana is one of the handful of states that still requires “certificate of need” to expand health care.

“These unnecessary, harmful laws require hospital systems and other health facilities to get approval from a government agency before they can open or expand their facilities in a given area,” said Clancy.

Often, just adding a single new bed or MRI machine requires government approval, a process that can add years and thousands of dollars in costs.

“All Certificate of Need laws should be repealed to boost competition and reduce costs for patients,” claims Clancy.

Kendall Cotton, President and CEO of Frontier Institute, reports that, “Under Montana’s “certificate of need” program, the government gets to determine if a new health care business is ‘needed’ in a process that lasts at least six months and charges a fee of $500, or 0.3% of the intended expenditure. The effect is to limit competition that could give residents more choices and lower costs.”

For example, in 2019 Montana denied new applications for home health businesses in Yellowstone County, despite the government’s own estimate of 795 patients in the county with an “unmet need” for home health care. Those new services could have opened up beds at hospitals and increased access to care during the pandemic.

In addition to home health, Montana requires certification for outpatient surgery centers, nursing homes and even drug rehabilitation facilities.

Certificate of need programs were pushed by the federal government in 1974, but by the mid-1980s the program was declared a failure and Congress withdrew it.

While 15 states dropped their certification programs, Montana did not. Existing health care facilities benefit from keeping out new competitors, so the programs remain stubbornly in place.

Research by the Mercatus Center at George Mason University shows abolishing certificate of need laws could help reduce health care costs, potentially saving each Montanan $214 per year.

An effort in the 2019 legislature to repeal Montana’s certification program was vetoed by Gov. Steve Bullock, who said the certification laws “prevent the creation of excess capacity in health care facilities.” In other words, the laws reduce competition that could increase access and decrease costs.

“With health care capacity at critical levels for many Montana counties, state lawmakers should repeal harmful and anti-competitive certificate of need laws,” advises Cotton.

Economist Barkey Gets Award

20 July 2022
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A University of Montana director recently received the most prestigious award from a national association of regional economic research centers.

Patrick Barkey, director of UM’s Bureau of Business and Economic Research, received the Thayne Robson Award from the Association for University Business and Economic Research (AUBER). The award is the highest honor that AUBER awards to an individual for longtime commitment and service to the organization. Award winners must be economic and public policy leaders in their state.

Barkey is the past president of AUBER, has served as Secretary-Treasurer for more than a decade and has been a member of the organization’s board of directors.  “I am humbled to receive this honor, especially considering the outstanding AUBER leaders who have preceded me,” Barkey said.

“No one has been a stronger advocate of AUBER than Pat,” according to John Deskins, AUBER’s president and director of West Virginia’s Bureau of Business and Economic Research. “He has devoted years to working to make the community stronger, and we owe him so much for his dedicated service. He is a great asset to applied economics research centers nationwide.”