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Making the situation more difficult, Baucus says, are partisan conservative bloggers and other pundits—"paid political hacks," he calls them—who he contends are propagating "a lot of negative misinformation," such as that the law will add trillions of dollars to the deficit, when the Congeressional Budget Office has projected that it will reduce the deficit.
But now that the Supreme Court has upheld the law, he says, "Americans are going to start taking another look, and saying, 'Gee, there may be a lot more here than we realized.'"
Polls conducted after the ruling suggest the law is becoming slightly more popular, but they still show a country fairly evenly split over President Obama's signature domestic achievement.
"Regrettably, there's going to be some background noise" from the law's opponents "up through the election," Baucus says. "But once the election's over, I think a lot of these attacks on Obamacare are going to dissipate because those who are making them, in my judgment, are motivated by political purposes, not by substance. There's a lot of misinformation being disseminated."
And come next year?
"Those who are working so hard against it will find that the wind is starting to come out of their sail," he says. "That's my hope. It's also my expectation."
Breaking new ground
The students at Missoula's Lowell Elementary School, on the Westside, surely would shrug at the mention of Medicaid expansion or medical loss ratios, but this fall they'll watch out their classroom windows as a new health clinic rises on a patch of ground between the school and playground. It will be Missoula's most concrete benefit of federal health care reform—a school-based clinic that will provide primary care and dental and behavioral health services to Lowell students and their families.
A program of the Affordable Care Act gave Missoula's Partnership Health Center $500,000 last year to build the one-story, 2,500-square-foot clinic, the first of its kind in Montana. It's designed to look like neighboring bungalows. Building crews will break ground any day.
Lowell School is in the center of one of Missoula's poorest neighborhoods. More than a quarter of its students qualify for free or discounted lunch, and dozens are classified as homeless. That demographic is largely why Partnership Health Center chose to build the clinic there. As with all of PHC's services, it will provide health care on an income-based sliding scale.
According to the National Assembly on School-Based Health Care, school-based clinics have been found to significantly increase student access to health care, reducing emergency room visits and Medicaid expenditures while lowering rates of student absenteeism and tardiness. Students are more likely to use the mental health services, leading to fewer disciplinary problems. All of that helps foster academic success. PHC Executive Director Kim Mansch calls it "a model that has demonstrated good health outcomes, but also good education outcomes."
You probably won't find any Affordable Care Act critics inside Partnership Health Center, which is a non-profit, quasi-governmental community health center in downtown Missoula, on Alder Street. Mansch uses the word "enormous" several times as she describes the effect the law's already had on it. The Lowell School clinic, which will be staffed by PHC providers, is just the beginning, she says.
Before the school grant, PHC received $570,000 through the health care act to begin renovating downtown Missoula's historic Creamery building on Railroad Street, which the center now occupies. That resulted in the doubling of the center's dental service capacity.
But the big boon came in the form of a $5.5 million ACA grant in May, which is allowing PHC to finish remodeling the Creamery building and add an entirely new wing. That building will also house a new medical residency program.
Montana ranks last in the country in the number of resident medical students trained in primary care, Mansch points out. The state doesn't have a medical school and its only residency program is in Billings. PHC is partnering with the University of Montana, St. Patrick Hospital, Community Medical Center and the Kalispell Regional Medical Center to add a second.
Beginning next summer, the three-year program will bring in 10 residents each year. Mansch cites studies showing that physicians tend to remain in the state they train in. "To help address Montana's primary care shortage," she says, "those residency programs are really important."
Because of the act, PHC will be able to serve roughly 22,000 patients, up from the 12,000 it has now. The growth is clearly needed, as evidenced by the six- to seven-week waiting period new patients currently face.