Citing attacks on the Affordable Care Act and a looming U.S Supreme Court decision, gubernatorial candidate Mike Cooney drew a sharp line Wednesday between his healthcare plans and that of his opponent, saying tens of thousands of Montanans depend upon the existing system for care.

While in Missoula, Cooney – the Democratic Party's candidate for governor – said healthcare has emerged as the most important issue facing Montana families.

“Our rural clinics and critical access clinics depend upon the ACA to keep their doors open and continue serving the rural parts of our state,” Cooney said. “Repealing the ACA would sever a critical lifeline for those hospitals and care facilities. I don't have to tell you what happens to a rural community when folks can no longer get the healthcare they need.”

The Republican candidate for governor Greg Gianforte has backed GOP efforts to repeal the Affordable Care Act, and in June he voted against a program expansion.

The measure passed the House regardless, making tax credits for health insurance premiums more generous, opening them up to those making 400% of the federal poverty line. It also required the federal government to negotiate the prices of at leas 25 drugs per year and it encouraged states to expand Medicaid.

But with the recent death of Supreme Court Justice Ruth Bader Ginsburg, Senate Republicans are on the fast track to name a court replacement before the Nov. 3 election. Seven days later, the U.S. Supreme Court is set to hear arguments on whether the ACA should be invalidated.

“If the Supreme Court gets rid of the ACA, Medicaid expansion is gone. That would be catastrophic for Montana,” Cooney said. “We know Medicaid works for Montanans. It keeps families and communities healthy, has been a lifeline to our rural health structure, and has created thousands of good paying jobs.”

While Cooney has no say in Bader's replacement or the pending Supreme Court decision, as governor, he said he would work to ensure elements of today's system remain intact, even if the ACA is repealed.

Detailing his plan, he said he would work with Republicans to codify in state law “the critical and popular protections” offered by the Affordable Care Act. That includes protecting those with pre-existing conditions so they cannot be denied care or forced to pay a higher rate.

Cooney's plan would also prohibit annual or lifetime caps on coverage to ensure that essential health benefits, including ambulatory care, mental health and substance abuse services are covered, along with maternity and newborn care.

“These measures will limit the fallout and protect some of the Montanans who would be left out to dry should the ACA be scrapped,” Cooney aid. “But we must be honest – getting rid of the ACA will be terribly destructive for our state. I am disgusted that we are in this position.”

Celeste Thompson, a healthcare worker in Missoula, is said to be the first Montana resident to sign up for Medicaid expansion in 2015, the year she learned she had cancer. (Martin Kidston/Missoula Current)
Celeste Thompson, a healthcare worker in Missoula, is said to be the first Montana resident to sign up for Medicaid expansion in 2015, the year she learned she had cancer. (Martin Kidston/Missoula Current)

Several healthcare workers defended Cooney's plan on Wednesday, including Celeste Thompson, the first Montana resident to sign up for expanded Medicaid. That measure was passed in 2015, the year Thompson learned that she had cancer.

Medicaid expansion provides health insurance to roughly 90,000 Montanans. If efforts to repeal the ACA succeed and Medicaid with it, Thompson said it would end her ability to receive care.

“I won't be able to go to the doctor or dentist because it's too expensive, and I can't afford it,” she said. “I work and live paycheck to paycheck. My health would decline and my cancer could return. If they repeal the ACA and Medicaid expansion, thousands of Montanans would lose their healthcare.”

Dr. Tom Roberts, a retired internist, described healthcare is a fundamental and inalienable right. He questioned Gianforte's views on science and his willingness to protect healthcare for those who need it.

“Given is views on evolution, it's not surprising he disregards science,” Roberts said. “He does not believe in, nor is he capable of developing, a rational approach to the pressing issues of our time.”