BILLINGS, Mont. — Health care could be one of the biggest deciding factors in this year's election for voters in Montana and nationwide. According to polling from the Kaiser Family Foundation, 75 percent of Americans say it's very important the Affordable Care Act provision protecting individuals with pre-existing conditions remains law.

Patrick Cobb is medical oncology director at Saint Vincent Healthcare in Billings. He said Montana lawmakers' decision to expand Medicaid in 2015, in addition to ACA protections for people with pre-existing conditions, opened up health care for many of his patients.

"Those protections that the Affordable Care Act gave to get rid of pre-existing conditions when you were trying to buy health insurance and the fact that people could actually get it - both of those things were big deals for us in cancer care,” Cobb said.

Nationwide, an estimated 27 percent of Americans ages 18-64 have some kind of pre-existing health condition, such as asthma, diabetes or heart disease.

Montana's U.S. Senate race between Jon Tester and Matt Rosendale is one of the most closely watched of the midterms. Montanans also will vote on Initiative 185, which would raise tobacco taxes to continue funding Medicaid expansion in the state.

Larry Bonderud is an optometrist and former Republican mayor of Shelby who supports many aspects of the Affordable Care Act and expansion of Medicaid in the state. Nearly 130,000 more Montanans have coverage under the program since the expansion. And Bonderud said doctors saw the effect this had on patients.

"Anybody who tracks this in Montana could see the decrease in medical bankruptcies and all the positive things - you know, the preventive care that came into place,” Bonderud said.

Cobb said he's worried about proposals to do away with the ACA completely and believes it would be better to build on the existing law.

"The important thing is that we take the best ideas from both sides and try to come up with real-world things that will actually work in expanding access to health care and trying to decrease costs,” he said.

Kaiser polling shows Americans across the political spectrum support pre-existing condition protections. That includes 86 percent of Democrats, 75 percent of independents and 58 percent of Republicans.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.