How Libby, Montana, Got Medicare for All

[Guest guest]

Health Law Expands Medicare To Montana Asbestos Patients

By Phil Galewitz, KHN Staff Writer Jun 18, 2011

This story was produced in collaboration with wapo.

grew up in Libby, Mont. -- a picturesque Rocky Mountain community

that was unknowingly poisoned for decades by deadly asbestos from a vermiculite

mine six miles from town.

Her grandfather, a miner, her grandmother and an uncle died of asbestos-related

disease. Both of her parents have the condition that has no cure. But she didn't

think it would hit her -- until doctors last year found a spot on her lung.

Like many of the nearly 2,000 people from Libby who have asbestos-related

disease and the 400 who have died from it, never worked at the mine,

which was owned by chemical manufacturer W.R. Grace. It produced much of the

world's supply of vermiculite, a mineral used in insulation, fireproofing and

soil conditioning, before closing in 1990.

But tremolite, a form of asbestos that was laced in the vermiculite ore, had

been spread throughout the Libby area. Miners brought it home in heavy dust on

their clothes helping to contaminate their families, residents took vermiculite

to use for insulation and tailings were spread as ground filler around town,

including at school and community sports fields.

Federal officials in 2009 declared the area the first national public health

emergency and have called it the nation's worst environmental disaster.

Without health insurance, , 45, relied on a state-federal grant program

and a medical plan funded by W.R. Grace to help pay for her medications and

doctor visits. Yet, with Grace in bankruptcy and the grant program scheduled to

end this summer, was concerned about how she was going to keep up with

mounting health bills for medicines and tests.

The 2010 federal health law is providing help. One provision, authored by Senate

Finance Chairman Max Baucus, D-Mont., gives full Medicare coverage to people who

had lived in Libby for a total of at least six months over a 10-year period

before their diagnosis of an asbestos-related disease.

" I feel good knowing I have this [coverage] and it's never going to go away, "

said . She is one of about 600 people from Libby who have signed up for

Medicare as a result of the law, according to the Social Security

Administration, which oversees the program with the Centers for Medicare and

Medicaid Services.

But she and others worry about Republican efforts to repeal the law.

" Losing this benefit would really knock the bottom out of people's lives, " said

Gayla Benefield, a Libby resident and 's mother.

U.S. Rep. Denny Rehberg, R-Mont., is among those fighting to overturn the law.

" It's tragic that assistance for so many deserving folks up in Libby was tied to

the anchor of Obamacare, with all of its mangled policy, unconstitutional

mandates and reckless deficits, " he said.

Rehberg, who has announced he is challenging Democratic Sen. Jon Tester and is

making the health law an issue in the campaign, said he will continue working to

help the people of Libby but would not say if he supports keeping the Medicare

option for them.

Baucus defends the coverage for Libby. " This provision is important because it

will provide vital medical services to Americans who — through no fault of their

own—have suffered horrible effects from their exposure to deadly poisons, " he

said.

Expansions Of Medicare Have Been Rare

It is just the third expansion of Medicare eligibility since the federal health

insurance program was established for the elderly and disabled in 1965. In 1972,

Medicare added people with end-stage kidney disease and in 2001, people with

amyotrophic lateral sclerosis, also known as Lou Gehrig's disease.

Unlike other deals senators secured in the law to help their own states, the

Libby provision elicited no public outcry, mostly because of its relatively

minor cost. The Congressional Budget Office said it would cost $300 million over

the next decade.

For , being on Medicare means long-term security. Because of the

contamination, " W.R. Grace proved that they are not to be trusted and I

definitely wasn't banking on having their medical plan for the rest of my life, "

said who now lives in Kalispell, about 90 miles east of Libby.

Even with the new Medicare coverage, Grace has no plans to close its Libby

medical plan, which has paid out about $21 million since 2000 and has about

1,100 current patients, said Corcoran, a vice president at Grace. About

70 percent of those in the company plan are 65 and older.

Grace, a chemicals manufacturer based in Columbia, Md., that bought the mine in

1963, has been paying medical bills in Libby for years and agreed in 2008 to

spend $250 million for an environmental cleanup of the town. The company, which

was driven into bankruptcy protection in 2001 by tens of thousands of asbestos

poisoning claims mostly unrelated to Libby, reached a tentative civil settlement

in 2008 to pay $3 billion to asbestos victims nationwide.

The federal-state grant program, which serves about 1,400 people, was intended

as temporary aid and is slated to end in July.

That program was set up because the Grace medical plan failed to cover everyone

who needed help, said Benefield, who also been a leading advocate to get help

for the town's residents. The Grace program hires its own doctors to

independently verify if applicants have the type of asbestos-related disease

connected to the Libby mine. The government program doesn't have this

independent verification process. Applicants merely have to submit information

from their own doctor certifying they had asbestos-related disease.

In 2010, the company accepted 50 of the 83 people who applied for the program.

Grace officials said those rejected could not prove their disease was caused by

asbestos. For example, if the lung disease was caused by smoking, it would not

be covered.

Broader Coverage Under Medicare

Both the Grace and the government grant program pay only for health services

related to asbestos disease and both supplement an individual's private

insurance. In contrast, the Medicare coverage pays for all types of health

needs.

" The Medicare coverage will be extremely important, " said Tanis ,

outreach coordinator of the Center for Asbestos Related Diseases, the

government-funded clinic. She said many people have not yet enrolled because

they can still get help from the grant program.

Exposure to asbestos is known to cause cancer and other lung diseases. The

asbestos-related disease can take decades to show up on X-rays and other tests.

Out of a population of more than 10,000 people in Libby and the surrounding

valley, new cases are being diagnosed at a rate of about four a week, according

to .

" I thought I was fine and I was not a smoker and was least exposed of my

siblings, " said who works as a receptionist at a veterinary clinic. But

there were early signs of health problems: She caught pneumonia when she was

eight months pregnant, was diagnosed with Swine flu, and in the past few years

she developed ear infections that took months to clear.

These days, when she shows her Medicare card at the doctor's office,

sometimes gets strange looks. " They say, 'You look so young. How can you be on

Medicare?' Then I explain I'm from Libby. "

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