State Legislature 2020: Kristen Spanjian

I was a happily retired physician until the last legislative session when my state representative voted against Medicaid expansion. He then sent a mailer implying that expanding Medicaid would limit resources to those already on traditional Medicaid. I know that is not true and it fired me up to run against him, even though I’m a political novice. I know how this program has benefitted Montanans (see below) and I refuse to let it go without a fight. Clearly, we need professionals who understand healthcare in the legislature. I have since found out that my opponent also voted against Country Of Origin Labeling – a program that helped our ranchers significantly and one I and my cattle­ producing neighbors whole-heartedly support.

1. Supporting rural healthcare
   1. Protection of Medicaid expansion from attempts to weaken
   2. Support for rural clinics, first responders, critical access hospitals
   3. Strengthen programs addressing mental health, substance abuse and suicide prevention
2. Rural and agricultural businesses
   1. Re-enact Montana’s Country Of Origin Labeling (COOL) program
   2. Support development of locally owned (or cooperative), mid-sized meat processors
   3. Support loans for small business start-ups
3. Protecting our public lands
   1. Ensure public access to hunting, fishing, camping,
   2. Land, water and wildlife conservation
   3. Protect our outdoor heritage and economy, which will also help attract/retain a talented workforce
4. Quality public education
   1. Adequate funding to attract and retain excellent teachers
   2. Ensure that tax dollars relegated for public education are spent on public schools, not those privately funded
   3. Support a state-funded public pre-K program

A delicate balance to be sure and in a perfect world this might be simpler. However, with the drastic effects of COVID-19 on our economy, I believe we are now pushed to use our resources for immediate mitigation, relief and stimulation. If we can get our economy back on the road to recovery, it should lay a foundation for a future stability and growth.

I am running to serve in the House of Representatives and I take the title “representative” seriously. I want to be elected because the voters in my district understand what policies are important to me and know I will stand up for them. While I realize there may be decisions on which I will have to follow my conscience, there will be many issues on which I need education and I will reach out directly to those interested constituents who have more experience in such matters. I am hoping to use a regular article in the local community newspapers and on-line website/social media page to update constituents on pertinent legislative matters and solicit their opinions.

It is unfortunate that compromise is even a question here. Of course, all sides of an issue need to be considered and working to a solution will require give and take. I also recognize that I will have to learn about many topics with which I am unfamiliar. Being a scientist at heart, I use data as a foundation and then get input from various stakeholders and work to a consensus. As an example, while serving on the state medical board, we were tasked to write rules regarding telemedicine. I led a group from various institutions, agendas, and backgrounds, including physicians, healthcare administrators, state medical association leaders, policy experts and public representatives. We each had our own section to research and then together we crafted a set of rules that then went to the full board and onward.

While I certainly would like to see the findings of those studies, I do believe a change in our tax system is warranted. Our state relies too heavily on property taxes – which can be unfair to the agricultural community as many may be “land rich, cash poor”. Even though Ag land taxes are calculated on productive value, they do command a higher rate. Despite the political unpopularity, I would be willing to consider a small sales tax which may be more equitable, and would allow for a reduction of property taxes. Nationally, states that use sales taxes provide about 32% of tax income that way and have lower property and income taxes. In the least, I support local option authority.

This pandemic has created unforeseen damage on all fronts and businesses doing their best to mitigate injury to their patrons and employees will likely still see unfortunate outcomes. For this reason, I would support release from COVID-19 related liability with the requirement that all CDC recommendations are followed or exemptions are approved by the local presiding public health official. In addition, healthcare providers (including volunteers returning to work from retirement to help in this time of need) should also be given malpractice protection due to new and extenuating circumstances, assuming no gross negligence or malintent.

Yes, I support full funding for Medicaid expansion because as a physician I know it has provided coverage for thousands of Montanans, improved health outcomes, supported rural hospitals by lowering uncompensated care by 30%, supported healthcare jobs and all without significant increases in state spending or cutbacks to other programs. This is accomplished because these federal dollars from Medicaid expansion are also used to offset other areas of state spending such as healthcare costs for those in the justice system. The federal government provides 90% of the funding for Medicaid expansion; if this program is terminated or weakened, those tax dollars Montanans pay to the federal government will not be spent on our citizens but will be spent elsewhere. Given the pandemic’s economic effects, the infusion of these federal dollars will also help our state. The work requirements now imposed are not helpful because the vast majority of Medicaid expansion recipients already work or are physically unable to – but the reporting requirements are so cumbersome many may fall out of the program for which they actually qualify.

First of all, we must recognize that mental health, suicide, and substance abuse are issues that are often underappreciated and undertreated in this state. As such, a greater priority needs to be given to them at the state level. Once again, the federal dollars allocated to Medicaid expansion are crucial to support clinics and programs that address these. I believe mental health issues should be the responsibility of the medical corridor, not that of our public safety departments – and budgeted as such.

The concept behind the 406 Impact Districts bill was a sound plan for the future business development of Montana. The 5:1 private:public investment seemed to be a very good deal for communities, and I was surprised to see this die in committee. Because I was not in the legislature and did not hear the arguments against this bill, I honestly do not have the knowledge to suggest a revision – though I would welcome education on the matter. The effects of the pandemic may make public investment less likely at this time; however, the low interest rates may make private developers more interested now.