Jan. 13 hearing advances 2024 discussion of access to medical care
By Jack Reaney SENIOR EDITOR
The Madison County Commission hosted a hearing in Virginia City on Monday, Jan. 13, to consider a small Big Sky subdivision’s petition to withdraw from the Madison Valley Hospital District. At the end of a four-and-a-half-hour hearing, commissioners voted 2-1 against granting the withdrawal.
Despite the small size of the 22-home Silvertip subdivision in the Moonlight Basin area, Big Sky officials said the Jan. 13 hearing could have “critically important” implications on a larger scale withdrawal effort to create a new “wellness district” in Big Sky.
The community-wide withdrawal petition stalled in January 2024 due to a disagreement on the required signature count, but the Big Sky coalition spearheading the petition sued Madison County in August and the case remains under review. Many arguments during Monday’s hearing pertained to the community-wide topic, given Silvertip’s potential to set a precedent for the larger battle.
Silvertip’s case revolved around proximity and access to medical care in the Madison County side of Big Sky.
Attorney Natasha Jones said that if a hospital district were created today based on modern populations, “there is no way that anyone would combine Big Sky and Ennis… Access matters. Geography matters. Proximity matters. And here, health care isn’t accessible in Big Sky through the Madison Valley Hospital.”
Attorneys and Silvertip residents contrasted their options for medical facilities, sharing firsthand accounts of emergency care being sought and provided by the Bozeman Health Big Sky Regional Medical Center—which is significantly closer along a state highway to Big Sky’s Town Center, versus the semi-private and relatively hazardous Jack Creek Road to Ennis.
In addition to Big Sky residents, Jones offered a scenario in which an Ennis resident is hurt while working or driving in Big Sky.
“They are going to go where health care is accessible in that moment… They’re going to get picked up by an ambulance, they’re going to go to the Big Sky clinic… because access and proximity matters,” Jones said.
Silvertip attorney Matt Hayhurst summarized the issue in his opening statement.
“Local taxes, like special district taxes, should provide a local benefit,” Hayhurst said. “They should be used locally by the local community, and they should provide benefit to the people who pay those taxes.”
Madison Valley Medical Center CEO Allen Rohrback, among other MVHD representatives and legal counsel, described MVMC’s medical services provided in Big Sky and its desire to continue growing those offerings, including doctors who visit Big Sky multiple times per week to provide care.
“Our vision is very big all over the hospital district, including Big Sky. We look at the Big Sky area as a big opportunity for our entire district,” Rohrback said. “… I believe Big Sky folks, including the Silvertip subdivision, need the Madison Valley Hospital District now, and will need it much more in the future.”
Rohrback also emphasized that the future will depend on collaboration between communities. “It will not be obstruction. And it will not be the removal of district funding,” he said, taking issue with Big Sky’s wellness district efforts.
In addition, the MVHD representatives claimed the Silvertip petition was invalid, based on nuanced residency requirements that excluded numerous signatures. That argument proved inconsequential as the commissioners voted to reject the petition on other grounds.
Commissioners stick with status quo
After hearing testimony from both sides, the commissioners asked questions of representatives and prepared for a short deliberation and vote.
District 3 Commissioner Bill Todd, whose jurisdiction includes Big Sky, said it’s a tough decision—his vote eventually settled a 1-1 tie with his decision to reject the petition.
“My opinions on everything are—well, they fluctuate depending on the presentation,” Todd said. “… I have a tough time in turning the status quo, just as a general rule for myself.”
Todd’s decision came down to “the certainty” of an evacuation event, such as a natural disaster.
“It has to be the worst possible scenario where [Big Sky residents] may obtain a benefit here,” Todd said. “And if you’re evacuating from the Madison County portion of Big Sky, you will come down Jack Creek Road. And you will need medical attention. And I don’t know where else you would get that, other than Madison Valley Medical Center.”
District 1 Commissioner Duke Gilman said the hearing is an important chance for Madison County to talk carefully about Big Sky’s health care challenges. He later voted to reject the petition.
“I really want to find some ways to find solutions to the issue through working together as a county, [rather] than as separate geographical areas,” Gilman said.
District 2 Commissioner Ron Nye expressed a desire to negotiate a settlement, though he did not see it as a possibility. He echoed Gilman’s desire for both communities to collaborate.
Nye motioned to grant the petition, and was the lone vote in favor as it failed, 2-1.
Paul Farrell, president of the Silvertip HOA, told EBS his community is disappointed with the commission’s decision.
“I think the facts are absolutely crystal clear to anyone who was in that room, or who has done any amount of research on this situation,” Farrell told EBS in a phone call Tuesday. He said no Silvertip resident has ever received care at MVMC, and every resident has used Big Sky Medical Center. He said MVMC is using “every road block that they can” to amplify negative narratives about the effort, and emphasized that residents are not trying to disparage MVMC or its personnel, nor skip out on paying taxes.
“I will not save one penny in taxes if this effort succeeds,” Farrell said. “Not one cent. It’s just allocating [taxes] to the resources I actually use.”
‘We can’t let that hospital close’
Montana Sen. Tony Tezak, whose senate district 35 includes Ennis and much of Madison County, voiced concerns about the working families who live in Ennis and drive Jack Creek Road to support Big Sky’s economy. He said if Big Sky withdraws from MHVD—his comments reflected the larger withdrawal effort, not the relatively small effort by Silvertip—the hospital would need to overhaul its funding structure.
“You know who we’re gonna shift that burden to? The backs of those working families. Because we can’t let that hospital close,” Tezak said.
The Madison Valley Medical Center launched a website encouraging public engagement against Big Sky’s hospital district withdrawal and similar school and library initiatives that could have “severe and far-reaching consequences” for the Madison Valley. The website stated that if Big Sky’s total withdrawal is eventually successful, MVMC would lose $2.9 million in annual property taxes, creating a budget shortfall and operating loss and jeopardizing vital health care services.
Tezak cautioned that the Missoula-based lawyers representing the Silvertip petition are not experts, and warned the commissioners, “don’t be intimidated by them. And don’t be intimidated by the money.”
He also warned against Montana’s potential Medicaid expansion and cautioned against large hospitals. “I’m telling you, the big hospitals, they are bad guys… We do not want Bozeman Deaconess to fight us. We don’t want that to happen,” Tezak said. He did not elaborate on the local impact of either Medicaid or large hospitals.
“It should be very hard to get out of a hospital district,” said Rohrback, CEO of the Madison Valley Medical Center. “And that’s why the statute is clear… the Silvertip subdivision and the greater Big Sky area will need to prove that there will be no benefit by remaining.”
‘Far from over’
Silvertip resident Paula Cleary said residents’ Madison County property taxes to MVHD have increased three times in the past 10 years, from $288 in 2018 to $702 in 2024.
“We have never used Madison Valley Hospital [sic] in that span,” Cleary said. “Never. We have frequently… used Big Sky Medical Center during that span. The allocation of our health care tax dollars should reflect that reality.”
However, the commissioners ultimately decided that the community could not prove its lack of benefit from MVHD.
Farrell, HOA president, said that the community is examining its options and the effort is “far from over.” He said other neighborhoods may launch similar petitions to withdraw.
“There’s going to be an appeal process… We’re gonna keep going until we get to a solution that is fair,” Farrell said. “And sending 100% of your tax dollars to Madison Valley Medical Center… is clearly not a fair or long-term solution.”
