Before a crowd of Flathead Valley residents on Wednesday, Montana Commissioner of Securities and Insurance Monica Lindeen whisked through a presentation about the Affordable Care Act.

At the standing-room-only event at Kalispell Regional Medical Center, Lindeen talked about subsidies, the need for Medicaid expansion and how she thought the first year of the program known as Obamacare might shake out.

She tried to calm concerns by letting people know things hadn’t been easy for insurance commissioners, either, in the three years since the landmark health-care legislation was passed.

“All of our lives changed that day,” Lindeen said, referring to her fellow 55 commissioners across the country. “We are Democrats, Republicans and independents, but it doesn’t matter. We have legal duties to take care of.”

An estimated 195,000 Montanans lack health insurance, Lindeen’s office estimates. Even with the implementation of the health-care act, 50,000 of Montana’s “working poor” still won’t have help should they get sick.

One theme during the presentation was the Montana Legislature’s refusal to expand Medicaid — federal insurance for the poorest residents. Montana was one of a few states that declined the expansion despite incentive money offered by the federal government.

Expansion of benefits would affect those making between 47 and 138 percent of the federal poverty level.

Montana AARP Executive Council member Jim Higgins spoke up in support of the expansion during the open question-and-answer session.

“There are 7,000 Montana veterans that would be able to get healthcare if Medicaid was expanded,” he said. “These are veterans who are poor or are too remote to get [Veteran’s Affairs] benefits.”

Lindeen said that although these people would not be insured, they would still receive emergency care if something happened. She said simply increasing who is covered by Medicaid would considerably decrease these charity costs hospitals are required to fulfill.

She went on to say that the failure to expand Medicaid would cost Montana $6.1 billion over the next eight years and 12,700 jobs with an average salary of $42,700.

There was no mention Wednesday of the federal government shutdown, playing out in part because of Republican efforts to derail Obamacare, but there was concern from several small-business owners about how the health-care act would impact them.

Businesses are not obligated to provide health insurance unless they have 50 or more full-time employees. A tax credit for businesses under 25 employees that elect to provide insurance would cover 50 percent of costs for the first two years of Obamacare.

Lindeen stressed that people already qualifying under Medicaid, Medicare, Veterans Affairs, Tricare and the Children’s Health insurance Program would not have benefits changed at all.

Those using Montana’s first three insurance companies to buy into the marketplace (states have options to use the federal marketplace or create one for themselves) would be able to buy into what Lindeen referred to as “a level playing field.”

Blue Cross/Blue Shield, PacificSource and Montana Health Co-op are the three firms from which Montanans are able to shop (with four plan levels of platinum, gold, silver and bronze) to find the best deals for their households.

Those making between 100 and 400 percent of the federal poverty level will be eligible for tax subsidies to help foot the bill for health insurance. Montana’s average household wage is $45,324, so Lindeen estimates nearly 80 percent of Montanans will qualify for some form of government subsidy.

This is negated if an employer offers “affordable” or “minimum coverage” insurance, but will help the working poor or semi-retired.

Another point in Lindeen’s presentation that drew a favorable reaction from the crowd is that no matter how unlucky a year someone has health-wise, the maximum out-of-pocket someone can pay toward health insurance would be $6,350 or $12,700 for a family.

Exemptions for the individual mandate include those who would still have to pay more than 8 percent of their annual income despite subsidies and rebates, those opposing it for religious reasons, Native Americans and those in a correctional facility.

“But don’t go out and get incarcerated,” Lindeen said.

Kalispell was the sixth city Lindeen had visited on her statewide tour to explain the changed landscape of health insurance.

More information on rates, subsidies and any other questions can be found at www.montanahealthanswers.org, www.healthcare.gov. For small business answers, go to www.sba.gov/healthcare.

Reporter Ryan Murray may be reached at 758-4436 or by email at rmurray@dailyinterlake.com.