Photo by Hannah Kearse


Montana 2020 Elections

Montana’s Attorney General visited the Madison Valley Medical Center on his campaign trail for governor.

Tim Fox is one of three Republican candidates running for governor in Montana’s 2020 elections. Fox and his running mate Jon Knokey, the former state Rep. out of Bozeman, spoke with MVHC leaders about rural healthcare as a Critical Access Hospital Jan. 30. Fox and Knokey addressed more issues close to Madison County later in the day at the Ennis Pharmacy.

Fox grew up on the edge of the Crow Indian Reservation in Hardin, Montana, adopted by a Native Crow family. He is the youngest of six brothers. Fox first entered public service in 1990. He helped develop an environmental regulatory program for the Montana Board of Oil and Gas Conservation, which administers the Montana oil and gas conservation laws and regulates oil and gas exploration and production. After practicing law in Billings since 1988, Fox moved his wife, Karen, and their four daughters to Helena.

He worked on Gov. Marc Racicot’s reelection campaign, became a division administrator of the Montana Department of Environmental Quality and vice president of Mountain West Bank. In 2012, Fox was elected Montana’s 24th attorney general. He was reelected to the attorney general office in 2016, where he broke the state voting record as the most voted statewide Republican candidate in the history of Montana. Fox looks to the governor’s office as his next role in the public sector. A divided house unites on the ballot as the University of Montana graduate paired up with Knokey, a former Bobcat quarterback, as a running mate.

“Too often I think Helena forgets about frontier Montana, rural Montana, and this small-town kid won’t do that.”


Critical Access Hospitals ensure rural communities, like Madison County, access to healthcare. Madison Valley Medical Center and Ruby Valley Medical Center succeed because of CAHs’ 101% cost-based reimbursement for Medicare and Medicaid patients and grants. The Big Horn County Memorial Hospital in Fox’s hometown of Hardin is a CAH. “If it weren’t for that hospital being in Hardin when my dad had his heart attack,” Fox said. “I wouldn’t have had a number of extra years to be with him.”

One of Fox’s proudest contributions during his eight years as Montana’s attorney general, is forming the Montana Healthcare Foundation. The Blue Cross Blue Shield of Montana and Health Care Service Corporation merger of 2013 generated $40.2 million. MHCF was created to facilitate the state law requirement that the proceeds went to a non-profit foundation whose mission is to improve the quality, availability and awareness of healthcare programs and services for Montanans.

Madison County and the Madison Valley Hospital Association have received grant money from the MHCF to support integrating behavioral health into primary care. Behavioral health focuses on treating disorders like substance abuse and addiction. According to MVMC CEO Allen Rohrback, CAHs receive less reimbursement for behavioral healthcare than other healthcare services. “To some you’ll have to talk about the bottom line,” MVMC Dr. RD Marks said. “But we’re talking about people’s lives.”


Fox supports delisting the Yellowstone Grizzly Bear, while being aware of unpredicted changes that could further threaten the species. Delisting would transfer the management of the population to the states. Areas around grizzly bear recovery zones, like Madison County, have witnessed the growing number of grizzly bear conflicts in recent years. The conflict resumes in the courts as groups disagree over the management of the Yellowstone Grizzly Bear.

Some fear that grizzly bear populations have not reached a point that secures their existence and benefits to ecosystems. For the same concerns of existence and the ecosystem, some support delisting the Yellowstone Grizzly. Others worry trophy hunters will devastate a social construct around the grizzly bear, if delisted. “My family and I have deeply held cultural and spiritual beliefs and at its core, it’s Mother Earth and our wildlife,” Fox said. “It’s difficult sometimes to understand the connection between an animal like the grizzly bear, but I can tell you it’s a big deal for our Native Americans. I think we have to respect that and have to try to understand that, and we have to factor that in in the wildlife management decisions that we make.”

Livestock depredation at the paws of grizzly bears is another aspect of grizzly bear management. It is a major challenge for ranchers. Twenty-nine predations of livestock in the Gravelly Range were confirmed in 2018, and it is likely there were more. U.S. Wildlife Services confirms livestock depredations for Montana ranchers to receive full market value compensation. But for every depredation accounted for, some are missed, according to Associate Director of Western Landowners Alliance Cole Mannix.

Due to the limited resources of USWS, it can take a long time to get on location, which makes confirmation less likely. Fox suggested extending the training of confirming livestock depredation to more wildlife departments, like Montana Fish, Wildlife & Parks. “We need to see if we can get rid of those roadblocks and hurdles, so more people can do those reviews and make sure that our farmers and ranchers and others are compensated in a more timely way.”


“It’s part of our DNA as Montanans for sure. They belong to all of us, and I support multiple use, multiple access,” Fox said. “I’ve done that in the state land board. I’ve voted for every conservation easement in acquisition of easements to open landlocked state sections so that we can access them.”

Five elected officials, including the attorney general and governor, make up the Department of Natural Resources and Conservation’s Montana Land Board. DNRC manages timber, surface and mineral resources on state trust lands to help fund schools and other Montana institutions. Montana’s coal severance tax trust fund, which receives half of the coal severance tax collections, allocated about $17.2 million to the school facilities fund in 2018.

“Under state law, the state land board have an obligation to enhance the proceeds to the school trust,” Fox said. “That is very important to me because I’m a product of a public education and I believe highly in the worthiness of a first-class education, so I’m supportive of responsibly developing our natural resources.”

Fox is for expanding Montana’s coal into foreign markets like Asia. As Montana’s attorney general, he sued Washington state for denying port expansion permits that would make the expansion possible. For the first time in Montana’s history, the state has made money available to develop affordable multi-family rental housing. The $15 million to the Montana Housing Board came out of Montana’s coal severance tax, which collected nearly $61 million in 2018.


A shortage in affordable housing is widespread in Montana. Fox supports altering aspects of housing development to lower housing costs. Fox holds regulations as a major contributor to the lack of affordable housing in Montana.

But according to a 2019 analysis from the Pacific Northwest’s largest economic consulting firm, EcoNorthwest, there is no evidence that regulatory or other constraints on development have had significant impacts on Montana’s housing supply since 2000. Providing developers and builders a cheaper path to construct affordable housing comes with mixed reviews.

“Economic prosperity is the key to the success of Montana in almost every realm,” Fox said. “Whether it be affordable housing, building your small business, you name it.” Fox also considers Montana’s dated tax structure to be at fault for an affordable housing shortage.

On average, Montanans pay 30% more on property taxes than the national average. “There’s an interim committee that’s studying our entire tax policy structure,” Fox said.” We need to take a good hard look at that because it’s antiquated. It was really, for the most part, formed in a time in which we could rely on coal, oil and gas, the timber industry and a lot of other natural resource sources of tax revenues that in this changing world are not as reliable as they have been.”

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The Madisonian

65 N. MT Hwy 287
Ennis, MT 59729

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