HELENA — Republicans are injecting instability into federal insurance marketplaces by suggesting lowering subsidies for people who buy coverage, and it's a "slick trick" to ensure the failure of the exchanges, the head of one of Montana's largest hospitals said Thursday.

Republicans favor the phrase "death spiral" when discussing the health of the Affordable Care Act, also known as Obamacare. One of the key provisions of the law, passed in 2010, was setting up marketplaces where people who didn't get insurance from their job or through federal programs like Medicare or Medicaid could buy coverage, often with subsidies covering much of the cost.

Great Falls-based Benefis CEO John Goodnow said the lifespan of the Affordable Care Act has been shortened because insurance companies are pulling out of the exchanges "because of all the fear that's been created over funding."

"All you have to do is threaten to defund the subsidies," he said Thursday on a panel in Helena organized by the Montana Nurses Association to discuss the bill.

The Better Care Reconciliation Act is the Senate version of a Republican bill to execute that party's long-promised repeal and replace of the Affordable Care Act. The Senate did not vote on the bill before their Fourth of July break because of a lack of enough support in light of a Congressional Budget Office estimate it would reduce the number of people with health insurance by 22 million.

Most of the discussion about the bill in Montana has focused on expected cuts to Medicaid by ending sufficient funding of an expansion of the program that offered coverage to the working poor and cuts to the overall program of $5.3 billion in federal funds in Montana alone over six years. About 120 groups in the state have come out against the bill. On Thursday, state Department of Public Health and Human Services director Sheila Hogan said the bill would cause 133,000 Montanans to lose coverage by 2022.

The Senate bill keeps the marketplace, which about 8 percent of Montanans use to buy coverage, but would reduce subsidies for people who purchase insurance on it.

About 85 percent of Montanans that buy on the exchange get subsidies. There are three insurance companies that sell on the exchange: PacificSource, Montana Health Co-op, and Blue Cross Blue Shield of Montana. Last summer, Blue Cross said it needed to raise its rates an average of 62 percent while PacificSource requested a rate change of almost 20 percent.

Blue Cross spokesman John Doran said at the time the increases were because the marketplace population used far more medical and pharmacy services than anticipated.

Increased rates and companies dropping out of the exchanges entirely — something that has not happened in Montana — have been cited repeatedly by Republicans as evidence of the Affordable Care Act's incipient demise.

On a tele-town hall earlier this month, Montana's Republican Sen. Steve Daines mentioned several times that a third of the counties in the country only had one insurer on the marketplace.

"I would just ask Sen. Daines to think about the people of Montana and think less about politics and do the right thing for the people he represents," said Todd Wampler, a member of the Montana Medical Association and a doctor in Helena.

On Thursday, Daines reiterated what he wants to see in a final version of the bill, which Senate Republican leadership has said will be amended further in the coming week or so and will need to be re-scored by the Congressional Budget Office.

"There are three things I'm looking to see in the Senate healthcare bill," Daines said. "We need to reduce premiums and make healthcare more affordable for Montana families, take care of those with pre-existing conditions so that they have access to care, and save and protect Medicaid for who it was originally intended for: the most vulnerable in our society."

Laura Terrill, vice president of external affairs for Planned Parenthood of Montana, was the most outspoken in discussing Daines.

While the senator did not take a stance on the bill during his tele-town hall, he did say that if the bill changed to no longer cut off Medicaid reimbursements to Planned Parenthood, which treats 15,000 Montanans annually, he could not support it.

"Our patients don't come to us to make a political statement," Terrill said. "They come to us to receive the health care they need and deserve."

Terrill called the bill the worst in a generation for women's health.

"It's not surprising to me not a lot of U.S. senators want to go back to their constituents and talk about the benefits of this bill, because it has very few," she said.

Daines, who has spoken out against abortion and Planned Parenthood in the past, has argued for moving funding to the 17 community health centers around the state, saying there are only five Planned Parenthood locations.

Goodnow told people to reach out to their senators. "The time to get to your senators is right now. People really need to be getting to their senators, particularly during this recess."

"Tester's not the issue," Goodnow said of Montana's other senator, Democrat Jon Tester. "Tester is dead set against this. … This is an issue for Montana with just Sen. Daines."

Dick Brown, president and CEO of the Montana Hospital Association, estimated a vote could come at the end of July.