Congress may be undecided about former President Barack Obama's Affordable Care Act, but Montana lawmakers are pushing through legislation they believe will bring down health care costs and increase price transparency regardless of what happens in Washington.
A half-dozen measures were still alive as the 2017 legislative session enters its final days. They include authorizing a high-risk insurance pool, allowing out-of-state insurers to sell policies in Montana, better informing patients about health care prices and giving tax credits to small companies that offer high-deductible plans to their employees.
"If all of this legislation was to pass, I think you will start seeing the cost curve for health care begin to bend down," Commissioner of Insurance and Securities Matt Rosendale said Monday. "Once you have true competition in the marketplace, then people will use their dollars where they see the best value."
Most of the bills are sponsored by Republican lawmakers who anticipate the Affordable Care Act will be repealed or significantly changed in the future, after an initial attempt at reform failed in Congress in March.
The legislation has generally been opposed by minority Democratic lawmakers. The bills also will have to escape vetoes by Gov. Steve Bullock, who already rejected one measure that would have authorized doctors, optometrists, dentists and other health care providers to enter into payment agreements directly with their patients.
Insurance companies are now trying to determine their rates for 2018 after several consecutive years of double-digit increases in the individual market served by the Affordable Care Act's exchanges. Blue Cross and Blue Shield of Montana and PacificSource lobbyists have been actively tracking the bills, endorsing some and seeking to kill or amend others with one overarching goal - to steady that fragile individual market.
"What we need in that individual market is stability," said Blue Cross spokesman John Doran. "We need solutions that provide stability and predictability."
Two measures will be on the House floor on Tuesday. One by Sen. Cary Smith, R-Billings, would offer companies with fewer than 50 employees that offer high-deductible health insurance plans a $250 tax credit per worker on that plan. It also would allow Rosendale to vet high-deductible health plans other states are using.
That measure is up for an initial vote in the House on the same day representatives will take a final vote on a resolution by Rep. Kathy Kelker, D-Billings, calling for a study on health care price transparency.
Last week, the Senate passed a bill by Rep. Rob Cook, R-Conrad, that would authorize Rosendale's office to create the framework for a high-risk pool or state reinsurance program. The idea is to make sure people with pre-existing conditions are still covered if the Affordable Care Act goes away, if insurers abandon the federal exchanges or if premiums become unaffordable.
Democratic lawmakers opposed the idea, saying it gives Rosendale a blank check to create a plan without their approval, and that the state's last try at a high-risk pool wasn't adequately funded.
"We tried it before," said Sen. Mary Caferro, D-Helena, during the floor debate. "It didn't work at keeping premiums down for everybody and it didn't really provide coverage for people with pre-existing conditions."
The House must agree with the Senate's amendments before that bill goes to Bullock.
Two bills are meant to better inform patients about prices for health care services. They would require insurance companies to disclose health care service costs, and which services are in their network. They would also require insurers have a website that shows the costs of different health care providers.
One bill is back in the House for approval of Senate amendments. The other has passed the Senate and is yet to be scheduled on the House floor.
The sixth bill would allow out-of-state insurers to sell policies in Montana, and it, too, is awaiting a House floor vote. Smith, the sponsor, said it would introduce more competition, but Democrats worry that the out-of-state policies won't cover all health services.