Last week, incumbent U.S. Sen. Jon Tester, a Democrat seeking re-election in this year’s midterm, voted to overturn what he calls “junk insurance,” the short-term plans that don’t meet minimum insurance requirements under the Affordable Care Act.
It’s something his Republican opponent, state Auditor Matt Rosendale, has supported in his role as the state Commissioner of Securities and Insurance, saying the plans give consumers more options.
The two candidates in this year’s U.S. Senate midterm are at opposite ends of the spectrum when it comes to health insurance for Montanans.
Rosendale tells voters he’s advocated for options that present Montanans with more affordable choices. Tester say those plans and what Rosendale has supported as auditor are dangerous for Montanans and put more than 152,000 people with pre-existing conditions at risk.
The Affordable Care Act, also known as Obamacare, has dramatically changed the health insurance landscape in Montana. The uninsured rate here dropped from 20 to 7 percent, and nearly 100,000 gained coverage under Medicaid expansion.
But insurance premiums have continued to rise on the individual marketplace set up under the law, to the point where some families are priced out of plans.
Tester and Rosendale have drastically different approaches to how to make health insurance more affordable in this rural state of just more than a million people. Tester has called for a fix to the Affordable Care Act, which he voted to pass in 2010, saying it has critical protections for those with pre-existing conditions. Rosendale is in line with Republicans nationally who have long called for the law’s repeal.
“The old system didn’t work well,” Tester said of the landscape pre-Affordable Care Act. “The ACA was put into place and it has some good things in it. Folks with pre-existing conditions, it prevented insurance companies from kicking you off, which seems like a reasonable thing.”
Tester said he's disappointed a Republican-dominated Congress has focused just on doing away with the act, not improving it.
“There was a lot of things about it that could have been changed if we had better partisan agreement to work on fixing it,” Tester said. “Now it’s just about repeal, nothing to replace it with.”
Rosendale believes there needs to be more options for people to purchase health insurance or get health care.
“(Tester) hasn’t brought any solutions forward and I have, so people can accommodate their health care in a way that accommodates their budget, their personal needs and their personal choices,” Rosendale said. “We’re making sure people have options. We’re making sure the folks are being held accountable, and we’re trying to do that at the local level to make sure pre-existing conditions are always covered.”
In his role as state Auditor, which oversees the insurance industry in Montana, Rosendale has brought in primary care agreements that allow people to enter into direct contracts with primary care providers outside of the health insurance framework.
He’s also advocated for the short-term plans, the ones Tester calls “junk plans,” and allowed a religious health care sharing ministry to return to operating in the state after it was banned in 2007.
“People have a multitude of options to take care of their needs in a way that recognizes their budget, their specific health care needs and their personal choices,” Rosendale said.
The primary care agreements were twice vetoed by Montana Gov. Steve Bullock, a Democrat, who said they did not provide value to consumers and often charged for treatments already covered by insurance.
Medi-Share, the health ministry that is operating in Montana, was banned in 2007 because of fraudulent practices after it did not pay a claim for a Montana man who had cancer. Both products are not regulated by the auditor's office because they are not traditional insurance.
Medi-Share and the short-term insurance plans do not guarantee coverage to people with pre-existing conditions, one of the landmark protections in the Affordable Care Act.
“The bottom line is what they are trying to go to, those junk plans, they won’t work in Montana because they don’t cover anything,” Tester said of the short-term plans. “People have the false sense of security they’ve got insurance, but when they read the fine print or get sick and read the fine print, they don’t have the ability to get their health care paid for by these junk plans.”
Rosendale argues that with proper awareness on what the plans are and aren’t, Montanans who can’t afford coverage otherwise or don’t want comprehensive plans can find something that fits their needs.
“Absolutely folks need to have the freedom to select the type of health care coverage that they want, whether that’s through an insurance product or some other means. As long as people are made aware of those, they should be allowed to have the freedom to select the type of health care delivery they want,” Rosendale said.
Rosendale said people are looking for those other options because plans on the federal exchange set up under the Affordable Care Act are too expensive. It’s one of the few things Tester and Rosendale agree on, with Tester running a campaign ad saying Rosendale “rubber-stamped 23 percent increases in premiums" for plans sold on the exchanges.
When Rosendale was head of the Auditor’s office in 2017, Blue Cross and Blue Shield, the largest seller of plans on the exchange, submitted an average rate increase of 23 percent.
While the state auditor has the ability to find rates unjustified or excessive, the office cannot change them. Rosendale held hearings on the increases that year but did not find them unjustified or excessive.
Rosendale has said Tester is misrepresenting his office’s ability to control rates in the ad. Tester countered that Rosendale had the ability to find the rates unjustified and push the company to change them. That last happened in 2016 under the previous auditor and led Blue Cross to lower its proposed hikes from 62-65 percent to 58.4 percent.
While Rosendale has repeatedly said he wants to preserve protections for people with pre-existing conditions, things he’s introduced — such as Medi-Share or short-term insurance plans — don’t do that. And a repeal of the Affordable Care Act could leave consumers vulnerable.
Rosendale points to a program called reinsurance that he says would help work as an “invisible backdrop” to help insurance companies cover people with high medical needs who buy their insurance on the federal marketplace.
Insurance companies buy reinsurance to offset risks from covering people with high-cost and sometimes pre-existing conditions, essentially protecting the companies from high claims for that group of people.
The state is exploring whether a Montana-run reinsurance program would help lower the premiums people pay when buying their health insurance on the federal marketplace, in some cases by 10 to 20 percent.
What’s unclear, however, is how that would continue to guarantee protections if the Affordable Care Act was repealed.