HELENA – Montana lawmakers are considering bills that offer residents lower-cost ways to meet their health care needs, some outside traditional, regulated insurance plans.
State Sen. Cary Smith, a Republican from Billings, is sponsoring a bill that would allow health care providers to contract directly with patients for certain basic care, such as annual physicals, office visits, vaccines, bloodwork and stitches.
“One of the reasons why our health care is so expensive in America is because of insurance,” he told the Senate on Jan. 27. “When you can set up an arrangement with a health care provider and you don’t have to deal with the red tape, with the paperwork, with the government regulation … you can cut those expenses way down.”
The Senate passed the bill 36-14 and it was heard by a House committee on Tuesday.
Bills aimed at reducing drug prices, expanding telehealth and increasing competition among medical providers are also on the agenda.
DIRECT PRIMARY CARE
Eight clinics in the state are working as direct primary care providers under a 2017 memo issued by then-Insurance Commissioner Matt Rosendale. Smith’s bill would make the memo law and allow dentists, chiropractors and other health providers to offer similar direct care contracts to patients.
The practicerepresents “medicine the way it used to be with all of today’s medical advancements,” Dr. Cara Harrop of Polson told lawmakers. For a set fee, she said, patients are allowed unlimited visits and phone calls and she’s willing to meet them on weekends at the office.
“It’s a predictable, dependable revenue stream for physicians with the flexibility to deliver care to patients in ways the meet the patient’s needs, not a third party’s,” Harrop said. “And it’s about keeping people healthy,” rather than just caring for them when they’re sick.
The average monthly costs are $70 for adults and $20 for children, witnesses testified.
Dr. Todd Bergland of Whitefish said the direct primary care model allows him to spend more time with patients and less time entering information into a computer to file an insurance claim.
The proposed bill makes it clear such contracts aren’t insurance and aren’t regulated by the insurance commissioner. Contracts are required to spell out the charges and services and any complaints would be handled under consumer protection laws.
In 2015, then-Gov. Steve Bullock, a Democrat, vetoed a similar bil, arguing direct primary care providers duplicated services already provided under traditional health insurance and offered no added benefit to most people.
Supporters argue the direct care coverage could be used in combination with lower-cost catastrophic health coverage to help reduce health care costs.
HEALTH CARE SHARING MINISTRIES
A bill by Sen. Tom McGillvray, a Billings Republican, would put into law another 2017 memo by Rosendale, who is now Montana’s representative in the U.S. House, that allows health care sharing ministries to operate in Montana with the understanding that they are not insurance.
Under such programs, people who share similar ethical or religious values pay a monthly fee and share each other’s eligible medical costs after a deductible has been met. Basic care, such as office visits and vaccines, are typically not covered.
About 18,000 Montanans are covered under health care ministries, McGillvray told members of the Senate Business, Labor and Economic Affairs committee. The committee passed the bill 8-3 on Tuesday.
Health care sharing organizations ask that people shop around and negotiate the cost of major treatments and commit to live a healthy lifestyle. Some block maternity coverage for unwed mothers, payment for in vitro fertilization and treatment of medical issues caused by drug, alcohol or tobacco use.
Opponents questioned whether consumers would understand the limits of their coverage under primary care agreements or health care sharing ministries, but supporters say the contracts are clear.
PRESCRIPTION PRICES
A bill that would require drug manufacturers and pharmacy benefit managers to provide more information to state regulators is moving through the Legislature. The bill, by Sen. Steve Fitzpatrick, a Great Falls Republicn, would require drug manufacturers to disclose the wholesale price of drugs so the insurance commissioner can post the information on a website.
Drug manufacturers would also have to provide more information when drug costs increase, including the cost of research and development and the reduced profit after name-brand drugs move to generics.
Under the bill, pharmacy benefit managers would have to disclose to health insurance issuers any rebates they receive from drug manufacturers, how much is retained by the pharmacy benefit manager and how much is passed on to the insurer.
Health insurers would also be required to report the 25 most frequently prescribed drugs, the 25 drugs that caused the greatest increase in total plan spending over the prior year, and the impact of the cost of prescription drugs on premiums.
The bill has passed the Senate Business and Labor committee unanimously. A similar bill was tabled during the 2019 Legislature.
A bill that sought to limit the monthly cost of insulin to $35 was tabled in committee.
OTHER BILLS
Montana lawmakers are also considering a bill that would require group health insurance plans to cover visits by telehealth if the services are otherwise covered by the policy.
Another proposal would eliminate a requirement for government permission to build or expand health care facilities, with the exception of long-term care facilities. The intended effect of the Certificate of Need law is to limit competition, said sponsor Rep. Matt Regier, a Kalispell Republican.