After last week’s proposal by legislative Republicans to establish a baseline budget for the state’s health and human services budget $1 billion lower than what fellow GOP Gov. Greg Gianforte recommended, the Democrats offered their vision of legislation that would help Montanans.
On Wednesday, a group of lawmakers presented three bills that would change healthcare in Montana. The state’s Department of Health and Human Services currently takes up more than 40 percent of the overall funding and covers 16 different divisions.
The first proposal, championed by Rep. Mary Caferro, D-Helena, would extend the Health Link program that focuses on supporting more healthcare professionals, especially for rural areas. The bill, LC1337, was still listed in draft form on Tuesday and the specific text was not available online.
“This is all about jobs, jobs, jobs,” Caferro said.
She said because the program is already up and running, extending it would not create a new expense.
Lawmakers on the other side of the political aisle said they are open to looking at the legislation proposed Wednesday.
“Senate Republicans will gladly work with anyone who has thoughtful proposals to create good-paying jobs, get Montana’s economy going, lower health care costs, and increase access to affordable health care,” said Senate Republican spokesman Kyle Schmauch.
Sen. Shane Morigeau, D-Missoula, is the sponsor of LC1163, which he said would mandate hospitals and clinics to provide upfront costs to patients before elective procedures so they would better understand the details.
“Many have lost trust in the healthcare system because they have been surprised by bills. This would require more transparency up front,” Morigeau said.
The draft of the legislation has not been made public, but Morigeau said the proposal would not be required for emergency or urgent care.
Katy Peterson, the vice president of communications for the Montana Hospital Association, said her organization is generally supportive of price transparency, but had not seen the bill.
She noted that federal legislation will require more transparent pricing on Jan. 1, 2022, and so Morigeau’s bill may not change what hospitals and clinics are already planning.
Morigeau, who ran for state Commissioner of Securities and Insurance, said that he wanted to make sure that transparency was enshrined in state law because federal legislation and court battles are constantly changing. He also said that he hopes his bill will be more proactive.
Currently, Morigeau said many hospitals and health systems have their prices online, but patients can’t find them or don’t know that. This would make sure providers present them with written documents, much like the other raft of disclosures patients typically get before a medical procedure.
“We support meaningful consumer information,” Peterson said. “We have found that prices don’t matter; what matters is out-of-pocket cost.”
Out-of-pocket costs are something that hospitals and clinics don’t have access to. For example, those same healthcare systems have a cost sheet, but that may not be helpful to those with insurance. That’s because what patients have to pay is often what they want to know, and it’s what hospitals can’t say.
“Hospitals don’t have that information. That’s an insurance issue,” Peterson said. “It’s just as difficult for us.”
Finally, LC1492 would require health insurance plans to cap costs of insulin at no more than $35 every 30 days. Rep. Jessica Karjala, D-Billings, pointed out that some Montanans can pay more than $2,000 total for seven vials of insulin.
“This would put as much as $2,000 back into the pockets of Montanans with diabetes,” Karjala said.
She also pointed out that the number of Montanans suffering with the disease has jumped from 2.9% in 2000 to 6.4% in 2018.
She said similar legislation has been adopted in other states, and health insurance providers have said the cap has provided a minimal increase in expense to their bottom line. She said that while $35 may not be the price point that is set by lawmakers, she pointed out that most diabetic patients wind up spending from $200 to $400 per month out of pocket, and this legislation aims to lower that amount.
Karjala’s bill would regulate employer-sponsored health plans, which operate under federal guidelines first adopted in 1974. Her proposed bill would not affect those on state-sponsored programs.
While she admitted that requiring a cap on out-of-pocket insurance price could result in an increased premium as insurance companies try to recoup the costs, she said the cost would be spread throughout the pool of those insured meaning small, incremental costs for a large group, rather than crippling costs for individuals.
“Yes, it’s cost-shifting, but isn’t that the point of insurance?” Karjala said.