Lindeen: Generally pleased with Legislature's work

Montana’s commissioner of securities and insurance said that, overall, she was pleased with legislation passed during the 2013 legislative session, including some issues she has been pushing for for several years.

State Auditor Monica Lindeen, head of the state office that regulates insurance and securities, said one of the bills that passed this year could help people understand what her office does.

The Legislature approved sending a constitutional referendum to the ballot in 2014 to change the name of the position from auditor to commissioner of securities and insurance.

“We’ve been trying (to get the name changed) for four years,” Lindeen said, adding that the proposed title would actually reflect what the office does.

She said her office had success on some policy issues she has been pushing for as well, such as the Legislature granting her office the right to review premium increases proposed by health insurance companies.

Montana had been one of two states that could not review proposals, and simply had to accept the increases, she said.

Now, her office cannot flat-out deny increases, but companies have to provide data and justification for increases, and if the commissioner’s office believes the increase is not justified, it can negotiate for a smaller increase.

She said, for example, that ability allowed South Dakota’s commissioner to negotiate an 18 percent increase proposed by one company down to a 6 percent increase.

Montana had to accept the 18 percent increase.

The Legislature also passed a bill dealing with patient-centered medical homes, which will make it easier for medical practitioners to transition into that model, set standards of care and set procedures on how insurance will cover the care in those models.

In a patient-centered

medical home, the patient participates in care provided by a team of health care providers.

The concept is to have a team working together to create a coordinated treatment for a patient, including preventative care and wellness, across different aspects of health care.

Another victory, Lindeen said, was the Legislature finding a way to fund Insure Montana, a program to help small businesses with two to nine employees insure those employees.

The program was funded using revenue from tobacco taxes, but as tobacco use drops and the cost of other programs funded by that revenue increased, the Insure Montana program lost its funding.

The Legislature finding a way to fund the program for the next two years is a victory for small businesses, Lindeen said, adding that 1,400 businesses participate, helping provide coverage for 8,000 Montanans.

In two years, the program will have to be revisited, she said, including seeing what need still exists after full implementation of the Patient Protection and Affordable Care Act.

Lindeen said she believes, especially considering how slowly the federal bureaucracy typically moves forward, that the implementation of that health care reform is going well.

“It’s actually amazing how much they’ve accomplished in the last three years, and getting to the point we’re at now,” she said.

Montana’s federally established insurance exchange — the 2011 Legislature denied Lindeen’s request to set up a state-run exchange — opens Oct. 1. Lindeen said people will be able to start buying insurance on the exchange on that date, which will go into effect Jan. 1.

Lindeen said three companies met a May 15 deadline to apply to offer insurance on the exchange. The companies on the exchange will be Blue Cross Blue Shield of Montana, PacificSource Health Plans, and the Montana Health CO-OP.

The online site for the exchange will help people figure out if they are eligible for Medicaid or the state Healthy Montana Kids children’s insurance program, and, if not, if they are eligible for tax credits or subsidies.

The exchange will also list the different plans offered by the companies — with varying premiums and how much of the health care cost will have to be covered by the individual versus the insurance — that are broken into different levels categorized as platinum, gold, silver and bronze plans.

Lindeen said people also need to be aware of the mandate to buy or provide health insurance — and its exceptions.

Under the law, people are required to buy health insurance. But that is dependent upon several factors — people who do not have to file a federal tax return, are below a certain level of income, who would have financial hardship if they paid the insurance premiums or are legally enrolled members of an American Indian tribe are exempt from the requirement.

People also may be eligible for tax credits or subsidies to help pay for the insurance.

Lucas Hamilton, Lindeen’s public information officer, said the exclusion for Native Americans is not intended to keep them from buying insurance. The intent still is to encourage them to buy insurance, including providing incentives to buy insurance and allowing their tribes to provide coverage, he said.

Lindeen said exemptions also apply to the rule that businesses provide insurance for their employees. Businesses with fewer than 50 employees — the majority of businesses in Montana — are exempt, and tax credits may be available for businesses as well, she said.

Many of the programs already in place — such as people being able to stay on their parents’ health insurance until they are 26 and the creation of a high-risk insurance pool — have received high praise from Montanans, Lindeen said.

She added that while the the cost of insurance is likely to bump up at first, programs are in place to level that increase out, and the increased number of people insured and the expected slowing of the increase in health care costs also should help mediate that.

She said one disappointment from the Legislature regarding the health care reform act was the defeat of expanding Medicaid coverage.

The U.S. Supreme Court ruled that the act was not unconstitutional, but that the federal government could not mandate states increase Medicaid coverage.

The House voted down expanding coverage in Montana to an additional 70,000 residents. Gov. Steve Bullock and most Democrats — and many Republicans — supported the expansion.

Lindeen said she believes passing the expansion would have been a good thing, providing coverage to more people and reducing how many people go to the emergency room and get care without being able to pay for it, often when conditions become more critical and more expensive. She also cited evidence that the expansion would have created thousands of new jobs in the health care field in the state and provided a boost to the economy, calling it an “incredible positive economic” benefit.

She said she will not take action to try to get the expansion put in place — “That’s between the governor and the Legislature” — but that she would not be surprised to see the issue come up on the 2104 ballot.

Montana already has passed on the first years of full federal funding, however, she added.

Under the Affordable Care Act, the federal government will pay the full cost of Medicaid expansion for three years, then drop to covering 90 percent of the costs fom 2017 on.

“We’ve given up millions of dollars,” Lindeen said.