Rosendale: Health care proposal a good first step

Montana State Auditor Matthew Rosendale hailed the new Republican legislation to repeal and replace the Patient Protection and Affordable Care Act, also known as Obamacare as a good first step Monday, but said more needs to be done to reduce health care costs and improve services.  

Rosendale said he sent a letter to Sens. Jon Tester, D-Mont., and Steve Daines, R-Mont., and Tennessee Republican Senator and Senate Health, Education, Labor and Pensions Committee Chair Lamar Alexander, R-Tenn., listing what he says are several barriers that prevent Montana from acting to reduce costs and improve health care services.

"Right now, as you look at the plan that came out, they are removing some of those barriers, but we are certainly hoping they remove a few more," Rosendale said.

He said the health insurance market in Montana is "extremely stressed," with costs rising and the number of options shrinking for consumers.

Though the state Department of Public Health and Human Services reports the number of uninsured has gone down in Montana from 20 percent in 2012 to 7.4 percent in 2016, Rosendale said a similar number of people who had affordable insurance previously are now paying more than they had before.

"It's a terrible trade-off with both of those paying more for the health insurance they actually receive," he said.

Medicaid Block grants

The state did accept federal money in 2015 to expand Medicaid coverage to 70,002 people, and hospitals are providing free medical care in their emergency rooms to the uninsured, he said, but it has not left hospitals in better financial condition.

Rosendale said his letter recommends the federal government delivers its share of Medicaid money through block grants for states. Rosendale said that would allow states more flexibility in crafting programs to meet their specific needs.

"I just think that the Legislature and the governor are just much-better-suited to develop a plan on how to utilize Medicaid resources than elected officials that are 2,200 miles away from here," Rosendale said, adding that he is certain any plan created by the state to deliver those services would be better than the existing program.

Rosendale said a large number of waivers issued after Obamacare and in states with Medicaid expansion shows that the federal government knows the existing Medicaid program can be better administered by states.

He also said block grant funds should be used to empower the Medicaid population to put that money in a health savings account, which would allow Medicaid enrollees to save and better manage their healthcare.

Rosendale said people who do not receive Medicaid also should be allowed to put money in a health savings account. Existing limits should be raised on how much a person can contribute annually to such an account and money in those accounts should be able to be used for any health-related needs, he said.

Individual health insurance is not exempt from being taxed the way health insurance provided by employers is and that should be changed, he said.

"What we have to try and do is have a tax plan or a tax program that starts being more consistent across the board on how different people are treated when they are purchasing products to accommodate their healthcare needs," he said.

Rosendale said that Obamacare's ban on insurance companies excluding people with pre-existing conditions should not be included in the bill being pushed by congressional Republicans. Rather, he said, that should be decided by individual states.

"I think that the more we can remove federal mandates from what we are trying to do here, the better off we will be," he said.

Instead, Montana should create a high risk pool for people with pre-existing conditions. Rosendale said that until last Summer Montana had a high risk pool.

He said his office is now looking at programs in Maine and Idaho for guidance in establishing such a pool.

High-deductible plans where consumers pay more out of pocket and less in monthly premiums should also be made available, Rosendale added.

"There are folks that much rather have a higher deductible and basic medical coverage and then they would have certain things they would like to have covered and for us to go in and mandate a whole list of additional things that is driving the cost," Rosendale said.

He said several bills being taken up by the Legislature now could help increase options for consumers. One, introduced by state Sen. Cary Smith, R-Billings, would allow  consumers to retain the services of primary physicians through direct payments rather than insurance.

Another bill also sponsored by Smith would require insurers to post on their website information on costs before  a medical procedure is carried out. That would allow people to compare prices on insurance and provide incentives for companies that provide such information, Rosendale said.