Montana Lawmakers Prepare Direct Primary Care Bill

Published January 11, 2017

Montana lawmakers will introduce legislation in 2017 to exempt direct primary care (DPC) practices from insurance regulations, having rewritten a DPC bill vetoed by Gov. Steve Bullock (R) in 2015.

DPC practices offer a range of preventive care services, tests, office visits, and minor procedures to patients for a monthly membership fee averaging $80, paid directly by patients instead of through insurers.

The draft legislation resembles a proposal Maine lawmakers have said they will introduce in 2017. (See article on p. 5.) Thirteen states have laws specifying DPC agreements do not constitute health insurance, according to DPC Frontier.

Veto and Learn

The 2015 DPC bill, Senate Bill 149, passed each Montana legislative chamber with Republican support and Democrat opposition. Bullock vetoed the legislation, saying in a letter he feared physicians would “double dip,” billing patients’ insurers in addition to charging patients monthly fees.

The bill prohibited providers from double dipping.

State Sen. Cary Smith (R-Timbercove), an expected sponsor of the new DPC bill, says Montana’s insurance commissioner poisoned Bullock against the 2015 legislation.

“I think a lot of what the governor did was based on the recommendations of the insurance commissioner that you just can’t have anything out there that isn’t regulated by government,” Smith said. 

Dr. Philip Eskew, founder of DPC Frontier and a practicing attorney, says prospective regulation by insurance commissioners deters physicians from opening DPC practices.

“The entire point of DPC legislation should be to appropriately define DPC so that physicians willing to practice under the terms of the legislation are protected without any doubt from the insurance commissioner,” Eskew wrote on his DPC Frontier blog following Bullock’s veto.  

New Sherriff in Town

The winds have changed for DPC legislation in Montana since 2015.

State Sen. Matt Rosendale (R-Glendive), sponsor of the original bill, was elected the state’s insurance commissioner on November 8, 2016. Additionally, President-elect Donald Trump and Republicans in Congress have said they plan to repeal the Affordable Care Act (ACA), including Obamacare’s individual mandate, which penalizes people for not buying health insurance.

Smith says the likely repeal of Obamacare increases the urgency for Montana officials to let patients access health care through alternative payment models.

“If the governor chooses to veto [the new bill], with Obamacare going away, he’s choosing not to give any alternatives to a system we’re not going to have any longer,” Smith said.

Seeking Bipartisan Support

Eskew, who helped Smith draft the new legislation, says the bill is designed to garner more bipartisan support than SB 149.

“I worked with [Smith] and his legislative assistant, and in less than two weeks, we seem to have some concise legislation that everybody is happy with,” Eskew said. “This bill is clean enough that I think it should have enough support to override a veto from [Bullock] anyway,” Eskew said.

At least one House member is expressing interest in passing DPC legislation in 2017.

“I would like to initiate the process of allowing doctors to establish DPC clinics in Montana,” state Rep. Brad Tschida (R-Missoula) told Health Care News.

Ready, Set, Free

Smith says his bill would reduce the cost of health care in the state by making it easier for physicians and patients to eliminate middleman-insurers.

“One of the very high costs of health care is insurance itself,” Smith said. “So, what this bill does is allow a person to enter an agreement with a health care provider without having to be involved with unnecessary regulations and having to work with a third-party person to handle their health care costs, as we have to with insurance companies. This will make health care more affordable for people.”

Republicans must prove themselves able to pass better health care laws than ACA, Smith says.

“We want to be ready to say we have bills that provide free-market solutions to replace Obamacare,” Smith said. “Knowing that Obamacare is going away, we want to make sure we start using some free-market programs to help reduce the high cost of health care.”

Tony Corvo ([email protected]) writes from Beavercreek, Ohio.

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