The Montana Legislature debated two bills last week that would give patients a more active role in determining the cost of their health care.
Senate Bill 100, introduced by Sen. Cary Smith, R-Billings, would give patients the option of directly determining payment options with their doctor for day-to-day care without having to go through insurance.
“This bill provides for the opportunity for an individual to go and talk to a doctor and say, ‘for a specific amount you will cover my basic health care needs,’” Smith said.
Smith introduced a similar bill last session that was ultimately vetoed by Gov. Steve Bullock. He said because the climate surrounding health care has changed, in part because of the potential repeal of the Affordable Care Act under President Donald Trump, that there is more of an appetite for direct payment options.
Greg Dorrington, representing the Montana Medical Association, said SB 100 opens the door for alternative payment models.
“The bill doesn’t mandate participation,” Dorrington said. “It empowers patient choice, it provides transparency in pricing.”
Senate Bill 96, also introduced by Smith, would give patients the “right to shop” for health care services. The bill would also give financial incentives for patients to shop in the form of shared savings. It also would increase transparency in pricing for individual services.
“We are very fond of the concept of transparency in health care and using that to bring down health care costs,” said Kris Hansen, representing the state auditor’s office.
Many argued that consumers are able to shop for everything except health services.
“It is rather insane that we accept that approach to shopping for one of the most important things we consume in this country,” said Cori Cook, representing Employee Benefit Management Services.
However, several insurance providers lobbied against the bill, particularly because of the incentives provided to consumers.
“This bill would incentivize consumers to ‘shop around’ for their medical services in a way they could actually have monetary gain,” said John Doran, representing Blue Cross Blue Shield.
Bruce Spencer, a lobbyist for America’s Health Insurance Plans, urged the committee to put off drafting a solution until there was some certainty about the future of the Affordable Care Act.
“We ask you to do it in a special session after we can see the whole picture, once Congress does what it’s going to do,” Spencer said.
Minimum wage increase tabled
The House Business and Labor committee tabled a bill last Tuesday that would have increased Montana’s minimum wage by almost $2.
House Bill 169, sponsored by Rep. Mary Ann Dunwell, D-Helena, would have made the state’s minimum wage $10.10 an hour by January of next year. Montana’s minimum wage is now $8.15.
Dunwell said a living wage in Montana is considered $14.40 for single individuals and $19 for a person with one child.
“This bill is a local economic driver,” Dunwell said. “It would prevent employees from going across the street for another quarter or 50 cents an hour more.”
Six people spoke in support of the bill. Galen Hollenbaugh, the deputy commissioner for the Montana Department of Labor and Industry, said 6.5 percent of Montana’s workforce consists of individuals over the age of 65. Roughly 94,000 workers are between the ages of 55 and 64. Hollenbaugh said that means a substantial portion of them will wind up retiring in the near future, which could hurt Montana’s economy if more workers aren’t lined up to replace them.
“There is no doubt that wage increases … will have some impact,” Hollenbaugh said.
Many other people, including business owners and representatives of interest groups, lined up to oppose the bill.
“I would urge folks to let the market set the wage rate here,” said Bridger Mahlum, government relations director for the Montana Chamber of Commerce.
Mahlum said the committee should consider legislation that would encourage businesses to increase wage rates of their own accord. Others argued that increasing the minimum wage would force businesses to increase prices.
Ken Beachy, owner of the Cozy Corner Cafe in Fairfield, said he believes a wage increase would only create further inflation. He said as wages increase for employees, the cost of workers’ compensation, insurance and unemployment would also rise, making it more difficult to keep prices down.
“It does not have the effect that is put out that it would,” Beachy said.
Campaign laws under scrutiny
The Montana House State Administration Committee heard three bills last week that would make changes to existing campaign regulations and finance laws.
House Bill 186, introduced by Rep. Forrest Mandeville, R-Columbus, would eliminate the requirement that candidates with no party affiliation gather signatures to get a spot on the ballot. Under current law, independent candidates must gather 5 percent of the total votes of the winning candidate from the previous election in order to secure a place on the ballot.
HB 186 would also change the Montana Code to refer to independent candidates as those with “no party affiliation.” The bill would still require that candidates who wish to have a third party’s name attached to their candidacy on the ballot to reach the 5 percent signature requirement.
House Bill 199, introduced by Rep. Dave Fern, D-Whitefish, would allow incumbent legislators who are seeking re-election the following term to freeze their campaign funds until the next election cycle. Currently, campaigns are required to dissolve their accounts once the cycle ends.
“It seems redundant to go through the reformation of the account and action of borrowing funds,” Fern said.
The bill was opposed by Commissioner of Political Practices Jonathan Motl, who said the bill unfairly favors incumbents by giving them a financial advantage at the beginning of their campaign. Motl also said that because the money is a lump sum, it would be difficult to determine where exactly the money came from, creating transparency issues.
House Bill 50, introduced by Rep. Wendy McKamey, R-Great Falls, would make a simple change to existing campaign finance reports. The form candidates use now to disclose finance information does not require that individual contributions more than $35 include the date of receipt. McKamey’s bill would require that the date be listed.
“This will enable us to have … clarity and transparency,” McKamey said.
Debate begins on Build Montana Trust
Discussion over how to fund state infrastructure projects continued throughout the third week of the Legislature, with Sen. Jon Sesso, D-Butte, introducing a bill that would create a new trust fund.
Senate Bill 88 would divert money collected from the existing coal tax into a new trust called the Build Montana Fund. The bill would place $50 million into the trust, and would collect interest over the next 10 years before being spent on infrastructure. Sesso said SB 88 is designed to create long-term sources of funding infrastructure development.
“There are many projects, and simply not enough money,” Sesso said.
Gov. Steve Bullock proposed the Build Montana Trust during his campaign last year as a long-term funding solution. SB 88 is part of a broad package of bills carried by Democrats that would create and bolster existing infrastructure projects throughout the state.
Both parties have named infrastructure investment as a session priority, but there have been many disagreements about how to generate the money to pay for it. Bullock and the Democrats have proposed revenue from tax increases, as well as bonding measures, while Republicans seek to fund projects through cutting spending elsewhere.
Some supporters of SB 88 said while they believe the Build Montana Trust is a good starting point, it does not provide quick solutions to Montana’s infrastructure problems.
“It doesn’t provide much immediate relief,” said Steve Wade of the Montana Contractors Association. “We think there should be an effort made to try and provide some of that.”
Mahlum, with the Montana Chamber of Commerce, said he wants to ensure that the money goes toward “critical need” projects, and that funding is secured sooner rather than later for some projects.
Both Sesso and Bullock’s budget director, Dan Villa, said SB 88 does not specifically cite the kinds of projects those dollars would be used for.
“We’re silent on that,” Villa said. “We understand we have a long way to go from introduction of the bill to ultimately where we wind up.”
Protection for whistleblowers
The House Judiciary Committee heard a bill last Wednesday that would increase protections for state employees who report suspected fraud.
Rep. Kirk Wagoner, R-Montana City, sponsored House Bill 208, which makes it unlawful to retaliate against whistleblowers.
HB 208 considers everything from discipline and reduction of hours to termination of employment as retaliatory. The punishment for retaliation against an employee would be imprisonment for up to five years and/or a fine up to $20,000.
The bill got support from Carol Bondy, who said she faced retaliatory action from the Department of Health and Human Services when she reported misuse of state funds. Bondy said she was unable to access records that would have allowed her to prepare an adequate defense, and was also barred from speaking with any of her employees. Bondy’s case was widely covered late last year.
Bondy said the retaliation for reporting this misuse was “severe.” She said many state employees are charged with insubordination, which denies them unemployment benefits.
“That’s not fair for saying, ‘Hey, I think we’re doing something wrong, let’s look at it,’” Wagoner said.
The bill faced was opposed by Motl, who said it would be better suited as an amendment to existing whistleblower laws as opposed to creating a new criminal offense.
“It does not belong in Montana’s campaign and ethics practice laws,” Motl said. “It wasn’t discussed with our office, despite our office having a major responsibility for enforcement.”
Mark Murphy, a lobbyist for the Montana County Attorneys Association, said making whistleblower retaliation a criminal offense overburdens law enforcement who “don’t have any expertise in the area.”
“It’s not something that’s usually in the skill set that law enforcement brings,” Murphy said. “We don’t want the work.”
Michael Siebert is a reporter with the UM Community News Service, a partnership of the University of Montana School of Journalism and the Montana Newspaper Association.