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Pandemic underscores need for reforms in healthcare transparency


December 9, 2020

By Senator Cary Smith

The covid pandemic has brought healthcare affordability into the spotlight like never before. The question is whether this crisis will be an impetus to rein in the alarming growth in healthcare costs or if we will go right back to business as usual.

At both the state and federal levels, reformers are working to make improvements to both the quality and affordability of healthcare.

In Congress, support is building to take up legislation to curb surprise medical billing. The impact of surprise medical bills on patients can be devastating, with families left with thousands of dollars in unexpected medical expenses. In Montana we were able to eliminate some of the most egregious surprise medical bills a few years back. However, the problem persists and Congress is well positioned to craft a solution that addresses bad actors while protecting our rural healthcare providers.

During the upcoming Montana legislative session, we will be working on solutions to increase transparency in healthcare pricing in order to drive down costs.

One proposal is the Right to Shop Act, which would require transparency in healthcare pricing in order to allow consumers to shop for the best price. Consumers who can show their shopping efforts resulted in a lower cost to the insurer would actually receive part of the savings back.

This is just one idea percolating in Helena, but the core concept is an important one: incentives matter in a market. The healthcare market is broken because the incentives are misaligned.

Insurers don’t have a powerful incentive to protect customers from surprise medical bills because the insurer isn’t on the hook to cover the cost of an unexpected bill. And healthcare providers don’t have the proper incentive to provide pricing transparency to patients because in the vast majority of cases those patients aren’t paying the bill—the insurer is.

We’ve made some small steps in recent years towards fixing healthcare markets by increasing competition—such as creating a market for direct primary care providers (an excellent example of pricing transparency) and allowing health sharing ministries to provide a low-cost health insurance alternative.

Montanans have benefited from these moderate measures—but really we’ve only been able to slow the growth in healthcare prices rather than truly make things more affordable. Much more needs to be done to start to finally reverse the massive increases in healthcare costs that resulted from the Obamacare disaster.

Legislators need to support market solutions to protect our patients and ensure access to quality care. But powerful special interests have stood in the way of reform before, and I expect they will pull out all the stops to keep the status quo. Perhaps this time will be different—healthcare is much more on the minds of Montanans today than it has been during past legislative sessions. Our job is to turn those concerns into positive actions that benefit all Montanans.

Cary Smith is the Majority Leader of the Montana Senate. He represents Senate District 27 in Billings.


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