Setbacks in Montana - A Below Average DPC Bill Met with the Governor's Veto

I received some surprising news from multiple friends recently.  It turns out that Montana had pending DPC legislation.  SB 149 authored by Sen. Matt Rosendale had been passed by the House and Senate and placed in the hands of Governor  Bullock who decided to veto the measure on April 27, 2015.  

I wish that the authors of the legislation had reached out to myself or others at the Direct Primary Care Coalition.  The bill has many problems that could have been remedied to make for stronger legislation in all likelihood would have garnered wide bipartisan support (just like the other ten states that have passed DPC legislation with wide support).  

The two most important problems were the poor definition of DPC and the lack of any true business of insurance protection.  The bill defined DPC as essentially any prepaid primary care plan using the language  "a plan offered by a primary care provider, group, entity, or practice in which fees are collected on a prepaid basis in order to provide primary health care for enrollees." As written the legislation provided some of the weakest language protecting physicians from the insurance commissioner anyway "(15) This code does not apply to direct primary care provider plans established pursuant to [sections 1 through 4] IF THE PLAN DOES NOT ASSUME FINANCIAL RISK or agree to indemnify for services by a third party."  The emphasized phrase could be used by an aggressive insurance commissioner to swallow the entire protection offered in the bill.  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.

Nonetheless, the Governor decided to justify his decision with one of the most ignorant and uninformed commentaries about DPC I have encountered.  Here is an excerpt (and a link to the full veto letter)

"Direct primary care provider plans offer little or no added value to most consumers. They charge fees for treatments already covered by a consumer's health insurance, such as preventative care that insurance covers at no out-of-pocket cost to the consumer. Moreover, many insurance policies already offer flat-fee office visits similar to what SB 149 contemplates.
SB 149 has been touted as cutting insurance-related administrative expenses. Yet the bill does not prevent providers from selling these plans to some patients while accepting insurance for others ¬≠meaning the provider carries the same insurance-related overhead, but receives another income stream at the consumer's expense. SB 149 is bad for Montanans, because it allows providers to charge unnecessary fees for service already covered by insurance and fails to deliver the administrative savings it promises." 

To Gov Bullock - please do some research - multiple academic studies have demonstrated the value of DPC practices, second - your concern about "double dipping" is unfounded, since this practice is prohibited in section 3 of the bill, and third - even if DPC had no value to any consumers, it is not causing any harm, so why attempt to prohibit patient choice?  The bill was revenue neutral and did not ask for any funding from the state of Montana. Why block patient freedom? The bill passed the House by a surprisingly close vote of 57 to 41 and the Senate by a vote of 29 to 20. This is highly unusual for DPC legislation, which typically has broad base bipartisan approval.  I suspect this occurred due to 1) errors in appropriately defining DPC within the legislation, and 2) communicating to the legislators why the legislation is helpful

In summary, given the weak and hollow protections from the insurance commissioner and the poor definition of DPC I am not too saddened by the legislation's failure.  I am more concerned about the confusion that clearly continues to surround the DPC movement. Resolving this confusion remains one of the central missions of DPC Frontier.