Montana: Disingenuous State Auditor Rosendale gives some TERRIBLE COVID-19 coverage advice

I've only written about Montana State Auditor (which includes acting as the Insurance Commissioner, as far as I can tell) Matt Rosendale a couple of times before. The first was in October/November 2017, when he pulled a cynical, disingenuous dick move by deliberately framing a non-profit insurance carrier into losing money for purely political reasons:

Montana commissioner chides insurance companies for raising rates, despite earlier offers to help

BOZEMAN — Montana's insurance commissioner chided two companies for raising rates on health insurance policies offered under the Affordable Care Act after federal subsidies ended, despite earlier telling them they could modify their rates if circumstances changed, the Bozeman Daily Chronicle reported.

...Matt Rosendale said he was "extremely disheartened" that PacificSource and the Co-op increased their premiums, adding that he had been assured by the companies that with or without the cost-sharing reduction payments they would be able to honor the rates they first submitted.

However, the Chronicle, through a Freedom of Information Act request, obtained letters Rosendale wrote to the companies in August saying that his office was aware of the uncertainty surrounding the Affordable Care Act and he would work with them to "ensure rates are modified to address new circumstances."

..."Why is he frustrated with something that was foreseeable?" Ward asked. "To be honest, it seems like a political game." Rosendale is seeking the Republican nomination for the U.S. Senate seat held by Democrat Jon Tester.

Read the whole story for details, but what basically happened was this:

  • Most health insurance industry experts were pretty sure that Donald Trump was going to cut off CSR payments sooner or later.
  • Some insurance carriers prepared for this possibility by jacking up rates; others were reluctant to do so.
  • In Montana, Rosendale apparently told the 3 insurance carriers in the state to stick with lower increases for the moment, assuring them that if and when Trump lowered the boom, they'd have his blessing to go ahead and jack up rates as necessary later in the summer.
  • When that did happen, Rosendale suddenly developed amnesia: "Blessing? What blessing? I said nothing of the sort! You have to stick with your original rates!"
  • A FOIA request proved that Rosendale was lying about not giving any assurances

The second was nearly a year later, when Rosendale scrambled to rewrite history regarding his record on protecting coverage of pre-existing conditions.

THEN:

And then there is Matt Rosendale, the Republican candidate who running against two-term incumbent Sen. Jon Tester in Montana. Rosendale is the state’s insurance commissioner, putting him in a unique position not just to talk about health care policy but also to enact it. Among his notable actions was last year’s decision to reverse a long-standing prohibition on Christian health sharing ministries ― which, like the plans Trump just approved, have some combination of exclusions for pre-existing conditions, limits on coverage and big gaps in benefits.

Rosendale, like the others, has been a vocal advocate for Obamacare repeal.

NOW: Protect pre-existing conditions, lower health care costs

For several years, my mom fought a battle with dementia and faced numerous health complications along the way. A few months ago, the doctors found a large mass on her kidney but they were unable to perform surgery because of her frail state and her health rapidly deteriorated until she passed away.

...Montanans deserve better. I will never give up on repealing and replacing Obamacare. I will continue to fight for health care reform that actually lowers premiums, protects Montanans with pre-existing conditions, and offers plans that fits our budget and personal decisions.

...My promise to each and every one of you is that I will never stop fighting to expand access and bring more affordable health care to Montana families and small businesses, and I will always protect those Montanans with pre-existing conditions.

Well, today I'm gonna lay into Mr. Rosendale (who ran a failed campaign for U.S. Senate against Jon Tester in 2018 and is now attempting to run for Montana's lone House seat) once again.

A couple of days ago he sent out this press release inm the midst of the ongoing COVID-19 pandemic crisis:

ROSENDALE REMINDS MONTANANS OF YEAR-ROUND OPTIONS FOR IMMEDIATE HEALTH COVERAGE

OPTIONS AVAILABLE FOR MONTANANS LOOKING FOR COVERAGE AMID CORONAVIRUS OUTBREAK

HELENA, Mont.— In light of ongoing coronavirus (COVID-19) developments, State Auditor Matt Rosendale is reminding uninsured and under-insured Montanans of additional options for health coverage outside of the normal open enrollment period for 2020 Affordable Care Act health insurance plans.  

"Montanans who are looking for healthcare coverage during this time should know that they have additional options that are available year-round.” Rosendale said. “Always shop around, ask your insurance agent questions about coverage and be aware of the fine print."

Open enrollment for individuals who buy their health insurance through the federal HealthCare.gov website and for small businesses with small group plans ran from November 1, 2019 to December 15, 2019 and is currently closed.

The Commissioner is working closely with CMS and the Montana COVID-19 Task Force, monitoring all possible developments that may happen at the Federal Level. If an open enrollment period is ordered, CSI will provide further updates as soon as details are available.

Below is a summary of additional options Montanans seeking coverage during this time may consider:

OK, so far, so good...

Direct Primary Care (DPC) Memberships

DPC Memberships provide a high-quality, affordable alternative for many people seeking routine testing or basic health care treatment.

DPC Memberships are arrangements for care between patients and their doctors, they are not insurance products. Memberships are open to anyone seeking care and most can be applied for online, at any time. There are at least eight DPC clinics operating in Montana.

Ummmmm...ok, I guess. I'm not really sure that DPC arrangements make much sense for someone dealing with COVID-19. Here's an overview from STAT News:

In a nutshell, direct primary care is a model for delivering primary care, and only primary care. The doctor charges each patient a monthly fee, generally ranging from $50 to $200, in return for timely, convenient access to him or her and a buffet-like menu of mostly basic primary care services. The amount of the monthly fee is presumably set in relation to the scope of services covered, though every practice may do it differently.

For services that aren’t covered under the fee, like more extensive management of a chronic disease, the patient’s insurance — if he or she has it — must be billed to pay for the service or, in some cases, the physician or practice will charge the patient extra fees to cover those services.

...Incentives to limit care. Another problem in the direct primary care model is the built-in incentive to limit care. The direct primary care physician or practice functions as an insurer by using the fees from their patients to pay for the services they provide. The pushback from direct primary care advocates here is, “Traditional primary care practice also has an incentive to limit care due to the ways they are paid by contracts with outside insurers.” That’s true. But replacing one conflict of interest with another isn’t necessarily an improvement, and the direct primary care potential conflict of interest here is significant.

...Patient expense. The direct primary care model can get expensive for patients, making it a model that caters to the affluent and potentially worsens inequities in the primary care delivery system in terms of the care that different individuals receive.

When I examined a retainer-based direct primary care practice near where I live in the Boston area, I found that the monthly retainer covered only a limited menu of basic primary care services and number of contacts with the doctor. Anything else required me to get services paid for through other health insurance I might have, and in the process be subject to paying copays and deductibles to get those services reimbursed.

I honestly don't know enough about DPC to make a definitive judgement call about whether it's Evil® or not, so I'll leave it at that.

It's Rosendale's next recommendation which made my jaw drop, however:

Short-Term Limited-Duration (STLD) Health Insurance

Short-Term Health Insurance may also be an option for Montanans seeking health coverage. STLD plans are a type of insurance meant primarily for those looking for temporary coverage and are available for enrollment year-round.

Several major companies offering short-term plans in Montana have already announced that they will waive deductibles, copays, coinsurance and prior authorization requirements for COVID-19 testing services.

Consumers are advised that not all short-term plans may cover testing for COVID-19. Always consult with your health plan or insurance agent about the specifics of your coverage prior to purchasing any insurance product.

Holy Crap. You've got to be kidding me, Mr. Rosendale. I appreciate that you included the "let the buyer beware" warning, and it's nice that a couple of companies say they're waiving costs for COVID-19 testing, but pushing anyone towards #ShortAssPlans right now, of all times, is ill-advised at best and dangerous at worst. Again, while there are certainly exceptions, on the whole, "Short-Term, Limited Duration" plans (STLDs) have a pretty terrible reputation with good reason:

  • Invasive and complex applications. Applicants for short-term plans typically must answer numerous questions about their health status, illnesses, and prior medical treatments.
  • Higher premiums based on personal characteristics such as gender and age. Unlike ACA plans, short-term health plans charge higher premiums to people based on their gender and can charge far higher premiums to older people based on their age than the ACA allows.
  • Denials of coverage for pre-existing conditions. Short-term insurers use various tactics to avoid paying out large amounts for people’s pre-existing conditions. As noted, they may simply deny coverage to people who report having a health condition. In addition, short-term plan contracts typically include a broad exclusion for any care related to a pre-existing condition...
  • High out-of-pocket costs for people who need care. Short-term plans can — and often do — fail to cover ACA essential health benefits. An April 2018 study of the short-term plans available through two major online broker sites found that 43 percent of plans didn’t cover mental health services, 62 percent didn’t cover substance use disorder treatment, 71 percent didn’t cover outpatient prescription drugs, and none covered maternity care
  • Some benefit gaps may be subtle, found only in the policy’s fine print. ...One odd provision found in short-term plans from Golden Rule (part of health insurer UnitedHealthcare) bars coverage of costs of room and board and nursing care when someone begins a hospital stay on a Friday or Saturday.
  • Short-term plans also can charge high deductibles and cost-sharing for the benefits they do cover (i.e., a $5,000 deductible for a policy that lasts three or six months), leaving patients responsible for the rest. Or, the plans include dollar limits on how much they will pay out for a given service or in total for benefits over the life of the policy, or during the life of the enrollee.
  • High premiums relative to the value of the benefits they provide. Even with seemingly low premiums, enrollees in short-term plans may still pay too much for the coverage these plans offer. Much of the money that consumers pay to insurers offering short-term plans actually goes toward plan administration, marketing, and profits — and little toward enrollees’ health care. 

(As an aside: To his credit, Rosendale does also make sure to mention that some people can, in fact, enroll in fully ACA-compliant policies if they qualify for a Special Enrollment Period via some other Qualifying Life Event...but he lists that last):

ACA Special Enrollment Period

Special Enrollment may be available for qualifying individuals who’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. 

To see if you qualify for a Special Enrollment Period, visit healthcare.gov/screener.

Montana insurers onHealthcare.gov have previously announced that they will waive deductibles, copays, coinsurance and prior authorization requirements for COVID-19 testing services.