June 30--When health insurance executive David Kibbe surveys the health care landscape in Montana one last time, he sees some very positive things: Emerging competition among insurers, expanding access to care and a growing focus on keeping people well.

Yet he says Montana, like any state, will face some hurdles as it implements the nation's new health care law, which he believes isn't doing enough to address the biggest problem facing health care: Controlling costs.

"It's great to expand coverage and access, and to stimulate progressive improvement, but (health care) is still really, really expensive," he said Friday. "I don't believe there was as much attention placed on cost-management, to assure the affordability of health care, as there could have been or should have been."

Kibbe, the president and CEO of New West Health Services -- once the second-largest private health insurer in Montana -- is stepping down today, after almost six years on the job.

He's leaving as the Helena-based company transitions to a new model, having shed its commercial health insurance business and become solely a provider of Medicare Advantage, a supplemental insurance package for those covered by Medicare, the government health plan for the elderly.

"I think it's good that New West can focus on its Medicare Advantage business and be really good at it," he said.

New West started the change in 2011, when most of its primary financial backers -- a half-dozen Montana hospitals -- decided they no longer wanted to be in the insurance business.

Some of New West's business migrated to its main rival and the state's largest health insurer, Blue Cross Blue Shield of Montana.

But a good chunk also went to a new face in the Montana market, PacificSource of Oregon, after the U.S. Justice Department stepped in and said more competition was needed in health-insurance markets in the state.

Kibbe said he's taken a new job with Universal Health Services, a Pennsylvania-based hospital management firm, working to arrange employment and other relationships with physicians or groups of physicians.

Kibbe said he thinks the health-insurance market in Montana is in relatively good shape, with the addition of PacificSource as a new competitor and, next year, the Montana Health Co-op, a federally financed nonprofit insurer.

But he also said many questions remain as the Affordable Care Act takes hold, in the wake of this week's U.S. Supreme Court ruling upholding the controversial law.

State-based health insurance "exchanges," which are Internet insurance marketplaces, are supposed to be launched in 2014, but the 2011 Montana Legislature refused to allow state regulators to prepare it, deferring instead to the federal government, he noted.

And once a mandate for people to buy insurance kicks in, it's uncertain whether younger people will buy health insurance or just choose to pay the tax penalty, he said.

"For people who are younger and healthier, it will probably be more expensive for them," he said. "If (younger people) choose to pay the tax and not get the coverage, that will make it more challenging to afford the system. It will drive premiums up. That's a fundamental concern that I have."

Still, Kibbe said he sees many good things in the federal law, such as its focus on preventive care and its goal of expanded coverage and access -- and hopes it can help overcome the looming problems, such as a physician shortage and the rising-cost conundrum.

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(c)2012 Independent Record (Helena, Mont.)

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