MT auditor urges Congress to renew health subsidies

Tens of thousands of Montanans are poised to see sharp spikes in health insurance costs should federal lawmakers decide not to renew a pandemic-era program designed to keep premium prices in check for lower-income earners.

That was the spirit of a letter sent last month by state insurance regulators, including Montana State Auditor James Brown, to leaders in both chambers of the U.S. Congress. It voiced support for reupping the enhanced premium tax credits — currently set to expire at the end of this year — in order to keep health insurance plans sold on the federal marketplace affordable for consumers.

“Without an extension of the enhanced tax credits in September, insurers and marketplaces will begin to notify over 20 million consumers in all 50 states of major premium increases in a matter of weeks,” leadership from the National Association of Insurance Commissioners wrote on behalf of regulators in every state, including Brown.

The Affordable Care Act (ACA) created an online marketplace where private companies sell health insurance plans to people who earn too much to qualify for income-based Medicaid, but don’t have coverage through an employer. Depending on income, enrollees might also be eligible for government subsidies to reduce the cost of premiums and incentivize sign-ups.

More than 77,000 people in Montana receive health care coverage through the ACA marketplace, and almost 90% of customers receive a subsidy to help cover costs.

Those subsidies were supercharged as part of COVID-19 relief efforts to make sure people didn’t lose insurance when budgets got tight. They were extended to more people and at higher amounts to enrollees who already benefitted.

Without congressional renewal, it’s those amped-up tax credits that would lapse. Congressional budget experts warn letting them expire will send costs sky-high and lead to people foregoing insurance coverage altogether.

Insurance regulators said in the letter there would be “more uninsured individuals, smaller and less stable insurance markets, higher costs for those who remain in the market and more uncompensated care for health care providers.”

Insurers in Montana are proposing double-digit rate hikes to marketplace plans, which they attribute at least in part to federal policy changes.

“What’s going on is there is so much uncertainty right now … with whether or not Congress is going to extend these enhanced premium subsidies, that the rates are really in flux,” Brown explained in an interview.

Also known as the commissioner of securities and insurance, the state auditor acts as the voice of consumers and regulates these two key industries. Though perhaps the least-well-known office in elected state government, the auditor’s work directly affects the pocketbooks of Montanans purchasing home, health and auto insurance.

Brown, a Republican, won election to the office in 2024. He had previously served as the head of the Public Service Commission and lost a bid for the Montana Supreme Court in 2022.

GOP lawmakers in Washington, D.C., have so far not been big fans of continuing the subsidies. When negotiating the mammoth budget bill, a Democratic proposal to renew them was left on the cutting room floor.

Recently though, 10 House Republicans introduced standalone legislation that would extend the subsidies for one year until after the midterm elections.

A spokesperson for Republican Sen. Steve Daines said in an email the senior senator “opposes any efforts to tie covid-era subsidies for Obamacare to government funding as the Democrats are advocating, and any future talk about any changes to ACA subsidies must be linked to strong pro-life protections like the Hyde amendment.”

That opposition was echoed by Republican Sen. Tim Sheehy’s office.

“Sen. Sheehy opposes the Democrats’ scheme to shut down the government over COVID-era Obamacare subsidies and will keep working to ensure Montanans have access to affordable, quality care,” a spokesperson said in an emailed statement.

GOP Reps. Ryan Zinke and Troy Downing did not respond to requests for comment about whether they would support extending the tax credits. Downing previously served as state auditor before being elected to the U.S. House of Representatives last year.

“I’m not worried about the politics of it,” Brown said about bucking party trends in supporting the subsidies. “What I am trying to do is the job that has been tasked to me by the Legislature to protect the consumer and provide regulatory certainty to insurance companies that provide ACA plans in Montana.”

The auditor is quick to point out that he thinks the ACA has done more harm than good when it comes to health care affordability, but as long as it’s the law, Brown says he’ll evaluate insurance rates accordingly.

“It’s clear the Affordable Care Act is no longer affordable,” Brown said in a statement. “Until Congress repeals and replaces the failed law that has driven rates higher for years on the American people, we are calling on the federal government to restore the ACA subsidies that help keep insurance within reach for Montana families.”

That same statement celebrated the auditor’s office denial last fiscal year of nearly $22 million in proposed rate increases across all types of insurance, including automobile, property, health and more. Though the auditor can’t outright set rates, Brown’s team reviews the reasons for an insurers’ proposed rate changes and determines if it seems reasonable based on the market. If it doesn’t, Brown raises the issue with the insurance companies.