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When it comes to health insurance, the promise of saving money can sound like yet another empty sales pitch. But there’s nothing for sale here — all we need is transparency and accountability.

As The Billings Gazette reported on Sept. 11, our state auditor has no ability to ask insurers to justify a rate increase. Montana is one of only a small handful of states where this is true. Most states have someone who can defend consumers from unreasonable rate hikes.

But in Montana, health insurers can raise our rates for whatever reason they want. As reported in the Gazette, one insurer (Time and John Alden) hiked rates on Montana consumers by 18 percent last year. In South Dakota, the same rate hike was knocked back to 8 percent because the state has authority to question whether the higher rate was justified. As it turns out, it wasn’t, and that saved South Dakotans 10 percent on their health insurance. They didn’t even need to make a phone call.

80% of the market

While a competitive marketplace helps keep prices down in most industries, only two health insurers control over 80 percent of the market in Montana. If you aren’t happy with your insurer, you might not have any better options. You can’t just walk away.

Reviewing rates keeps insurers honest. We know because in the last year, rate reviews have saved Americans more than $1 billion. That’s a lot of money that stayed in the pockets of hardworking people. If the insurer can show the rate increase is justified because of increased costs within a given group, the rate increase moves forward. But they have to show the increase does more than pad their profits with our hard-earned dollars.

Our Legislature can stand with consumers when they return to Helena in January by passing a law that gives Montana officials clear authority to keep insurers’ rate increases in check.

The other way Montana could save us money is by expanding Medicaid, the public health insurance program for low income families, children and the elderly. Right now, 40 percent of all Medicaid dollars go for nursing home care. That’s a huge percentage of the program helping protect Montana seniors.

An estimated 60,000 uninsured Montanans would qualify for Medicaid under the new, expanded program. Many are entrepreneurs or work for our small businesses who don’t offer health insurance. Right now, anytime one of them gets sick or has an accident but can’t pay for their care, it’s the people with insurance who end up paying in the form of higher premiums. Having more people insured saves all of us money.

Expanding Medicaid

This opportunity to expand Medicaid makes good fiscal sense. It would return hundreds of millions of dollars to Montana, because for the first several years, the expansion would be entirely paid for by the federal government. After that, Montana would pay only 5 percent to 10 percent of the expansion. These are tax dollars coming back to Montana, creating health care jobs and generating economic activity.

This is an opportunity Montana cannot afford to miss if we are serious about addressing the problems in our health care system and ensuring a bright financial future.

Reviewing insurance rates and having more people with insurance saves you money, and that’s good for all families and businesses.

Steph Larsen works for the Center for Rural Affairs in