Few Montanans have experience with direct primary care health models, largely because state regulations have made these models more difficult to implement. Basically, in direct primary care, health services are provided based on a fixed monthly rate “directly,” skipping the use of insurance altogether.  Co-owner of Cost Care in Missoula, Lesley Von Eschen has been working to open a direct primary care service in western Montana, she explains the legislative roller-coaster her business has experienced.

"There was a bill presented in 2015 and again in 2017, protecting the direct primary care model," said Von Eschen. "The protection comes in the fact that this is not insurance, and so it can't be treated as insurance or an insurance product, that's where the protective language comes in... well, this year it passed the house, it passed the Senate, it had bipartisan support, but then it got vetoed on Steve Bullock's desk."

Von Eschen says Governor Bullock’s argument for vetoing the bill reveals that he confused direct primary care with concierge care, which does bill insurance. After the veto, Montana Insurance Commissioner Matt Rosendale issued a Memorandum of Understanding which opened the door to Von Eschen’s business, but he is now running for U.S. Senate, and she says she is concerned a Bullock appointee to the Insurance Commissioner’s Office could rewrite the rules.

"We brought that up in a meeting with the Insurance Commissioner's office and if Matt is no longer in that position and if a different commissioner is appointed by Steve Bullock, will we still be protected?" Von Eschen asked. "Nobody has that answer, so we need to re-write the bill, re-put it through the next legislative session, hoping that we can actually get the bill passed at the state level."

Direct Primary Care has been in existence in Washington State for about a decade, one model was even kick-started by Amazon Billionaire Jeff Bezos. Von Eschen says the three providers through the new Cost Care direct primary care service in Missoula will work directly with about 600 people, each paying a monthly fee of $70 for unlimited access to their provider starting January 1 of 2018..