Topic 1 of 9
Universal coverage, built on what already works
Every American deserves quality, affordable healthcare, and where you live or what you earn shouldn't decide whether you get it. We already spend more on healthcare than any country on earth, roughly twice what comparable nations spend, and still rank dead last among them on results, with four in ten adults carrying medical debt to show for it. That is not a money problem. It is a broken-system problem. People act like universal coverage is impossible. It isn't: we already run a version of it, and many of the best ideas for finishing the job are already written into American law. My plan is to build on the parts that work, fix the parts that were broken on purpose, and be straight with you about what it costs. This is not a government takeover; it still runs through private doctors and community hospitals.
What I mean when I say TRICARE
TRICARE is the health program for our military families, and I don't mean the base clinic or the VA. I mean the side where the public pays the bill and the care comes from private doctors and community hospitals in your own town. That's not a small corner of it: more than two-thirds of TRICARE's care is bought from civilian providers, with public dollars covering the bill. That's the model worth building on: public financing delivered through private, community-based care. It's proven, and it has worked for decades.
Finish what the ACA started
The honest truth about paying for it
About one of every four dollars we spend on healthcare, between 760 and 935 billion a year, is waste, and the single biggest chunk is administrative red tape, roughly 265 billion a year. This isn't about punishing anyone for making a living; it's about the waste. A real plan gets measured against what we already spend treating the uninsured in the ER, not against zero. I won't sell a fairy tale: universal coverage moves more cost onto the federal budget, and that has to be funded with honest revenue. So the first thing I'll do is the homework Washington keeps dodging: commission real, independent studies before we scale, so we build something that can pass and survive.
Break up the middlemen driving up your costs
Americans pay nearly three times what other wealthy countries pay for the same medicines. Look at the pharmacy benefit managers: just three handle about eight in ten prescriptions, and each is owned by a giant that also owns an insurer and a pharmacy chain. The same parent sets the price, fills it, and decides whether to pay. The fix is more competition, not less: break up that self-dealing so the company that sets the price can't also own the pharmacy and the insurer. There's already a bipartisan bill to do it.
Nobody should overpay at the pharmacy counter
Here's a rip-off most people never see: sometimes the cash price of your medicine, or the price on a discount app, is actually lower than your insurance copay. Congress banned the "gag clauses" that used to forbid pharmacists from telling you that, but the rip-off didn't stop, because nobody is required to proactively tell you, and the middlemen still pocket the difference through what are called "clawbacks." One study found patients overpaying on nearly a quarter of prescriptions. The fix is simple: require the pharmacy to tell you the lowest price every single time, ban the clawbacks, and put cash prices and payment-assistance programs front and center instead of buried. Cheaper medicine shouldn't be a secret you have to know to ask for.
Coverage means nothing if there's no doctor
You can hand someone the best insurance card in the world, and it's worthless if the nearest doctor is a hundred miles away. New doctors finish training owing a median of about $205,000, so they're pushed toward the highest-paying specialties in the biggest cities, not primary care in a small town. So we grow our own: wipe out medical-school debt for doctors, nurses, and dentists who serve rural and underserved Montana, and lift the residency cap frozen since the 1990s so we train more of them, at our own universities and tribal colleges.
Federal levers — what a Senator can do
- Restore & make permanent the enhanced ACA premium tax credits; add a public option; close the coverage gap federally.
- Break up the PBM monopolies — the bipartisan Patients Before Monopolies Act (structural separation).
- Lowest price at the counter, always — require pharmacies to proactively tell you when cash or a discount beats your copay, ban PBM "clawbacks," and make payment-assistance programs easy to find.
- Let Medicare negotiate more drug prices and defend the $2,000 out-of-pocket cap and $35 insulin.
- Grow the workforce — NHSC loan forgiveness for rural/tribal service + lift the Medicare residency cap.
- Commission independent scaling studies before standing up universal coverage, so it can pass and survive the lobbies.
What this means for Montana
About one in eight Montanans is uninsured, and last year Montana hospitals absorbed roughly $370 million in care they were never paid for, a weight our low-margin rural hospitals can't carry for long. This isn't abstract here. It's whether the hospital down the road keeps its doors open.
Topic 2 of 9
Mental health is health
The strongest people I know aren't the ones who never struggle. They're the ones who learned it's okay to be human, to be vulnerable, and to ask for help. I've led people I would trust with my life, and I'll tell you plainly: we don't make strong warriors by telling them to bury it. We make them strong by facing the hard things head on and getting them the help they need.
I've spent my career around the hardest things people live through. I've sat with survivors of trafficking and of sexual violence and seen what it truly takes to heal. And I've served alongside the agents, the officers, and the legal teams who work those cases and carry them home long after the file is closed. Both of them need real mental health care, and far too often neither one gets it. That isn't weakness in them. It's a failure in us.
Mental health is health, no different than a broken bone or a bad heart. And care isn't one-size-fits-all: a combat veteran, a kid who's just coming out, a survivor of trafficking, a rancher three hours from the nearest clinic are not all carrying the same thing, and they shouldn't be handed the same generic referral and wished good luck. Everyone deserves a provider who actually understands what they're carrying. Right now the entire state of Montana is a mental-health-provider shortage area, and care beyond the medication mill should be something you can actually get. We make strong people by naming the battle and treating it, not by masking it.
And we cannot keep looking away from our kids. Montana's young people die by suicide at more than three times the national rate, in a state that has ranked among the five highest for suicide for thirty years. Behind every one of those numbers is a family in a small town that never saw the help arrive. We don't hide our struggles here. We admit that every one of us is a work in progress, and that progress only happens when we're honest enough to ask for help, and when that help is actually there to meet us. That's not weakness. That's how we get stronger, together.
Federal levers — what a Senator can do
- Make parity real — enforce the 2024 mental-health parity rule (network adequacy + reimbursement) so insurers cover the mind like the body and pay enough that providers take insurance. This administration paused it; end the pause.
- Specialized care for everyone — fund training and networks for veteran-, LGBTQ+-, tribal-, and trauma-competent providers, and restore the 988 youth crisis line this administration cut.
- Care across state lines — back the telehealth licensure compacts so rural and reservation Montanans can reach the right provider and keep them when they travel.
- Fix the shortage at its root — loan forgiveness for providers who serve rural/tribal Montana, and take on the runaway cost of medical education that keeps the pipeline too small.
- Team-based care (Collaborative Care) so a doctor is in the loop and people reach the right level of care instead of giving up after one bad experience.
What this means for Montana
Montana's suicide rate has ranked among the five highest in the nation for 30 years, and our kids die by suicide at more than three times the national rate. Every county is a mental-health-provider shortage area. This is one of the places Montana can't afford to keep looking away.
Topic 3 of 9
Rural health & keeping hospitals open
Out here, an emergency is a math problem: how far to the nearest hospital, and will it still be open when you get there. About one in three of Montana's rural hospitals is at risk of closing, several of them immediately, and when a rural hospital closes it doesn't just cost jobs, it costs lives measured in the extra miles to the next ER. Keeping care close to home is not a luxury in Montana; it's the whole ballgame.
Federal levers — what a Senator can do
- Fix rural reimbursement — Medicare/Medicaid rates that reflect the real cost of rural care, and the Rural Emergency Hospital designation done right.
- Protect Medicaid — it's the backbone of rural hospital budgets (see the Medicaid section).
- Grow & keep providers — NHSC loan forgiveness + residencies at Montana universities and tribal colleges.
- Permanent tele-health so distance isn't destiny.
Topic 4 of 9
Women's health
Half of Montana's counties are maternity-care deserts, with no hospital or OB provider, and many of them are tribal. At the same time, Washington spent the last two years gutting the research that keeps women alive, purging billions in NIH studies and even moving to cancel the Women's Health Initiative, the largest study of women's health in the country, until public and bipartisan pressure forced a reversal. Women's health is not a niche. It's whether a mom in eastern Montana can deliver her baby without driving two hours in labor.
Federal levers — what a Senator can do
- Restore the research — reverse the NIH cuts a federal judge called illegal discrimination against women's health before the Supreme Court let them proceed, and change the law that allowed it.
- End maternity deserts — HRSA maternal-health grants (RMOMS), Medicaid OB reimbursement, and 12-month postpartum coverage.
- Protect the providers & the clinics that keep rural and tribal women covered.
Topic 5 of 9
Reproductive freedom
The decision about a pregnancy belongs to a woman and her doctor, not a politician in Washington and not a prosecutor in Helena. Montanans have said so at the ballot box. My job in the Senate is to protect that freedom, keep the government out of the exam room, and make sure a woman's care, and her privacy, don't depend on which state she happens to live in.
Federal levers — what a Senator can do
- Protect access at the federal level so it doesn't come down to geography.
- Protect medical privacy — keep reproductive health data out of the hands of prosecutors and data brokers (ties to the Privacy position).
- Defend contraception and IVF access.
Topic 6 of 9
Long-term care: the bill Medicare won't touch
Most families don't learn this until they're already in a crisis: Medicare does not pay for long-term care, not the nursing home, not the home aide, not the daily help an aging parent or a disabled family member needs. A private nursing-home room now runs about $128,000 a year. People who did everything right still get wiped out, spending down a lifetime of work until they qualify for Medicaid. About half the people in nursing homes on Medicaid were not poor when they arrived. This is a middle-class cliff. About seven in ten of us who reach 65 will need long-term care, and most would rather get it at home, but the help to stay home is rationed, with hundreds of thousands stuck on waiting lists. And 38 million unpaid family caregivers already provide about $600 billion in care a year, too often burning out alone.
Federal levers — what a Senator can do
- Fund home- and community-based care and cut the Medicaid HCBS waiting lists so people can age in their own communities.
- Support family caregivers — real respite, tax relief, and Social Security caregiving credits.
- Take on the cost of a long-term-care market that all but collapsed, so it isn't all-or-nothing.
Topic 7 of 9
Medicaid: don't lose it to a paperwork trap
Medicaid isn't a big-city program. In Montana it keeps rural hospitals open, covers about a third of all births, and pays for most long-term care. The threat right now isn't a vote to end it; it's work-requirement paperwork designed to knock eligible people off by making them re-prove themselves over and over until they miss a form. People who are working lose coverage anyway, to the red tape. I won't trade Montanans' healthcare for a paperwork trap that saves nothing and costs lives.
Federal levers — what a Senator can do
- Block the paperwork traps — oppose work-requirement red tape that disenrolls eligible people.
- Protect Medicaid funding that rural hospitals, births, and long-term care depend on.
- Streamline enrollment so eligible Montanans stay covered.
Topic 8 of 9
Doctors decide, not algorithms
The cruelest thing in American health care usually isn't a vote to take your coverage away. It's making the care you already paid for so hard to actually get that you finally give up. The denial letter, the billing code, the prior authorization, the eighth phone call. It's a wheelchair two doctors say you need, denied and appealed and denied again until you finally quit. The system is wearing people down on purpose, and it lands hardest on the ones with the least fight left in them: seniors, people with disabilities, and the family members trying to help them.
And now the denials are being automated. Insurers are running algorithms that turn down valid claims in bulk, overruling your own doctor and stripping out the human being who is supposed to look at your actual case. One of the biggest insurers used a tool to cut off rehab care for seniors that got reversed in more than nine of every ten appeals, while employees were reportedly pushed to keep patients' stays within one percent of whatever the algorithm predicted, regardless of the person in the bed. That tells you the machine wasn't reading medicine. It was hitting a number.
I am not anti-technology. Automation is a real tool for getting through millions of claims, and used right it can speed care up. But speed cannot come by deleting the human in the loop. A computer should never have the final word on whether you get care your doctor ordered. A licensed person who actually looked at your case, and is accountable for the call, makes that decision. Always. The same goes for the equipment people need to live: a power wheelchair or an oxygen machine shouldn't take months of appeals and two doctors' signatures.
Federal levers — what a Senator can do
- A human in the loop, by law — an algorithm can never be the sole reason your care is denied; a qualified clinician who reviewed your case decides. Make the 2024 CMS rule permanent and take California's Physicians Make Decisions Act national, to every insurer.
- Open the black box — require insurers to disclose and independently audit their denial algorithms, and be accountable when a tool denies care that appeals overturn nine times in ten.
- Fix prior authorization — deadlines, real-time decisions, and gold-carding so trusted providers stop re-justifying obvious care.
- End the equipment fight — cut the coinsurance and the repeated denials on wheelchairs and the durable medical equipment people need to live, and modernize the outdated "in the home" rule.
- Flip the burden — faster appeals in plain language and real penalties for bad-faith mass denials, so a sick person isn't the one out-fighting a computer.
Topic 9 of 9
Your body doesn't come in separate plans
Somewhere along the way, we decided your teeth, your eyes, and your ears weren't really part of your health. There's no medical reason for it, just an accident of history from 1965 and a stack of separate insurance forms. But your body doesn't come in separate plans. A kid who can't see the whiteboard gets called a slow learner when all she needs is glasses. A grandfather goes quiet at his own dinner table because he can't afford hearing aids. And an infected tooth someone can't afford to fix can put them in the ER, or worse.
It isn't spread evenly, either. The people who need this care the most — children, whose teeth, eyes, and hearing are still developing; seniors, who lose them with age; and anyone on a fixed income — are the same people who can least afford to pay out of pocket. So the coverage gives out exactly when it's needed most.
And it is not a niche problem. About one in four adults has no dental insurance at all, and it's worse the less you earn. Even the people who have a plan are stuck with a yearly cap of a thousand or fifteen hundred dollars, the same as in 1973, which today covers a single crown and little else. Eighty percent of the people who would benefit from hearing aids don't have them, because a pair runs one to eight thousand dollars and is rarely covered. And Medicare, the country's biggest health program, covers none of it, a carve-out written in 1965 that set the template everyone else copied. So people wait until it's an emergency, when a routine visit would have caught it early, and a cleaning becomes a root canal they can't pay for. That isn't saving money. It's moving the pain down the road and making it worse.
Care means all of you. A senior shouldn't have to choose between eating comfortably and paying the rent, and a working mom shouldn't have to ration her kids' trips to the dentist. I'll fight to cover the parts of your health they've been calling optional for sixty years.
Federal levers — what a Senator can do
- Cover the whole body — put dental, vision, and hearing into Medicare (the Medicare Dental, Vision, and Hearing Benefit Act), and require real coverage in private and marketplace plans too.
- Un-freeze the benefit — modernize the dental caps stuck since 1973 and cap what families pay out of pocket.
- Make hearing care real — cover hearing aids and the audiology help to actually use them, with honest pricing and standards so people can choose, not one captive vendor.
- Bridge coverage now — expand Medicaid adult dental and vision, fund community-health-center dental, and keep over-the-counter hearing aids affordable.
What this means for Montana
In a rural state with long drives to the nearest dentist or audiologist and a large share of seniors and kids on Medicaid, the "optional" carve-out bites hardest exactly where care is already farthest away.
Health care is a service, not a business. The job now is to finish what we started, pay for it honestly, and make sure that where you live in Montana never decides whether you get care.