Health care is shaping up to be a defining piece of this year’s race for the U.S. Senate between Democratic incumbent Jon Tester and Republican challenger Tim Sheehy.

Abortion has been front and center on the national stage since the Dobbs decision overturned federal abortion protections in 2022, and it’s become a flashpoint during the current election cycle in Montana. 

Already the subject of extensive political gamesmanship, Constitutional Initiative 128, which would amend the Montana state Constitution to codify the right to an abortion until fetal viability, will be on the ballot this November. The two candidates vying to be Montana’s next senator have also put themselves on opposite sides of the debate around reproductive rights and the ballot initiative. Whereas Tester markets himself as a staunch defender of reproductive freedom, Sheehy, who is endorsed by Donald Trump, has said he opposes abortion except in the case of pregnancies caused by rape or incest, or when the life of the mother is at risk. 

LEFT: U.S. Sen. Jon Tester speaks at the Montana Democrats' annual Mansfield Metcalf Dinner at the Lewis and Clark County Fairgrounds in Helena on March 2. RIGHT: Republican candidate for U.S. Senate Tim Sheehy addresses supporters at a primary election night party in Gallatin Gateway on June 4.

Time and time again since Dobbs, when given the chance to either restrict or enhance abortion access, voters have signaled support for protecting abortion. It's been true in blue bastions like California and Republican-majority states like Kansas and Ohio. 

Whichever party controls the White House and Congress will influence which federal abortion measures are proposed. The race between Tester and Sheehy is considered one of the most critical to determine which political party controls the Senate. Tester is one of only two sitting Democratic senators in the country seeking re-election in a state won by Trump in 2020.

But it’s not just abortion access that could be determined by the makeup of the next Senate. Whichever political party has the majority in the upper chamber could propose and cast votes on legislation about contraception and prescription drug prices, health care affordability, how to fund fledgling Social Security and Medicare programs and more. Congress could consider bills banning abortion or reinstating the protections once articulated under Roe v. Wade.

Montana voters are tasked with selecting between these two candidates to represent them for six years. In doing so, Montanans are poised to have a particularly profound impact on the near-term future of health policy. 

The Montana State News Bureau asked both campaigns to explain to voters how their candidates would vote — or why they have voted, in the case of Tester — on legislation that has already been introduced in Congress or could come to the floor for a vote during the next term.

Responses are from campaign spokespeople over email. When campaigns did not respond directly, the bureau referred to Tester’s voting record or looked back at past on-the-record comments from either candidate.

This bipartisan bill passed the House of Representatives in December 2023. Supporters say it requires providers to be more transparent about pricing and makes Medicare rates for certain treatments equal regardless of where patients receive care, saving Medicare money. Opponents include the American Hospital Association, which says “site-neutral” reimbursement rates make it harder for hospitals to operate and threaten the health care system.

The bill is currently in the Senate.

TESTER: “I’ll always support legislation to increase transparency and lower costs for Montanans, which is why I support the bipartisan Lower Costs, More Transparency Act. As this debate continues, I will work to make sure this legislation works for Montana’s patients and health care providers.”

SHEEHY: The Republican candidate did not respond directly when asked whether he would support the legislation in a Senate vote. Sheehy has spoken frequently about the need to address runaway prices and soaring inflation, which he attributes to a Democratically controlled Senate and White House. If elected, Sheehy says he would work to reduce those pressures on everyday Montanans. More government control has only made things worse for the health care system, according to Sheehy. 

U.S. Sen. Jon Tester speaks at the Montana Democrats' annual Mansfield Metcalf Dinner at the Lewis and Clark County Fairgrounds in Helena on March 2.

This bill passed 51-50 in the Senate along partisan lines with Vice President Kamala Harris acting as tie-breaker. It includes a $35 co-pay cap on insulin for all Medicare and required negotiations between the federal government and drug manufacturers to lower prices for Medicare enrollees. The first round of negotiations was recently announced and reduced list prices will go into effect in 2026. 

TESTER: “Montanans should never have to choose between life-saving medication or putting food on the table — which is why I was proud to support the Inflation Reduction Act, which is capping insulin prices and lowering prescription drug costs for seniors by finally giving Medicare the power to negotiate drug prices.”

At a press conference in Hamilton on Aug. 22, Tester said it was "long past time" that Medicare be granted the authority to negotiate prices directly with drug manufacturers, a power the Veteran Affairs Department already possesses. "This should have been done decades ago, but we got it done," Tester said. "And we are going to continue to see benefits of this law for years and years to come." 

SHEEHY: “We absolutely need to do more to lower prescription drug prices for all Montanans, including our seniors. It’s despicable watching these pharmacy middlemen drive up prices to line their pockets at the expense of lowering drug costs. The problem is this corrupt system is hurting Montanans and there needs to be accountability here." 

The Republican candidate has criticized the Inflation Reduction Act as a surreptitious driver of higher prices for insurance premiums, a sentiment echoed in the following response: "Montana seniors need relief yesterday, as they are being crushed by inflation from this disastrous Biden-Harris-Tester economy. That is why Tim is fighting to make Montana affordable again by defeating inflation, increasing access to affordable generic drugs, and supporting common sense solutions like greater price transparency, competition, and shopping for services in our health care system."

Republican candidate for U.S. Senate Tim Sheehy speaks at a Donald Trump rally at the Brick Breeden Fieldhouse in Bozeman on Aug. 9.

The landmark health care legislation took full effect in 2014. At that point, millions of people gained health care coverage but far more people viewed the legislation unfavorably than favorably. Almost a decade later, though, sentiments have changed entirely with 59% of people viewing Obamacare as a good thing. Most Republicans have stopped calling for its repeal. Some Democrats have called for further reform such as a Medicare for All plan.

SHEEHY: "Year after year, Montanans are facing higher and higher premiums and have lost access to doctors and health care plans they were told they could keep under Obamacare. The truth is, Jon Tester and the entire Democratic Party broke our health care system. If we’re all being honest: we do need meaningful reforms to health care and they should be focused on protecting Montanans with pre-existing conditions, actually lowering premiums and cost for Montanans, and protecting rural hospitals and rural access to health care. We need to promote greater transparency, competition, and shopping for services in our health care system. We should be rewarding outcomes and innovation to help drive down costs."

The Republican candidate remarked at an August 2023 meet-and-greet in Glasgow that he believes "we need to return health care to pure privatization," harkening back to a time when the system wasn't bogged down by a web of federal subsidies and bureaucracy. "You look at the balance sheet of a hospital, and you can't understand it," he said in audio obtained by Semafor. 

TESTER: “Health care prices are out of control, and every hardworking Montanan deserves affordable health care. The Affordable Care Act has changed the lives of thousands of Montanans by protecting people with pre-existing conditions, and I’ll never support stripping health care from the folks who need it most.”

Tester has come down hard on his opponent for suggesting government has no role in health care, referring to the role of federal programs in delivering essential public benefits and providing medical systems and rural hospitals with reimbursement that allows them to keep the doors open. "That's federal dollars that are allowing them to stay in business," Tester said during a press conference lats month in Hamilton. "So to say that you want to purely privatize health care means you don't understand Montana. Its impact on people (is) huge." 

Sen. Jon Tester, D-Mont., walks to the chamber for a vote, at the Capitol in Washington, Thursday, March 2, 2023.

When Roe v. Wade was overturned by the U.S. Supreme Court, abortion regulations fell back to the states. Advocates for reproductive rights have long speculated that if Trump, who nominated three conservative justices to the highest court, were to be re-elected, he would sign off on a national abortion ban should it make its way through Congress. But the Republican National Committee opted to adopt a party platform that opposes such a ban and instead explicitly cedes the authority to set limits to the states. 

SHEEHY: "As parents to four beautiful kids, Tim and Carmen are proudly pro-life and believe there should be exceptions for rape, incest, and the life of the mother. Tim strongly believes in helping bring more life into this world, including through his philanthropy benefitting Montana health care, which helped bring the upgraded neonatal intensive care unit (NICU) to southwest Montana to provide critical care to at-risk infants.”

TESTER: “Montanans of all stripes don’t want the federal government telling them what to do, and they don’t want politicians or judges stripping away their personal freedoms. Just last year, politicians in Montana ignored the voices of the voters and passed abortion bans. I opposed these bans and will always fight to protect Montana women’s freedom to make their own health care decisions."

Democrats in Congress sponsored a handful of bills related to reproductive rights including formal congressional support for access to reproductive health care, a prohibition on the government preventing travel to another state to receive health care that is legal in a person’s home state, a block on state governments from preventing, restricting or disadvantaging health care providers from offering reproductive health care services if they are lawful in the state, and a right to contraception.

TESTER: During the June debate between the two candidates, Tester said he wants Roe-like protections reinstated. “I want to see women being able to make their own health care decisions the same way it's been my entire life,” Tester said. “Choice is something that's very important. The federal government should not be telling our women what health care choices they should be making. It simply is not part of who we are as Montanans.” The senator signed on as a co-sponsor to the Reproductive Freedom Act, a formal expression from Congress in support of protecting access to reproductive health care, in July.

Sheehy: While Sheehy did not provide direct comment on each of these bills, he’s made his position on abortion clear. “At some point, when the baby is viable, when it can feel pain, when it can come out of the womb and be a healthy child to grow and become our next generation, that baby has rights too, and we have to have common-sense protections for the baby's life as well,” he said during the same June debate at the Fairmont.

Republican candidate for U.S. Senate Tim Sheehy, talks with supporters outside the Donald Trump rally at the Brick Breeden Fieldhouse in Bozeman on Aug. 9.

Both Republicans and Democrats put forth their own bills that would have taken steps to protect IVF. Under the GOP version, states that prohibited licensed physicians from performing IVF would be barred from some federal funding. The Democrats’ version articulated a right to receive fertility treatment and make decisions regarding the donation, storage, use and disposition of any genetic reproductive material.

SHEEHY: "Tim also stands in support of IVF as a path for Montana families to grow and thrive when they struggle to conceive naturally, like his brother and sister-in-law who battled infertility, and eventually were blessed with his nephew through IVF. Tim will fight against any effort to restrict IVF treatments for women and families." 

TESTER: “We’re seeing attacks on basic fertility treatment like IVF across the country, like when an Alabama state court ruling forced IVF clinics to cancel their appointments. I will fight tooth and nail to ensure that never happens in Montana.”

As the population ages and life expectancy increases, the accounts behind Medicare and Social Security benefits are draining more quickly than they are being replenished through regular tax payments from workers. Lawmakers are tasked with figuring out how to ensure that seniors receive the benefits they have helped finance for the duration of their working lives. Some ideas have included raising the retirement age so that people pay into the accounts longer or raising taxes on certain groups of people to bulk up the coffers.

TESTER: “I will always fight to ensure Social Security and Medicare are fully funded, and I believe millionaires and massive corporations can be doing more to pay their fair share. I authored a balanced budget proposal that would protect Social Security and Medicare benefits that our seniors have earned, while still forcing the federal government to stop racking up the debt and passing it along to our kids and grandkids.”

SHEEHY: "Tim believes we must keep our commitment to every Montana senior to protect their Social Security and Medicare benefits. Our nation made a promise to our seniors, and Tim will fight every day to honor that promise and preserve the benefits they’ve earned. Moreover, we shouldn’t be raiding these accounts to pay for reckless spending. Social Security and Medicare dollars should absolutely stay in account to pay recipients of Social Security and Medicare.”