Sweeping health insurance changes clear Legislature ? Health ...

AUGUSTA, Maine ? House lawmakers voted largely along party lines Thursday to pass a major overhaul of Maine?s health insurance policies that Republicans insist will lower rates through competition but Democrats warn could devastate health care in rural Maine.

In the first deeply divisive battle of the legislative session, House Republicans held ranks to defeat a half-dozen Democratic attempts to amend a bill that changes how insurance companies can calculate rates and how Mainers can shop for coverage. The House voted 78-68 ? with two Democrats in support ? to pass the bill.

The bill was headed back to the Senate on Thursday evening for additional votes amid an increasingly partisan atmosphere. If senators re-affirm their earlier vote in support of LD 1333, the bill would go to Republican Gov. Paul LePage?s desk for his signature.

?I listened to the people of my district who have been begging and pleading for this, and I know they are in your district too,? said Rep. Jonathan McKane, R-Newcastle.

Among other things, the insurance overhaul bill eventually will allow Maine residents to buy coverage offered in other states and allow small companies to band together for greater purchasing power. It also creates a ?high-risk pool? to cover Mainers who use more services, which will be paid for with a $4-per-month charged on every policy holder.

Supporters claim such steps will bring more young, healthy people into the insurance pool, thereby lowering costs for everyone.

But Democrats cautioned the bill could lead to significantly higher rates for older Mainers and those living in more rural areas. That is because the bill changes the formulas on which companies can base rates, taking into account age, geography and occupation.

While assailing the majority party?s tactics to quickly usher the bill through, Democrats also predicted the measure?s negative effects will be felt most sharply by rural Mainers who could be forced to travel long distances for care or see their local hospitals shuttered.

?I am amazed the industry has succeeded ? and they have succeeded ? in being able to unify the members of the majority party into a block that will destroy the hospitals of rural Maine,? said Rep. John Martin, D-Eagle Lake. ?And in two years, if this goes the way it is going now, you will see the results.?

LD 1333 has been a deeply partisan issue ever since Republicans passed a GOP-drafted bill out of committee after minimal debate.

Republicans leaders say the contents of the bill have been discussed for years, but Democrats accuse their counterparts of ramrodding through an industry-written bill without allowing the state?s own Bureau of Insurance to study the effects.

Thursday?s debate illustrated the power of party unity and the closed-door caucus process as Republicans defeated all of the Democratic amendments, often without any GOP lawmakers standing up to respond to hours of criticism from the other side. The lack of response only further angered Democrats, however.

?The silence of the majority is deafening,? said Rep. Chuck Kruger, D-Thomaston.

One of the few Republicans to speak on the bill was Rep. Kenneth Fredette of Newport, who told Democrats that while the bill may not be perfect, it makes much-needed changes that will open up Maine?s insurance markets.

?This bill can be amended next session,? Fredette said. ?In the meantime, I?m going to do something to help our young people and to keep them in the state of Maine.?

In one of the most controversial aspects of LD 1333, the bill would repeal a law that prohibits insurers from requiring Mainers to travel long distances for care rather than use smaller and often costlier local hospitals or clinics. Supporters of the change say insurers still will have to pay for local care, but companies can offer policy holders financial incentives to seek lower-cost care at larger hospitals.

Critics, meanwhile, fear the changes?will hurt residents and access to health care in rural Maine.

Sen. Troy Jackson, D-Allagash, said older Mainers in rural areas could be pressured financially into making the three-hour drive to seek care in Bangor, or even Portland.

That same change means small hospitals, which are key employers in northern Maine, could lose the health care customers they need to keep their doors open, he said.

?I can?t go back [to Aroostook County] with a clear conscience without getting more clarity on the impact of this bill, and I can?t get that,? he said.

But Jackson?s Republican colleague from The County, Sen. Roger Sherman of Houlton,

said that he was ?kind of nervous? about various provisions of the 50-page bill until he took the time to read it through and ask questions. His sources included the analyst for the Insurance and Financial Services committee and other lawmakers, he said.

?I wasn?t in favor of doing this until I understood what was in it,? he said, but now he feels confident that LD 1333 will improve the health insurance market for all Mainers, including his rural constituents.

Jackson and other Democrats repeatedly accused Republicans of not giving the Maine Bureau of Insurance time to crunch the actuarial data.

?The Bureau of Insurance has been non-existent in this whole thing,? Jackson said. ?In the past, we?ve always had the benefit of the BOI giving us the numbers and the information we need. Not this time ? somewhere along the line, someone has kind of muzzled that department ? [Insurance Superintendent] Mila Kofman has been relegated to the bench.?

Kofman?s secretary said Thursday afternoon that the superintendent was away at a conference. A request for comment left on Kofman?s cell phone was not returned. Adrienne Bennett, spokeswoman for Gov. Paul LePage, said Kofman has not been barred from the discussion of LD 1333.

?It is important to clarify that the superintendent of insurance is responsible for the?implementation of state statutes? and is not charged with participating in the legislative process, Bennett said. Bureau staff has been available to answer questions as requested by lawmakers, she said.

Tensions were still high late Thursday as the Senate prepared to take up the issue for a final, enacting vote. Normally, any bill that has a financial impact on the budget must go through the Appropriations and Financial Affairs Committee. But talk that Republicans planned to bypass the committee had Democrats infuriated.

?If this is the beginning, let me just say it is going to be a tough two months in the Appropriations Committee,? Martin, the Eagle Lake Democrat and former longtime House Speaker, told his colleagues.

? ? ?

LD 1333

Following are key provisions of Maine?s the health insurance overhaul bill:

• A change in rate structure that gives health insurance companies more freedom to charge higher rates to Mainers who are older, sicker and live in rural areas. Supporters of the measure say the expanded ?rating bands? will allow insurers to charge significantly less to younger, healthier Mainers and spread the risk over a larger pool.
• The creation of a ?high-risk pool? to cover Mainers who use a lot of health care services. The benefits offered in this separate group are not spelled out in the bill and would not be subject to state mandates that govern the general insurance market. The high risk pool would be established as a quasi-governmental program similar to the Dirigo Health Agency and funded through a $4 assessment added to the monthly premium of every Mainer with private coverage. The monthly assessment could rise as high as $6 before requiring additional rulemaking.
• The repeal of ?Rule 850? a 1991 regulation that protects Mainers from having to travel more than 30 minutes from their home for primary care and more than 60 minutes for hospital services. Promoters say the measure allows insurers to provide consumers with financial incentives to seek high-quality, low-cost care outside their immediate communities. Skeptics fear it will create financial hardships for Mainers who choose to get their care close to home, keep some from seeking the care they need and jeopardize the financial stability of small, rural hospitals.
• The marketing of out-of-state insurance plans in Maine, as well as the banding together of certain businesses to form insurance-buying groups. While supporters say these measures will help spur competition in the market, others predict out-of-state companies will ?cherry-pick? Maine?s healthier, younger consumers. Plans known as ?association health plans? will not be subject to Maine?s insurance regulations.
• The repeal of the State Health Plan, a biannual assessment of health care facilities and services available in Maine, aimed at ensuring cost-effective investment and development. The bill also disbands the Advisory Council on Health Systems Development, a 20-member group representing consumers, hospitals, insurers and public officials and charged with finding cost savings in the health care system.
• ? Several provisions that conflict with the rollout of the Affordable Care Act national health reform in Maine, including one that limits the coverage of children 26 and under on their parents? health insurance to those dependents who reside in Maine.

Source: http://new.bangordailynews.com/2011/05/12/health/sweeping-health-insurance-changes-clear-legislature-%C2%A0/

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