The director of consumer health issues at the Bureau of Insurance resigned earlier this month after sending a tersely worded e-mail to state officials predicting that policy changes in the wind would further harm people who need health insurance.

Alice E. Knapp, who’d been wth the bureau nearly 11 years, wrote that she expects the current course of state and federal policy will result in “a steady erosion of health plan benefits combined with higher co-pays and deductibles.”

“This will ultimately represent a massive cost shift to consumers that will make the impact of the increase in oil prices on low- and middle-income families pale in comparison,” she wrote. People will forgo needed care in their struggle to balance limited household budgets. This will drive up costs and result in poor health outcomes.

The e-mail was sent Oct. 18, and Knapp concluded her duties Nov. 2. Five days later she began work as an attorney specializing in health care issues at the Bangor office of Duane, Morris & Heckscher LLP.

Knapp, who is a selectman in Richmond where she lives, said in an interview that leaving the Bureau of Insurance would give her a better opportunity to advocate for changes to health care policy that would do more than shift costs from one group to another. She said she plans a run for the Legislature in several years.

The shifting of insurance costs from one group to another is one of the potential outcomes of portions of the Bureau of Insurance’s latest proposal to the Legislature, she said.

The insurance regulation overhaul proposed by the Bureau would scale back legislated mandates from the 1990s intended to benefit the poor and the sick. That’s entirely “rational,” if one is trying to make insurance more affordable, Knapp said. But it won’t help everyone get access to medicine.

“My concern is that we’ll just keep going around in circles like a hamster wheel,” Knapp said.

She grew tired of the wheel at the Bureau.

“It was a great job, but I had a “eureka!” moment,” she said Friday. “I couldn’t tolerate another moment of bureaucracy.”

The Bureau became much more efficient during her time there, but efficiency has its limits, she said.

“It is principle underlying the tools that matters, but the tools take over and you lose the principles,” Knapp said.

She said bureau employees have a deep knowledge and understanding of the system that could be better tapped to make positive changes.

Superintendent of Insurance Alessandro Iuppa said he can only make limited changes, not the kind that will make the system ideal for everybody.

“I’m the superintendent of insurance. I’m not the superintendent of the world or the U.S. or of health care in the U.S.,” Iuppa said.

Instead, Iuppa said he knows what he can’t change so he sticks to issues over which he has some control. He said the proposals the bureau is now offering would strengthen insurance in the state by attracting new insurance companies to Maine and by relaxing some regulations to make insurance more affordable for young, healthy Mainers and less affordable for older, sicker Mainers. Attracting the younger people would ultimately drive down insurance costs for everyone, he said.

As director of the Consumer Health Care Division, Knapp heard many consumer complaints against insurers firsthand. She tried to have the department do more to educate insurers about how to avoid repeating their mistakes. But as insurance companies have merged, it’s gotten even harder for them to do that, she said.

Should Knapp run for the Legislature, she said she’d try to instigate global reform by nurturing nonpartisan action. To deal with health care, she said you start with “giving everyone medical access” then you develop the options to get there.

Her October 18 e-mail made a similar plea to state leaders.

“I hope the administration bears this in mind as it weighs in this session.” she said. “Our failure as a state and a nation to realistically address the inequities and irrationalities of our health care system will continue to fuel a steady political backlash, which to date has largely done little but drive partisan grandstanding and ill-conceived ‘solutions’ which simply trade off one set of problems while creating another.”