Single-payer system studied by computer

AUGUSTA – Both major party candidates for governor say turning the insurance system in Maine on its head with a government-run, single-payer plan isn’t realistic. But like it or not, the next governor and Legislature will be handed an economic feasibility study for such a system.

Mathematica Policy Research Inc. representatives told the state-appointed Health Care System and Health Security Board on Monday that work is progressing well on a computer model to show the economic consequences of two benefit plans envisioned under a single-payer system.

The model will be ready in about a month and will take into account a wide range of data collected from local, state and federal sources. It will be constructed to permit some tinkering with revenue, economic and other variables in order to allow lawmakers to develop different scenarios, Mathematica representatives said.

Board co-chairman Rep. Paul Volenik, D-Brooklin, who has relentlessly promoted a single-payer plan as the answer to Maine’s health insurance woes, was eager to hear any preliminary findings during a conference call between the board and the consultant Monday. But Mathematica’s Deborah Chollet said there won’t be any findings until the model is complete and it is allowed to churn out a forecast given the variables plugged into it.

Volenik is hoping for a positive forecast. He wrote the single-payer bill in 2001 that passed the House, but narrowly failed in the Senate. A compromise led to the creation of the board to study single-payer for Maine.

The committee’s work, which started with just $10,600 from the Legislature, got a boost with a $200,000 grant to hire Mathematica from the Maine Health Access Foundation. Ironically, the foundation was created with money from the sale of Maine Blue Cross Blue Shield to Anthem Insurance Cos. Inc. of Indiana – a group that would be put out of business in Maine by a single-payer plan.

During Monday’s meeting, an insurance company representative asked if Mathematica had taken into account the jobs that might be lost from a single-payer system. Chollet said that her team has anticipated job losses that would likely result from eliminating insurance company operations and the related administrative positions in hospitals and doctor’s offices.

But she said Mathematica was also calculating the possible economic stimulus coming from employers being able to hire workers for less money given lower health care insurance costs. Additionally, she said that as uninsured individuals gained access to the health care system, especially in rural areas, new medical jobs would be created.

“We’ve had some of those discussions already,” she said.

Mathematica’s work is based on two benefit plans provided by the board. Both plans would charge nothing for necessary medical care of individuals with incomes of up to two times the federal poverty level. The plans would not cover some items like cosmetic surgery and sex changes.

A person making more than twice the poverty level would foot up to $500 a year for out-of-pocket medical expenses under plan A or up to $1,000 under plan B. For hospital costs, both A and B would charge $50 a day with a $300 maximum per admission.

Co-payments for services would range from $10 to $50 under both plans for primary care, specialty care and emergency room visits. Unlike most plans in use today, the single-payer proposals would give equal coverage to mental health or substance abuse problems.

Most preventative care, which medical experts say reduces the costs by treating problems early when they are minor, would be covered without cost sharing.

Prescription drugs would carry co-payments, but there would be a $200 out-of-pocket maximum for individuals.

Several board members complained that the task before them demanded more time to adequately come to grips with the complexities of a health insurance overhaul. They noted, for instance, that they would have just weeks after Mathematica’s model was presented to make recommendations to the Legislature.

Although already asking for a short extension of a couple of weeks, several board members are asking for additional time before making recommendations.