Health care Protections

Maine is among only a half dozen states that mandate broad consumer protections for health insurance. Opponents of these requirements – to guarantee coverage, cover a range of medical services, limit charges based on health – say they add cost to Maine’s health care system, push out competition and leave too many Mainers without insurance at all. LD 1496, sponsored by Rep. Kevin Glynn of South Portland, would do away with many of the mandates for individual health plans.

If mandates restrict coverage, the numbers don’t show it. According to U.S. Census data, Maine ranks 16th best for the percentage of people covered by health insurance. That’s nothing to cheer about, but it is worth noting, along with the fact the other states with broad mandates – including New York, Vermont, Massachusetts – also rank in the top half for coverage. Maine’s insurance rates are about average when making an even comparison of what is offered to consumers.

LD 1496 also would eliminate the state’s certificate-of-need process for health care facilities. CON requires state approval for major hospital purchases to ensure they are medically necessary and it is one of the few controls on overall health care costs the state has. It would create pools of high-risk consumers, an idea tried here before that died from lack of support.

Maine’s health insurance debate currently has two ends: Gov. Baldacci’s Dirigo health plan, which maintains mandates and emphasizes public accountability, and a less-regulated environment where products such as health-savings accounts are emphasized. Anthem recently reported that its officers were happily surprised by the number of people – more than 5,000 – who had signed up for its Dirigo product, but admitted that its health savings account, begun at the same time as the Dirigo coverage, had fewer than 10 people signed up, though admittedly preferred state tax treatment might help.

That isn’t defining, but it should make legislators consider the direction state residents themselves choose to go in. It is further telling that the state’s largest insurer, Anthem, would not testify in favor of dumping the mandates – no doubt it understands it would lose its least expensive customers were the market to lose some of its regulations, creating an adverse selection that drives up health insurance costs for many.

These protections in Maine’s coverage help the elderly and the sick, the very people who need insurance most. Before lawmakers think about loosening or dropping them altogether, they should be sure they understand how they make insurance affordable for the most vulnerable in Maine – and then ask which residents won’t eventually join that vulnerable group.