TOPSHAM — The purpose of health insurance is to protect people when their need is greatest.

Maine has been a leader in creating a health insurance market that balances the needs of its diverse population and provides for its citizens regardless of their health status.

For nearly two decades, the state has prevented insurers from discriminating against people with serious medical conditions like cancer, heart disease and stroke.

Maine’s current insurance laws ensure that people with cancer and cardiovascular disease or other life-threatening chronic diseases can afford adequate health coverage despite their medical history.

In addition, the state’s rules for setting premiums prohibit insurers from charging people with pre-existing medical conditions more than healthy people.

The situation for patients is very different in many states across the country, where people with cancer and heart disease can be denied lifesaving coverage or charged amounts they can in no way afford.

To its credit, the Legislature is grappling with the very difficult issues of health care access and cost, and exploring a range of alternatives to Maine’s current system. Unfortunately, the legislation under consideration is misdirected.

Proposals now before the Legislature would significantly alter the state’s insurance system to the detriment of those with serious medical conditions.

Initially, the proposed overhaul to Maine’s insurance regulations would have repealed an important consumer protection, the right to buy any plan offered. Instead, it would have allowed insurers to push applicants with serious medical conditions into a few plans that could have limited benefits or result in exorbitant out-of-pocket costs.

In the past few days, legislative sponsors have made a couple of significant changes to their bill, seemingly in recognition of the harm that their previous version would have inflicted on those most in need of health coverage.

However, the proposal still remains seriously flawed.

Under the proposed legislation, insurers would no longer have to comply with current requirements that are essential to ensure quality and access, especially to people in rural areas. The legislation would change the rules for how premiums are set to allow insurers to charge older applicants more, the people who are most likely to have serious medical conditions.

It would also allow further health insurance premium increases based on a person’s geographic location, occupation or the industry in which they are employed. These and other proposed changes might lower health insurance premiums for some by eliminating important consumer protections that benefit all.

But does Maine really want to reduce health insurance costs by abandoning protections that are vital for people when they become ill or have a chronic disease? The U.S. Department of Health and Human Services estimates that 45 percent of Maine’s population under age 65 has a pre-existing medical condition.

The American Cancer Society estimates that there were 8,650 new cases of cancer in Maine last year, and the state has one of the highest cancer incidence rates in the country.

American Cancer Society research shows that people without health insurance are more likely than those with coverage to be diagnosed with advanced-stage cancer, which is less curable and more deadly than cancer caught at its earliest stages.

The American Heart Association’s research finds that the uninsured with cardiovascular disease experience higher mortality rates and poorer blood pressure control than their insured counterparts.

Similarly, those who suffer a stroke and are uninsured experience greater neurological impairments, longer hospital stays and up to a 56 percent higher risk of death than the insured.

The proposed legislation is tantamount to rationing health care for those with serious medical conditions. By creating a system in which those who are more likely to have health conditions can be charged much higher rates, the Legislature is rationing care to many of those most in need.

If enacted, this proposal would turn back the clock on benefits that have long safeguarded older and rural Mainers, those people who are more likely to have cancer, cardiovascular diseases and other serious medical conditions.

We must protect people when their need is greatest and not pass legislation that would put many of the most vulnerable Maine residents at risk.

 

– Special to The Press Herald