HALLOWELL – One of the most formidable challenges facing Maine and America is reforming our health care system to make it more affordable and ensure that all people have access to quality care. Our economic future and the prosperity of families and businesses hang in the balance.

For more than a decade, Maine stood in the forefront of innovation and progress toward these goals. But in 2011, the first session of the 125th Maine Legislature took giant steps backward with LD 1333, a proposal that gives more power and profits to insurance companies at the expense of consumers — the rural, older Mainers in particular.

The early results are in, and premiums for many small businesses, especially in rural Maine, are soaring. But there is hope on the horizon.

At the national level, key provisions of the landmark Affordable Care Act designed to drive down costs will soon take effect. And in Maine, several legislators have filed bills to address some of the worst aspects of LD 1333 in the Legislature’s upcoming session.

Under the ACA, states will implement “one-stop” health insurance exchanges beginning in 2014 to help individuals and businesses save time and money through comparison shopping for health insurance from a standard product menu. In each state, the governor and Legislature will design the exchange and determine who has a say in the process.

Unfortunately, Gov. LePage’s appointments to oversee Maine’s exchange allowed insurance agents and companies to dominate the process while shutting out consumer advocates.

LD 1333 provides another example of putting the interests of insurance companies ahead of Maine consumers.

First, it unfairly favors insurers by subsidizing their risks in the individual market through a new monthly fee on both individual and small group insurance policies. Insurers will appoint five of the 11 members of a board to oversee distribution of the funds collected among insurance companies.

LD 1333 also eliminated the Maine Bureau of Insurance’s authority to review and rule on all individual insurance market annual rate increases less than 10 percent.

When Anthem recently proposed a 9.7 percent increase in individual rates, the Bureau of Insurance limited it to 5.2 percent after a thorough review. Under LD 1333, the bureau could not review even a 9.7 percent increase in the future — not the best outcome for Maine businesses and families!

LD 1333 also fails to address the factors that are truly driving health care costs through the roof: inadequate chronic disease management; wide variation in the cost and quality of care; and inefficiencies such as reliance on emergency rooms for basic preventive care or employing expensive screening tools or medications when less expensive but equally effective options are available.

To level the health insurance playing field for Maine families and small businesses, we need the LePage administration and Legislature to return to basic good governing principles.

They must insist that business is conducted in an open, transparent manner. They must insist upon rigid accountability standards to eliminate interest conflicts.

And above all, they must ensure a fair balance among competing interest groups that puts access to quality, affordable health care for everyone who needs it ahead of insurance company profits.

On Oct. 31, Maine’s Legislative Council will decide which bills it will allow the Legislature to consider when it reconvenes in January. It is important that council members hear from consumers about the inequities and burdens resulting from LD 1333 and other aspects of our current state health insurance regulatory policies.

They must demand that the council allow legislation to move forward that will restore balance and protect the best interests of families and small businesses.

One important step would be to restore the Bureau of Insurance’s individual market rate review process; re-examine the design and regulation of the guaranteed reinsurance program; and direct the bureau to monitor LD 1333’s many provisions rigorously and report on the impacts on families and small businesses statewide, especially in our rural communities.

Another key step is to resurrect the Advisory Council on Health Systems Development to revisit and inform the process of establishing Maine’s Health Insurance Exchange and pursue further health care system reforms.

Key provisions of LD 1333 threaten the access of thousands of Mainers to quality affordable health care coverage. Legislation to level the playing field will do much more to assure fairness and control costs for Maine families and small businesses.

– Special to the Press Herald