Friday, December 13, 2013
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PROVISIONS OF INSURANCE MARKET BILL
L.D. 1333 would overhaul Maine’s health insurance market for about 40,000 people – those who buy independently or through employers whose companies have 50 or fewer workers. It would:
• Allow companies from every other New England state except Vermont to sell insurance in Maine, beginning in 2014. Current law prohibits out-of-state companies from selling insurance here.
• Give insurance companies more leeway in how much they can charge policyholders based on age. Starting July 1, 2012, some people could pay three times as much for their policies as other people because of their age.
• Prohibit insurers from rejecting people for pre-existing conditions. It would create a mechanism for covering insurance costs of people with chronic illnesses.
The nonprofit Maine Guaranteed Access Reinsurance Association would subsidize the insurance of people who have high medical costs. It would be funded by a tax on premiums of as much as $4 per person per month on almost every policyholder in Maine. Legislators and state workers would be exempt from the tax.
Insurance carriers would cover policyholders’ first $7,500 in medical expenses per year. The nonprofit would cover 90 percent of the next $25,000 in expenses, and 100 percent after that.
• Repeal Rule 850, a section of Maine’s insurance code that requires insurers’ provider networks to have primary care physicians within a 30-minute drive of policyholders’ homes, and hospitals within an hour’s drive.
• Allow companies to band together and form their own insurance company to cover their employees. The insurance company would have to follow the same regulations as other insurance companies.
• Repeal the State Health Plan and eliminate the Advisory Council on Health Systems Development, a 20-member group that analyzes factors that drive health care costs and reports to the Legislature. Hospitals would be allowed to expand without complying with the cost containments provisions in the State Health Plan.
– Tom Bell
Sen. David Trahan, R-Waldoboro, said angrily that the bill's opponents have been spreading false information, such as telling cancer patients that they would lose their insurance.
He said the bill would not allow insurance companies to deny coverage to people because of pre-existing conditions.
Nevertheless, he said, a man he knows from his district came to the State House to protest the bill.
"This man was getting treatment for cancer," Trahan said. "He was shaking. To look in that man's eyes was horrifying to me. ... This man was scared, trembling that his insurance would be taken away."
Raye, who sat with the rest of the Senate to join the debate, rather than chairing the meeting, said the bill would lower insurance costs while ensuring people access to health care.
"Maine people are reeling from the growing pressure of annual double-digit increases in the cost of health insurance," he said. "This is unacceptable."
Republicans say the changes would foster more competition in the health insurance market.
They say the reforms would encourage more young people to buy insurance, and that a larger pool with more healthy people would lower premiums for all groups.
The bill would create a mechanism for paying the premiums of people with chronic illness, by spreading the cost over more than 650,000 policyholders in Maine, rather than just 40,000 in the independent and small-group market.
The plan would be funded by a $4 per-person monthly tax on almost every health insurance policy in the state. The policies of state employees, including legislators, would be exempt.
A nonprofit group that would administer the program could increase the assessment. The Senate passed an amendment Wednesday to cap the assessment at $6.
MaineToday Media State House Writer Tom Bell can be contacted at 699-6261 or at: