As commissioner of the Maine Department of Health and Human Services, and as superintendent of the Maine Bureau of Insurance, we spent the better part of the last year developing the Made for Maine Health Coverage Act, a bill that will improve health insurance for Maine people and small businesses.

So, we were surprised to read a recent commentary (Jan. 12) by David Anderson and Mitchell Stein, which suggests the bill would increase costs for Maine people and small businesses. We would like to clarify how the Made for Maine Health Coverage Act would – and would not – work.

What the legislation would do is make some of the most common medical visits free for consumers and simplify shopping for health care by providing clear, straightforward choices of health plans. It would make premiums more affordable and stable for small businesses, helping to better control ever-increasing costs. And, it would put Maine – rather than Washington – in the driver’s seat when it comes to running the health insurance marketplace, a reform that will allow us to better meet the specific needs of Maine people.

What the bill would not do is raise premiums for Maine people or small businesses, despite the columnists’ contention. To arrive at their conclusion, Stein and Anderson compare “risk scores” (a measure of enrollees’ expected costs) to come up with the premium impact of the proposal. But that analysis is oversimplified. It assumes that everyone is in the same plan and is charged the same premium, no matter their age or location.

In reality, there are big differences in both plan selections and the ages of people buying health plans in the different health care markets. That is why the Maine Bureau of Insurance is using more-detailed information that reflects these differences as it conducts a comprehensive evaluation overseen by two independent sets of experts.

That evaluation also takes into consideration that our plan would capture savings that the authors incorrectly assert the “federal government would pocket.” This is a fundamental element of our proposal. Our plan would reroute any savings to Maine and use them to help prevent premium increases for small businesses.

Our bill also includes important safeguards to ensure that costs do not increase. Specifically, both the state and federal governments would have to agree that premiums would stabilize or be reduced. If not, this part of the proposal would not be implemented.

Similarly, we also don’t believe that requiring the first primary care and behavioral health visits to be free for patients will result in increased premiums. Making those early visits affordable would allow Maine people to get the care they need to stay healthier, helping to prevent more expensive treatments and emergency room visits down the road.

Additionally, the Affordable Care Act requires health plans at different levels to cap the average out-of-pocket costs people have to pay (e.g., 10 percent of total costs for “platinum” plans and 40 percent for “bronze” plans). Insurance companies cannot significantly increase or decrease the overall amounts consumers pay. As a result, insurers would have to prioritize primary care and behavioral health visits while offering the same overall level of coverage, rather than increasing premiums.

Last year, more than 57,000 Maine people were able to access life-saving health care through Medicaid expansion. With the Legislature, the Mills administration strengthened critical health protections for Maine people through L.D. 1 and implemented a comprehensive prescription drug reform package.

With this bill, the administration is building on that progress to improve health insurance for Maine people and small businesses. As the governor said last week, the Made for Maine Health Coverage Act offers pragmatic solutions tailored to the needs of Maine people. If enacted, it would represent a major step toward providing relief from complicated, high health care costs for Maine people and small businesses. We look forward to helping make that happen.


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