May 25, 2018
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Do you know what your health insurance covers?

By Adam Goode, Special to the BDN

Last November, voters on the west side of Bangor put their trust in me to serve them in the state House of Representatives. As a new representative in a new job, I hope to bring my energy and enthusiasm to Augusta.

I will be serving on the Insurance and Financial Services Committee. Issues facing this committee range from insurance, to financial institutions such as banks and credit unions, to health care reform.

This session, we’ll expect to see a number of bills regarding the transparency of health insurance policies. We all know where the profits of health insurers come from — our pockets. What we don’t yet know is where that money goes and what we get out of it. You can buy a health insurance policy today and not even know what it will cover. Health insurance is one of the only products that you can buy without knowing what you are getting. In our community, people buy policies that cover “pregnancy services,” only to find out later that they do not

cover giving birth.

One story that was brought to my attention echoes what I heard from many community members last fall. Helen Hanson of South China spoke at a recent press conference about how she thought her family’s health

insurance policy had a $10,000 deductible, only to find out later that it was a $10,000 deductible for each family member, requiring her to pay $30,000 out-of-pocket before the policy covered any costs. Imagine if you bought a car at a local dealership, then had to pay an enormous fee each time you had to drive somewhere, or if you went a fast-food restaurant, bought a hamburger, then had to pay even more money before you took a bite?

We should be able to know exactly what we are paying for when we purchase health insurance. Right now, the average consumer does not have the information they need to be able to comparison shop for insurance plans.

I’ve already caught wind of a number of proposals that the current Legislature could enact to better help consumers deal with the complexities of the private insurance industry. For starters, insurance companies should comparatively post information regarding how much they spend on administrative costs, profits, and lobbying public officials. We should know what our money is getting us.

Insurance carriers also should be required to spend at least 85 cents of every premium dollar on actual medical care. If we want to get better value for each dollar we give an insurance company, more should be spent on actual medical care. Public insurance programs usually spend 95 to 97 cents of each dollar on real medical care. Private insurance companies should be held to a similar standard.

It is also not a secret that insurance companies often hike their rates while simultaneously awarding CEOs handsome bonuses. We should tie the growth rate of the actual cost of medical care to the amount insurance companies can raise rates. If rates are raised more than that growth, consumers should get to know what their money is paying for.

Finally, certificates of coverage for insurance policies should be posted on insurance carrier Web sites and the Bureau of Insurance Web site. This will help consumers know what they are paying for. Posting detailed descriptions of what plans cover would allow us to see which plans offer the coverage we need at the best price.

Most health care interests in the state are committed to guaranteeing access to quality, affordable health care to every Mainer. To start, we must address transparency in our insurance coverage to provide consumers with information to make better choices. It will help us save money and get the information necessary to reform our health care system.

Adam Goode of Bangor represents District 15 in the Maine House of Representatives. He works at the Maine

People’s Alliance as an environmental organizer.

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