AUGUSTA, Maine — A Republican-backed health care overhaul bill aimed at encouraging competition and driving down insurance premiums in Maine has been put on hold until Monday.
Republicans and Democrats debated through the night before the Senate decided shortly before 1 a.m. Friday to adjourn without a final vote.
House lawmakers voted largely along party lines Thursday to pass a major overhaul of Maine’s health insurance policies that Republicans insist will lower rates through competition but Democrats warn could devastate health care in rural Maine.
But partisan differences over the legislative process delayed a final Senate vote late Thursday and threatened to open a sizable political rift in the committee responsible for crafting a new, $6.1 billion budget in the final weeks of the Legislature.
“I am extremely concerned with the ability of this committee to function with what is going on here tonight,” said Rep. John Martin, D-Eagle Lake, a member of the budget-writing Appropriations and Financial Affairs Committee.
In the first deeply divisive battle of the legislative session, House Republicans held ranks to defeat about a half-dozen Democratic attempts to amend a bill that changes how insurance companies can calculate rates and how Mainers can shop for coverage. The House voted 78-68 — with two Democrats in support — to pass the bill.
Republican leaders had planned to hold what would likely have been a final Senate vote Thursday evening and send the measure to Gov. Paul LePage’s desk for his signature. But as tensions escalated between the two parties and the clock approached 1 a.m., it looked increasingly likely that the Senate would delay a vote.
Among other things, the insurance overhaul bill, LD 1333, will allow Maine residents to buy coverage offered in other states and allow small companies to band together for greater purchasing power.
Supporters claim such steps will bring more young, healthy people into the insurance pool, thereby lowering costs for everyone.
“I listened to the people of my district who have been begging and pleading for this, and I know they are in your district too,” Rep. Jonathan McKane, R-Newcastle, said during House debate.
The bill also creates a “high-risk pool” to cover Mainers who use more health services, paid for with a $4-per-month fee paid by every policy holder. But Democrats lambasted the assessment as a hidden tax equivalent to nearly $200 a year for a family of four, employing an argument often used by the GOP when Democrats controlled the State House.
Democrats also cautioned the bill could lead to significantly higher rates for older Mainers and those living in more rural areas. That is because the bill changes the formulas on which companies can base rates, taking into account age, geography and occupation.
While assailing the majority party’s tactics to quickly usher the bill through, Democrats also predicted the measure’s negative effects will be felt most sharply by rural Mainers who could be forced to travel long distances for care or see their local hospitals shuttered.
“I am amazed the industry has succeeded — and they have succeeded — in being able to unify the members of the majority party into a block that will destroy the hospitals of rural Maine,” Martin said. “And in two years, if this goes the way it is going now, you will see the results.”
LD 1333 has been a deeply partisan issue ever since Republicans passed a GOP-drafted bill out of committee after minimal debate.
Republicans leaders say the contents of the bill have been discussed for years, but Democrats accuse their counterparts of ramrodding through an industry-written bill without allowing the state’s own Bureau of Insurance to study the effects.
Absent those new calculations, Democrats said they were forced to use a 2007 study by the Bureau of Insurance that shows insurance rates rising dramatically in rural Maine because of changes that allowed companies to weigh age and geography more heavily in setting rates.
The liberal-leaning Maine Center for Economic Policy noted that the 2007 study forecast that individual rates would increase 19 percent in Aroostook County and 22 percent Down East while insurance rates paid by businesses in those areas would increase 17 percent and 9 percent, respectively.
Republicans say that Democrats are using an old study that does not reflect the scope of the changes in LD 1333 and appears to overstate price difference based on age and geography. Additionally, they point out that the bill contains price protections to prevent insurance companies from significantly increasing premiums for those in the high-risk pool.
Thursday’s debate illustrated the power of party unity and the closed-door caucus process as Republicans defeated all of the Democratic amendments, often without any GOP lawmakers standing up to respond to hours of criticism from the other side. The lack of response only further angered Democrats, however.
“The silence of the majority is deafening,” said Rep. Chuck Kruger, D-Thomaston.
One of the few Republicans to speak on the bill was Rep. Kenneth Fredette of Newport, who told Democrats that while the bill may not be perfect, it makes much-needed changes that will open up Maine’s insurance markets.
“This bill can be amended next session,” Fredette said. “In the meantime, I’m going to do something to help our young people and to keep them in the state of Maine.”
In one of the most controversial aspects of LD 1333, the bill would repeal a law that prohibits insurers from requiring Mainers to travel long distances for care rather than use smaller and often costlier local hospitals or clinics. Supporters of the change say insurers still will have to pay for local care, but companies can offer policy holders financial incentives to seek lower-cost care at larger hospitals.
Critics, meanwhile, fear the changes will hurt residents and access to health care in rural Maine.
Sen. Troy Jackson, D-Allagash, said older Mainers in rural areas could be pressured financially into making the three-hour drive to seek care in Bangor, or even Portland.
That same change means small hospitals, which are key employers in northern Maine, could lose the health care customers they need to keep their doors open, he said.
“I can’t go back [to Aroostook County] with a clear conscience without getting more clarity on the impact of this bill, and I can’t get that,” he said.
But Jackson’s Republican colleague from The County, Sen. Roger Sherman of Houlton,
said that he was “kind of nervous” about various provisions of the 50-page bill until he took the time to read it through and ask questions. His sources included the analyst for the Insurance and Financial Services committee and other lawmakers, he said.
“I wasn’t in favor of doing this until I understood what was in it,” he said, but now he feels confident that LD 1333 will improve the health insurance market for all Mainers, including his rural constituents.
Jackson and other Democrats repeatedly accused Republicans of not giving the Maine Bureau of Insurance time to crunch the actuarial data.
“The Bureau of Insurance has been non-existent in this whole thing,” Jackson said. “In the past, we’ve always had the benefit of the BOI giving us the numbers and the information we need. Not this time … somewhere along the line, someone has kind of muzzled that department … [Insurance Superintendent] Mila Kofman has been relegated to the bench.”
Kofman’s secretary said Thursday afternoon that the superintendent was away at a conference. A request for comment left on Kofman’s cell phone was not returned. Adrienne Bennett, spokeswoman for Gov. Paul LePage, said Kofman has not been barred from the discussion of LD 1333.
“It is important to clarify that the superintendent of insurance is responsible for the implementation of state statutes” and is not charged with participating in the legislative process, Bennett said. Bureau staff has been available to answer questions as requested by lawmakers, she said.
Tensions were still high late Thursday as the Senate prepared to take up the issue for a final, enacting vote. Normally, any bill that has a financial impact on the budget must go through the Appropriations Committee, which could have delayed the bill’s progress. But Republican opted to exempt the bill from the committee process, further infuriating Democrats.
“I think it is important that you understand how deeply disrespected we feel,” said Rep. Peggy Rotundo, D-Lewiston.
In the end, the Appropriations Committee voted 8-4 along party lines to exempt the bill, opening the door for a Senate vote.