Analyst: Health insurance overhaul law needs a hard look by Legislature

By Seth Koenig, BDN Staff
Posted Oct. 31, 2011, at 4:45 p.m.

PORTLAND, Maine — The head of the Maine Center for Economic Policy said state lawmakers are due for a “gut check” on the controversial health care law passed during the last session.

Garrett Martin, executive director of the left-leaning think tank, dueled with Joel Allumbaugh, health insurance expert with the right-leaning Maine Heritage Policy Center, Monday in a debate held in Portland at the University of Maine School of Law. In that setting, Martin said legislators will need to summon the political will necessary to reopen the health insurance law and make changes during the upcoming session, in part, to control rates.

Both men said lawmakers and stakeholders should take care to ensure the conversation about how to improve health care access, affordability and insurance is not derailed by partisan politics.

During the forum Monday, Martin revealed skepticism it will be when state lawmakers reconvene in January. He said LD 1333, Maine’s recently passed health insurance overhaul law, needs a hard look.

“The Legislature has a chance to revisit this proposal and improve it,” Martin told a room full of law students and members of the public. “The question is, will they?”

The Legislative Council, made up of party leaders in the House and Senate, met Monday to decide which bills to allow for consideration in the session that begins in January. Several addressed changes to the recently passed health care reform package but not all made it through the council.

Martin and Allumbaugh agreed Monday that major work remains both in-state and nationwide as policymakers tackle rising health care costs, which in turn drive up insurance prices in an economy when many Americans can least afford it.

They disagreed on the impact of LD 1333, however.

“You have to separate our health care challenges with our health insurance industry,” said Allumbaugh, a two-time board president of the Maine Association of Health Underwriters. “We need to make our health care system affordable and accessible no matter where you live, but [increasing] our insurance regulations are not how we get there.

“I agree that this [law] doesn’t solve the bigger problem,” he said, “but I disagree in that [I feel] this is a huge step forward in stabilizing the insurance market.”

Martin argued that the law’s elimination of insurance rate reviews and the Advisory Council on Health Systems Development forfeit much of the state’s oversight of health insurance companies, while the highly touted provision allowing Mainers to shop across state lines for insurance is a political “red herring,” a strong talking point that won’t drive down prices through increased competition as promised.

Martin said that in the upcoming legislative session lawmakers should reinstate the advisory council and rate review process, which he said proved its value when it held Anthem Blue Cross and Blue Shield of Maine to a 5.2 percent rate increase earlier this year in the face of a proposed 9.7 percent rate hike.

He also said the law’s reinsurance program, which uses a monthly $4 fee charged to Mainers with private insurance plans to create a subsidy offsetting the cost of higher-risk clients to the insurance companies, should be extended to small group buyers. Currently, only high-risk individual buyers benefit from the subsidy. Martin also said the Maine Bureau of Insurance should be charged with collecting data on the health insurance law and reporting back to the Legislature.

During the debate, Allumbaugh defended the law, saying previous in-state rate limits restricting insurers from charging their oldest and most rural clients any more than 1.5 times what they charge their youngest and least expensive clients effectively drove away younger, healthier insurance buyers. Instead of keeping costs down for elderly and rural buyers, he said, it drove costs up for younger, urban customers.

The new law allows insurance companies to charge rates three times as expensive for older, higher-risk clients as for younger, lower-risk ones — and the law includes an additional 1.5 multiplier based on geography and access to medical care. By allowing the gap between highest-risk and lowest-risk customers to grow, lowering prices for younger and healthier buyers, Allumbaugh argued the law promises to attract those buyers back into the pool and help stabilize rates for everyone.

Anthem, the state’s largest health insurance carrier, reports having less than 300 customers between the ages of 18 and 24 in the state of Maine, Allumbaugh said. The company has nearly 1,800 from the same age group in New Hampshire, where rates gaps are less restrictive.

He also lauded the law for provisions creating a tax credit for businesses promoting employee wellness, saying long-term solutions for controlling health care costs — and by extension, insurance costs — should create incentives for individuals to reduce hospital trips by living healthier.

http://bangordailynews.com/2011/10/31/health/analyst-health-insurance-overhaul-law-needs-a-hard-look-by-legislature/ printed on September 1, 2014