By overwhelming majorities in both the House and the Senate, Maine lawmakers this week overrode Gov. Paul LePage’s veto of a new law, LD 1030, which requires health insurance companies to pay for services provided by naturopathic doctors.
The law, which applies to all insurance plans in effect on Jan. 1, 2019, requires insurers to pay for health care provided by licensed naturopaths just as if the care were given by other licensed providers, including medical doctors, osteopathic doctors or nurse practitioners.
It prohibits insurers from charging higher out-of-pocket spending, such as co-pays or deductibles, for naturopathic care. And while it does not require insurers to specifically include naturopaths in their provider networks, it prohibits them from excluding them on the basis of their training and licensure.
There are about 50 naturopathic doctors licensed in Maine. Naturopathic doctors must attend four years at an accredited college of naturopathy and pass a standardized national licensing exam before they can practice. They are also licensed and regulated by individual states. They study many of the same subjects studied by medical doctors, or MDs, but with a greater focus on using diet, exercise, lifestyle, and stress management to promote health and correct disorders. Herbal and homeopathic remedies are among their recommended therapies, along with massage, meditation and therapeutic counseling.
“I’m tickled pink,” said naturopathic doctor Elizabeth Yori, who practices in Belfast and is the president of the Maine Association of Naturopathic Doctors. “The impetus of this legislation was to protect patients’ access to naturopathic care in the state of Maine.”
While most insurers doing business in Maine already cover some naturopathic services, she said, they have not been required to do so, and at least one company did not.
When Anthem discontinued its participation in the individual health insurance market last year, Yori said, many Anthem clients had trouble finding coverage that included the naturopathic services they preferred.
“Some patients had to switch insurers, and [their naturopathic] services were no longer covered,” she said.
For example, Yori said, she has successfully treated a female patient who had not found relief for her chronic gastrointestinal disorder through more conventional, or “allopathic,” approaches, including commonly used diagnostics and pharmaceuticals. By taking more time to determine the woman’s food sensitivities, intestinal bacteria and other factors, Yori said she was able to correct the problem with careful changes in diet, the use of herbal supplements and biofeedback sessions to promote better digestion.
“Then she lost coverage,” Yori said. But the new law will allow her patient to return to her care, by requiring the insurer to pay what it would pay an allopathic doctor for treating the same disorder.
It’s not a question of pitting allopathic doctors against their naturopathic counterparts, she said, but of providing a range of complementary services and approaches to meet individual patients’ needs and preferences.
“All of us actually work pretty closely with doctors,” Yori said. “But interest and support for alternatives to traditional medical practice is on a roll. People are looking for this.”
At the Maine Association of Health Plans, executive director Katherine Pelletreau said there was not a “huge deal” of opposition to the measure from insurance companies. “Most of our provider networks already include naturopathy,” she said. The concern was that any law limit the range of services insurers are required to cover.
“Health plans want to cover medically efficacious services,” she said. “They wanted to cover the [naturopathic] services they were already covering and not an expanded range of services.”
With growing consumer interest in alternative therapies, she said, “insurers are responsive to what their members want.”
Bill sponsor Sen. Justin Chenette, D-Saco, said a constituent from Old Orchard Beach approached him with the need to ensure consistent payment for alternative therapies to treat her chronic Lyme disease.
Chenette said it’s important to recognize growing public interest in therapies that “move away from pharmaceuticals and get to the heart of trying to heal folks.”
“Everyone is supposedly mandated to have health insurance now, and then they find out their insurance doesn’t cover the care they need,” he said. “So insurers get rich and Maine people are getting screwed.”
While his proposal initially was met with opposition from insurers and skepticism from many GOP lawmakers, Chenette said it was bolstered by a study from the Maine Bureau of Insurance showing there would be no negative impact on monthly premiums or other costs associated with the health care market. After that, he said, there was cooperation for arriving at language and provisions all could agree on, and the bill passed out of committee with unanimous approval.
LD1030 also won broad bipartisan endorsement in both the House and Senate in February, only to be vetoed last week by LePage, who said in his veto message, “… this bill would restrict [insurers’] ability to construct provider networks to deliver quality and cost-effective services. If this bill passes, naturopaths will have no incentive to join insurance networks to perform their services as primary care physicians.”
LePage’s veto was overridden in the Senate on Tuesday with a vote of 32 in favor and two opposed, and in the House on Thursday with a vote of 135 in favor and 11 opposed.
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