There is no easy answer, as some might have you believe, to Maine’s healthcare problem. For someone to say that one plan or idea would fix the situation simply shows there is not an understanding of the depth of the issues here in Maine or in this country.
All ideas need to be on the table, discussed, and thoroughly vetted.
One idea that has been successful around the country as part of a health insurance reform plan is the “high-risk” pool, sometimes called a chronic care pool. A high-risk pool or re-insurance mechanism covers the most vulnerable among us while allowing others to buy health insurance at a cheaper rate.
Bi-partisan federal legislation is helping fund high-risk pools or re-insurance mechanisms up to $1 million for states that wish to do so.
Thirty-four states have high-risk pools or similar mechanisms and all those states have cheaper premiums than we have in Maine. These states have encouraged more competition in the health insurance market – something we don’t have here in Maine. Only the largest insurance companies (Anthem) can survive under our current market structure.
These programs, however, are only a small part of a very large and complex healthcare equation that could help Maine reduce health insurance premiums. See www.jonmckane.com – Alternatives to Dirigo.
We must change our “community rating” law. This law requires all premiums to vary only a small amount; no matter one’s age, health or habits. This creates a system that subsidizes the older, less healthy and often wealthier people with the artificially high premiums of the younger, healthier and less wealthy.
As a result, younger and healthier people drop out and we get adverse selection – more unhealthy people are concentrated in Maine’s insurance pool, resulting in higher claims and more requests by our monopoly health insurance carrier, Anthem, for higher rates on those people who remain.
By widening our community rating bands, younger and healthier people with very low risk would be allowed the benefit of their youth and age.
We must also offer catastrophic policies for young, healthy people. Because of Maine’s mandate laws, we are all forced to buy expensive “Cadillac” coverage policies, which can mandate coverage that someone may never need or want.
Also, if Maine people were allowed to purchase health insurance out-of-state, many of us could buy policies for much less than we can in Maine. Sadly, the status quo in Augusta would rather we stay right here and purchase from our monopoly carrier.
Health Savings Accounts (HSAs) are showing themselves to be popular and very useful in not only saving tax dollars but in making wiser healthcare consumers. Tax credits and larger allowable tax deductions would also make health insurance more affordable.
And we must confront the high cost of the care itself.
We have to get our Medicaid program (MaineCare) under control. Because Maine has such a large number on Medicaid (21 percent – the highest in the country), because of our high cost per enrollee (almost double the national average), and because of Medicaid’s low re-imbursement (75 percent of the cost of treatment) we have a huge unpaid MaineCare bill that is shifted to healthcare providers and consumers.
We need better case oversight, and higher reimbursement to providers and perhaps a sliding-scale subsidy program such as we have with DirigoChoice to help people out of MaineCare. See www.jonmckane.com for more on MaineCare.
Prevention is certainly a big part of controlling costs. Seventy percent of Maine people die from four diseases; heart disease, cancer, lung disease, and diabetes, (according to the Maine Bureau of Health).
Tobacco use, physical inactivity, poor nutrition, high cholesterol, and high blood pressure are five contributing factors to these diseases.
All these factors are manageable through education, lifestyle changes, and improvement in economic status.
Healthcare has lagged behind virtually all other industries in the implementation of information technology to promote quality and efficiency. Our medical records are fragmented and incomplete and this can lead to medical errors, duplication of services, unnecessary testing and improper care.
We need to examine the regulatory process that our healthcare providers must comply with. Doctors offices, clinics and hospitals all employ many people who do nothing more than mandatory reporting and compliance.
Medical malpractice liability continues to be a burden on all health care. Unnecessary and redundant tests and care to guard against heavy lawsuits are expensive and we all share the cost. Medical malpractice lawsuits need to be capped.
In this “oldest state in the nation”, the demand for healthcare services is growing and the healthcare workforce is not keeping up.
To keep up with the demand, healthcare providers will be forced to pay housing, transportation, schooling and living expenses to retain workers and the expense will be passed on to the healthcare consumer. We need to be able to provide healthcare educational opportunities here in Maine. I have submitted a bill title for this session that would study the feasibility of a medical school in Maine.
Health clinics are becoming more abundant in Maine’s urban areas but the emergency room is still the only option in many rural areas. More rural clinics and on-call physicians could help reverse the use of this expensive practice.
We need to continue to look at all ideas including former Gov. Mitt Romney’s Massachusetts plan. But we should be wary of jumping in with both feet as we did with the Dirigo Health program.
There is no simple solution or quick fix to our enormous healthcare problem. We have top quality care here in Maine and, for the most part, people who need it get it. The problem is paying for it.
As Sen. Susan Collins has said, “neither Democrats nor Republicans have the monopoly on good ideas.” Our best ideas – either as legislators or as people – come from keeping an open mind. It’s easy to take an idea out of context and shoot it down, stifling the free exchange of ideas. We do our best work when we listen to the other side and work together. Using this method we can solve our healthcare problem.
State Rep. Jonathan McKane (R-Newcastle) represents Bristol, South Bristol, Damariscotta, Edgecomb, Newcastle and Monhegan. He can be reached at www.jonmckane.com.
