L.D. 1 Testimony

TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

IN SUPPORT OF

L.D. 1, AN ACT TO PROTECT HEALTH CARE COVERAGE FOR MAINE FAMILIES

 

Joint Standing Committee on Health Coverage, Insurance & Financial Services
Room 220, Cross State Office Building, Augusta, Maine
Tuesday, January 29, 2019, 1:00 p.m.                                                    

Good Afternoon Senator Sanborn, Representative Tepler, & Members of the Joint Standing Committee on Health Coverage, Insurance & Financial Services.  My name is Andrew MacLean, Interim CEO of the Maine Medical Association (MMA), and I am pleased to be here today to speak in favor of L.D. 1.

 

The MMA is a professional organization of more than 4300 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The MMA appreciates that the 129th Maine Legislature’s Presiding Officers have made a commitment to protect patient rights in our health insurance market through their sponsorship of L.D. 1.  I understand that you are conducting this hearing not on the printed bill but on the draft circulated by your Analyst last week, and that revising continues.  I hope that the Committee can build upon bipartisan work of this Committee during the last legislature towards health care reforms all of us would support as patients.  MMA is prepared to participate in the hard work that will be necessary to achieve bipartisan consensus on these issues.

The Maine legislature has a long history of enacting patient protection laws on the recommendation of this Committee. 

In the early 1990s, during the national health care reform debate prompted by the Clinton Health Care Reform Task Force, this Committee recommended that Maine adopt a modified form of community rating.  While this is a regular part of any health care reform discussion today, it was quite a new concept at the time.  In that same era, in reaction to widespread public backlash against “managed care” health insurance, this Committee recommended passage of L.D. 1513, An Act to Ensure Fairness and Choice to Patients and Providers under Managed Health Care (117th Maine Legislature, P.L. 1995, Chapter 673), a bill brought forward at the request of the MMA and a coalition of other provider, consumer, and patient advocacy organizations.  L.D. 1513 established the part of the Maine Insurance Code known as the Health Plan Improvement Act and resulted in Bureau of Insurance Rule Chapter 850, Health Plan Accountability.  These Maine laws enacted patient protections we all take for granted today, and Maine enacted them prior to the federal Health Insurance Portability & Accountability Act (HIPAA) and Patient Protection & Affordable Care Act (ACA).  This Committee has acted boldly in the Dirigo tradition and been in the forefront of protecting the rights of Maine patients for many years.  I encourage you to continue that tradition with thoughtful consideration of L.D. 1.  While the bill draft may seem daunting, please remember that it seeks to reconcile aspects of existing law – reconciling provisions of the ACA with pre-existing provisions of Maine law to provide the strongest possible protections for Maine patients.

Part A of the bill does the following:

  • Establishes reasonable limits on variation from a community rate in the individual and small group markets;
  • Raises the medical loss ratio requirement in the individual market from 65% to 80%;
  • Gives the Superintendent of Insurance rulemaking authority to specify dates and criteria for open and special enrollment periods in the individual market;
  • Removes restrictions on dependent coverage up to age 26;
  • Limits the imposition of pre-existing condition exclusions in the individual and small group markets;
  • Narrows insurance carriers’ right to rescind an insurance policy once issued;
  • Amends the provision of Maine’s Health Plan Improvement Act on insurance carriers’ descriptions of the health plans they offer to conform to the ACA;
  • Prohibits insurance carriers from reducing or terminating benefits when a patient is undergoing a course of treatment during an appeal process;
  • Further restricts insurance carriers’ prior authorization of prescription drugs;
  • Clarifies insurance carriers’ obligation to extend rebates to policyholders;
  • Ensures “guaranteed issue” protections in all market segments; and
  • Prohibits annual or lifetime limits in most health plans.

Part B of the bill does the following:

  • Ensures that health plans cover an appropriate scope of services, known under the ACA as “essential health benefits” and that levels of coverage and patient cost-sharing limitations are consistent with the ACA.

Part C of the bill does the following:

  • Adopts non-discrimination standards, including a requirement to ensure effective communication, consistent with the ACA.

Part D of the bill does the following:

  • Ensures that Maine’s existing mental health parity laws apply across all market segments whereas current law requires a “mandated offer” of mental health parity benefits in the individual market.

Again, I understand that this is a complicated bill and the Committee has a lot to digest early in the new legislature, but I encourage you to have a thoughtful and methodical discussion, with the help of the stakeholders, to reach bipartisan consensus on a final bill.  Many Mainers, including us, have faced some of the issues addressed in this bill, so the people of Maine will appreciate your efforts.

Thank you for considering the views of the MMA on L.D. 1.  I would be happy to respond to any questions you may have.