Only Maine seeks waiver from provision of health-care law

[Maine-ah]

Source: BDN

With a significant federal health insurance regulation taking effect Saturday, the fate of Maine’s request for an exemption remains uncertain.

Although several others are expected to follow suit, Maine is the only state so far to have filed for an exemption to an Affordable Care Act regulation that requires health insurance companies to maintain a minimum “medical loss ratio” of 80 percent. That means the companies must spend an average of at least 80 cents of every premium dollar for health care services delivered to policyholders. The remaining 20 cents can be used for operational expenses such as administration and marketing as well as for boosting profits.

The current minimum medical loss ratio in Maine is 65 percent, and Maine Insurance Superintendent Mila Kofman, a strong supporter of national health care reform, would like to keep it that way for now.

In a July 1 letter to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, Kofman expressed concern that implementing the 80 percent medical loss ratio here “would have a serious destabilizing effect in our individual market.” With only two companies competing effectively for the Maine individual market, Kofman said in her letter, one had already indicated its intent to pull out of the state if the higher loss ratio were imposed.

Read more: http://new.bangordailynews.com/2011/01/01/health/only-maine-seeks-insurance-waiver/

[xchrom]

1. Sounds like one of the 'individual market' providers

Is trying to hold Maine hostage.

[Maine-ah]

2. if Maine would allow more providers in

we'd see more competition and our premiums would go down.

One of the responses to the article:

"Here's the reality of health insurance in Maine - my premium (to cover my children and spouse) this year doubled. Doubled. Nobody was sick last year and our use of insurance was limited to a couple of well child checks and a trip to walk in care for stitches. The insurance industry, and much of health care is broken and corrupt. I'm sick of seeing specialists pulling in $300K+, Pharmaceutical reps with business degrees selling drugs from their Suv's and insurance company fat-cats wintering in Boca Raton, while my kids feel the pinch of their greed. This system needs a complete overhaul and any Mainer who doesn't understand that is out to lunch."

[Lasher]

3. This is one reason why the insurance industry is so afraid of the public option.

They wouldn't be able to pull shit just like this.

[xchrom]

4. indeed. nt

[radhika]

5. Medicare for All Individuals in Maine?

This would be a great way to force opening Medicare to all uninsured. If the only individual plans refuse to operate in maine due to the 80% rule, let them leave. Into the breech, open Medicare for All on a premium basis to the uninsured of Maine. I see no problem - just a really nifty solution.

[molly77]

8. Maine has sliding scale for the poor

The very poor pay virtually nothing for medical, dental and drugs.The insurance companies were very upset when the plan first got started.

[radhika]

10. Interesting....if you aren't very poor...

you might still want an individual plan - for example, self-employed. But if the InsCos leave Maine because of the 80% rule for individual plans, those kind of people would need coverage. Would Medicare4All help them?

Does the sliding scale for the poor come out of the InsCo pocket - or does the state subsidize premiums?

[customerserviceguy]

6. Sorry to say it, but the Repukes actually have the solution to this problem

Allow health insurance companies to sell across state lines.

All through the HCR debate last year, I never saw one person here at DU who told me why that was a bad idea.

[Maine-ah]

9. I think it's one of the things many republicans and democrats

up here agree on. I think we should allow the competition.

[SoapBox]

7. Bingo! And the problem is..."With only two companies competing effectively..."

THAT is exactly the problem.

Where is the competition?

All this blather about competition in the market place (and it applies to any number
of business areas where companies maintain a virtual monopoly) is BULL.