BY ETHAN WILENSKY-LANFORD
Staff Writer
Maine lawmakers are trying to forbid health insurers from capping the amount of benefits a policyholder can receive. If successful, Maine would become the first state to outlaw the practice.
Supporters of the bill, L.D. 1620, say the legislation would make Maine a leader in protecting consumers from a calculating maneuver that insurance companies use to make a profit.
?No Maine family should ever have to choose between receiving the care they need and losing their income, their small business, or their life savings and retirement fund, whatever they have, because of a catastrophic illness,? said Rep. Meredith Strang Burgess, R-Cumberland,a co-sponsor and breast cancer survivor.
Insurers, however, believe this added restriction would raise premiums.
?Requiring insurers to offer products without a lifetime maximum will likely increase the cost of premiums to everyone in the health insurance market and reduce the affordability of coverage,? said Chris Dugan, director of corporate communications for Anthem Blue Cross and Blue Shield in Maine.
The proposed legislation would eliminate both annual and lifetime insurance caps. Private insurers began writing payment these caps into policies in the 1970s. Anthem, the state?s largest private insurer, did not have caps in most of its Maine policy plans, according to Cherilee Budrick of Consumers for Affordable Health Care.
Anthem has started writing $3 million lifetime benefit caps into a majority of its plans this month, according to Dugan. He said this change was necessary to control rising costs of health insurance in Maine.
Most insured, however, never reach their caps; it is usually triggered by chronic, life-threatening maladies such as cancer, AIDS, diabetes, hemophilia and multiple sclerosis.
Richard ?Rocky? D?Andrea, 63, of Limerick hit his insurance cap in June 2009, after being diagnosed with melanoma, a type of cancer. His wife, Theresa D?Andrea, said in a State House news conference recently that the couple didn?t know their policy had a cap until they reached it.
?Little details about our policy most people don?t notice until something like this happens meant that the insurance company stopped paying for our health care very quickly,? Theresa D?Andrea said, ?because we hit the $250,000 lifetime cap soon after his diagnosis.?
Richard Cauchi, program director for health at the National Conference of State Legislatures, said he?s unaware of any similar bills being considered in state legislatures in 2010.
Also, no other yet state has banned insurance benefit caps, according to the National Association of Insurance Commissioners.
?As legislators, we always say we want to protect the most vulnerable,? said the bill?s sponsor, House Majority Whip Seth Berry, D-Bowdoinham. ?Who is more vulnerable than those who are so sick they run out of health coverage to pay for the bills??
Advocates such as Budrick claim that because so few people typically hit coverage limits ? fewer than than 100 in Maine since 2002, she said ? this legislation would cost insurance companies a minimal amount to administer.
Berry said the bill would also save taxpayers money by reducing the amount of charity care provided by hospitals.
?When people can?t get the care they need when they need it, they really have two options,? Berry said. ?They will die, or taxpayers, in one way or another, are going to have to pick up the bill.?
A public hearing on the bill is scheduled for 1 p.m. Wednesday.
Ethan Wilensky-Lanford ? 620-7016
ewlanford@mainetoday.com
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- Bill would halt caps on benefits
- Breast Cancer Medication and Health Insurance Coverage Problems
- Opening for those locked out of coverage
- Affordable Health Insurance Coverage Doesn?t Explain Breast Cancer Disparities
- Opening door for those locked out of coverage
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