Bill would prohibit caps on insurance
State House

Bill would prohibit caps on insurance


By Meg Haskell
BDN Staff

AUGUSTA, Maine — A bill that would prohibit health insurance companies from capping the amount of money they will spend covering policyholders drew an impassioned crowd to the Insurance and Financial Services Committee room at the State House on Wednesday.

The bill, LD 1620, would do away with the insurance industry practice of terminating payment of insurance claims based on a policyholder reaching an arbitrary annual, lifetime or other threshold.

Proponents of the measure argued that most people are unaware their policies are capped until they are suddenly denied coverage and are thrown into financial crisis. Opponents — all representing the insurance industry — said eliminating caps would lead to an increase in the cost of individual and small-group coverage.

Theresa D’Andrea of Limerick said she and her husband, Rocky, were shocked to discover that the coverage they had paid for faithfully for several years came with a $250,000 cap. When Rocky was diagnosed in 2008 with malignant melanoma, it didn’t take long to hit that cap.

“Now we are struggling to meet our mortgage, our credit cards are maxed out, we’ve spent all our savings and retirement, all because my husband got cancer,” D’Andrea testified.

The bills keep piling up, and Rocky was unable to testify at the public hearing because he was receiving a blood transfusion, she said.

“My husband and I have worked hard our whole lives. We’ve paid our taxes. He even served in the Vietnam War — when his government called, he answered right away,” D’Andrea said in her testimony. “We figure we’ve paid about 60 years worth of taxes and money to Medicare, Medicaid and Social Security. And yet now we are in financial ruin. We are asking ourselves who will answer our call for help?”

Former emergency physician Paul Lebow told the committee that he, too, ran into a benefits cap he never suspected existed. After undergoing a heart transplant and extensive treatment for complications, he said, his insurance company denied payment for a $20,000 heart catheterization because he had reached a $1.25 million lifetime limit.

“I thought I didn’t have to worry about paying my medical bills because I had insurance,” he said.

Instead, he said he finds himself without any coverage and doing what he can to avoid becoming ill or triggering his ongoing cardiac problems.

A parade of consumer advocates spoke in support of the legislation, including representatives of the Maine Chapter of the American Cancer Society, the Maine Women’s Lobby, the Maine Medical Association, Consumers for Affordable Health Care and the Catholic Diocese of Portland.

Mitchell Stein, a public policy consultant and a representative of the Maine Council of Churches noted that some insurance companies began imposing $1 million caps in the 1980s. In 2010 dollars, he said, an equivalent cap would be $10 million.

Insurance Superintendent Mila Kofman also testified in favor of the bill.

“Lifetime limits hurt people with catastrophic illness,” she said. “Health insurance needs to work for you when you are sick and not just when you are healthy.” She cautioned that eliminating lifetime caps could raise the cost of health insurance, but said a survey of insurance companies doing business in Maine indicates that the increase would be small — about 0.4 percent.

Kofman said most Mainers insured in large employer-based groups do not have caps on their benefits, but a growing number in the small group and individual market do.

Anthem Blue Cross and Blue Shield, the largest carrier of small group and individual plans in Maine, began including a $3 million cap in many of those policies this month. Testifying on behalf of the insurance company at Wednesday’s public hearing, Christine Ossenfort said caps are needed to protect insurers and hold down costs for most consumers.

It is rare that anyone reaches or exceeds a benefits cap in Maine, she said.

Other insurance providers also testified in opposition, including lobbyist Dan Bernier, representing the Maine Association of Insurance Underwriters. Bernier said benefit caps “keep the actuaries happy” by protecting against unlikely losses. While decrying the D’Andreas’ $250,000 cap as inadequate, Bernier advised the committee members to consider setting a minimum cap of $3 million — high enough to meet the needs of the great majority of individuals while still protecting insurers against “remote possibilities.”

A work session on the bill is scheduled for Tuesday, Feb. 9.

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Comments
37 comments on this item

Just one of the reasons this country desperately NEEDS health care reform that includes a public option. Government run insurance would NOT deny coverage just because a person has a medical illness that is expensive to treat. Having a public option would FORCE these greedy insurance companies to be competitive and EARN consumer business.

She said all that?

It could happen to YOU, JW.

You think health insurance is exspensive now?....Wait till its "free"

No, hooligan, I didn't. I posted a few weeks ago in response to a bunch of people bashing single mothers who receive help that I had gotten assistance in the past after leaving an abusive relationship (back in 1994). Now he keeps making personal attacks against me based on that one thing. He's just a troll, which is obvious by his choice of user name. Why the administrators haven't just banned his IP is beyond me. If they just did that with the comment section trolls then they wouldn't have to close so many comments down.

Russ, they aren't trying to make it free. A public option would be insurance people would pay for just like they do regular insurance. The only difference would be that since it would be run by the government it would not be focused on profit so it would cost MUCH less for people to pay for which means that almost everyone would be able to afford healthcare and all the people whose employers don't offer it could buy the government option insurance. They aren't trying to create a system like Canada or Europe...all they are attempting to do is change things enough so the insurance companies can't behave in a way that is unfair and harmful to people like you and I, to make insurance more affordable and to make it available to everyone who wants to buy it.

Lower the cost of medical care. I took a friend to a hospital , on the bill, they had listed 4 pills for $134.00. Which turned out to be asprin. You could buy a bottle of 100 for under $8.00 at the time. That was about 25 years ago.

insurance companys are notting but evil ! They are for profit and that is the bottom line.when was the last time anyone has heard of a Insurace company going broke? other then AIG and what they did was a crime.I for one Iam tired of the insurance companys giving the same service that the bull gives the heifer

Anything run by the government isn't going to work, you can bet your life on that!

The insurance industry should have to adjust their cap, it's only fair. They should not be able to ask for more money, yet keep the cap the same.

"insurance companys are notting but evil ! They are for profit and that is the bottom line"

Funny how I keep hearing people say it is wrong for the insurance company to make a profit but OK for doctors, nurses, Drug Companies, Medical Supply Companies, etc...

You need food to live yet those greedy farmers continue to make a profit off of your needs.

Funny how silly that sounds but you don't see it when you talk medical issues.

Maybe people should read the policy. We have a cheaper option with a max benefit, but I used my brain and decided not to choose it. It was cheap, though, so I bet a lot of people pick it and then I'm sure will complain when it bites them in the butt. Nanny state politics...

prohibiting caps by insurance companies would go a long way in one aspect of unsurance reform.

WE ARE GOING TO SEE WHICH LEGISLATORS ARE DIRECTLY "INFLUENCED" BY BIG INSURANCE... VOTE THEM OUT OF OFFICE, NO MATTER WHAT PARTY THEY BELONG TO...!!!! IF THEY WERE WORKING FOR YOU, THERE WOULD BE NO INSURANCE DOLLAR CAP.........

DO NOT GET TRAPPED BY THE INSURANCE COMPANY BS......

To me, the key word is REASONABLE! I wouldn't mind paying premiums to a for - profit insurance company if they only wanted REASONABLE profit margins. I don't expect to pay for cheap insurance with no or little deductible - but I would like REASONABLE premiums with a REASONABLE co-pay. Come on, this is America - the youngest, most successful company in the world to date. It didn't get that way by how it has been run the last 30 years. Sure there has been greed and corruption since the beginning of time but it is time that people wake the hell up and stop letting CEO's, insurance companies, Bankers continue tarnishing and destroying this country!

Why doesn't some sane person enter this discussion and create a catastrophic health care program that is govt run? That would be one area the govt might be able to run efficiently. Insuranc companies are businesses pure and simple. They have to be profittable to stay in business. Another solution would be for individuals to purchase catastrophic policies. Arbritrailly forcing insurance companies to cover unlimited medical expenses is not the answer. It would drive up premiums for everyone. I have a very basic policy, but it is a catastrophic policy. I pay out of pocket for all my routine medical needs. It's not that much money every year.

newportres How much do you think it cost Doctors for malpractice insurance get a law past that DRs can NEVER be sued that would lower cost. Look at all the test they have you take just to cover them selfs from law suits you don't need half of the test.

We finally found the real "Death Panel", those insurance companies deciding when your illness is no longer profitable.

On 2/4/10 at 9:07 AM, wollydevil wrote: Repeated separate thumbs down will cause comment to be hidden

newportres How much do you think it cost Doctors for malpractice insurance get a law past that DRs can NEVER be sued that would lower cost. Look at all the test they have you take just to cover them selfs from law suits you don't need half of the test.

So a negligent doctor or hospital should be able to be as irresponsible and incompetent as they want with no chance of recourse by the victim? Great idea.

"but I would like REASONABLE premiums with a REASONABLE co-pay."

The devil is in defining the word, what is reasonable for me is not reasonable for you.

"newportres How much do you think it cost Doctors for malpractice insurance get a law past that DRs can NEVER be sued that would lower cost. Look at all the test they have you take just to cover them selfs from law suits you don't need half of the test.

So a negligent doctor or hospital should be able to be as irresponsible and incompetent as they want with no chance of recourse by the victim? Great idea."

How about they just lose their license if they screw up?

They are sued way too much and insurance companies settle because it is easier then fighting it in most cases.

Lawyers are getting very wealthy off of this deal.

Why isn't that being addressed?

My dad had pancreas cancer. He also had a policy with a million dollar cap. We NEVER thought it would cap out. Well, at EMMC it did. The social worker approached me one day, I was dad's voice while he was unable to speak, and she said, I'm sorry Mr....., your dad's insurance has maxed out. We had to put our house up as collateral. OUR HOUSE!

This happens folks, and a life threatening disease can ruin an entire family. Check your policies. KNow what the hospital will ask you to do BEFORE you are shocked into putting up your house as collateral.

Our healthcare system is so broke.

I just don't understand why we cant have what the senate gets for insurance. They have it made.

I don't understand the defense of for-profit insurance companies. Heroin dealers make a profit, too, and in a purely free-market system they would thrive, because they supply a product their customers want and need. That doesn't mean they aren't evil, or that they aren't ruining lives with their product. We have laws designed to protect people from them. We need laws to protect us from the worst policies of the insurance companies.

"I don't understand the defense of for-profit insurance companies."

I don't understand why you wish to demonize the insurance companies (heroin dealers?) when it is pretty obvious that it is the cost of health care that is the problem here. The hospitals and doctors and drug companies and medical supply houses are robbing you yet your only answer is to attack the people who help you pay because they won't give you more money for the robbers to steal. "We NEVER thought it would cap out. Well, at EMMC it did."

Why does Aspirin at EMMC cost $100 a pill?

Some of the problem is since medicare won't fully pay doctors (government healthcare at its best) they have to charge other customers more for consumables to make up the cost. Your welfare already cost me more so you want more welfare?

So Anthem is simultaneously raising rates a great deal, instituting a cap, and lobbying against health reform bills? Wow, talk about Easy Street!

Hank,

Heroin dealers DO work in a free market, as there is no government intervention with prices. That is precisely why prices remain stable over time for their product...check it out, not much price inflation for tar-heroin on the street over the last decade or so. Now look at the price of healthcare since the mid 1960's, when government first got involved. The entity that is evil here is the government and it's unitended consequence of price distortion through monetary policies that foster mal-investment and skyrocketing consumer prices. Asking for more government intervention to 'protect' you will only cause you more misery through further escalation in healthcare costs.

I've got a novel idea. Why not pay medical personnell at the same rate of pay that each and every one of us earns. Also let us shop for our bandaids, if I use a bandaid at your facility I can replace it with one which I have shopped for. Some of you may see the silliness in this but I assure you it seems no sillier than some of the proposals that have been around lately just watch cspan for a few minutes during the health care debates.

"Opponents — all representing the insurance industry — said..."

Funny howthe BDN fully covers the special interests in the crowd here but COMPLETELY ignored the makeup of the "budget cut protestors" in Augusta a few weeks ago.

BDN: Is this a fresh start at finding the story-behind-the story or just more of the same?

Lifetime limits are just about the worse thing the insurers do...keep it up and you WILL talk yourselves out of business.

other examples of relatively stable prices where government does not intervene with the market, cell phones, cable and internet providers. Unfortunately the list is pretty short, as most people, for some unkown reason, prefer a large, cumbersome government that slowly decreases their quality of life.

LarrySellers: true, but people don't need those things. People do need health care, of some kind...eventually. Maybe it should be treated like a utility rather than a commodity.

newportres - no one needs to demonize health insurance companies - they do a fine job all by themselves! Their profit margin has increased something like 300-400 percent in the last decade, they give themselves HUGE bonuses, not too mention their already substantial salaries! If you are not employed by the health insurance industry, your just trolling...

"If you are not employed by the health insurance industry, your just trolling... "

I am not employed by healthcare but I am employed and there are very few businesses that are doing well these days. I am concerned about the trend we seem to have now in this country where Rich=Bad and Poor=oppressed.

There is way too much of that and without some real solid lines of who is rich and who is poor it won't be long before I start getting defined as rich by someone and you start taking what I have because you think I didn't earn it or don't deserve it.

I have no problem with "rich", my problem is how they got that way. When you get "rich" by taking advantage of people, to me that = bad. How CEO's, bankers, insurance execs, etc. who are paid disproportionately generously for what they actually do sleep at night is beyond me. Once upon a time in this country, hard work was something to be valued, not anymore, that to me, is beyond heartbreaking and has corrupted our country. Today far too many people think that manipulation and taking advantage of people who don't have the money to lobby and skirt the edge of ethics is far more important then actual hard work...

Who are you to decide what is hard or how much money one should get for the task they perform.

Do you have any idea what it takes to get the degrees some of these bankers get or how long they had to climb the ladder to get to where they are?

You all seem to think they fell into or were born into their positions for some reason.

Like banker is a breed or something.

newportres - A little defensive aren't you.... I take it your a banker? Are you honestly going to justify what CEO's, Bankers, etc... have been giving themselves? Especially those who were more then glad to accept taxpayer's dollars after they ran their business into the ground with shady dealings and are back to taking HUGE salaries not to mention bonuses? I'm beginning to think that although a banker isn't a breed, it certainly takes a certain breed...

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