Editorial was mistaken about health insurance reform

The Bangor Daily News makes several incorrect assumptions about Maine’s Republican-led health insurance reform in its editorial, “Health reform praised for what?” published on Monday.

The editorial acknowledges that some of Anthem’s premiums are now lower, thanks to the Legislature’s passage of health insurance reform known as PL 90. But it assumes that lower premiums also mean less coverage.

The editorial also assumes that lower premiums for younger people will increase the cost of premiums for “older, often poorer, people.”

Neither of these assumptions is true.

First, the editorial states that the deductible under Anthem’s new HealthChoice Plus, which reaches as high as $24,000 for a family, is too high. But, in fact, it’s an improvement from the old plan, which had a deductible for a family that reached up to $30,000. Under the new plan, thanks to PL 90, the family deductible is $6,000 less than it was under the old plan.

The editorial also stated that the new plans have co-insurance, while the old plan paid 100 percent after the deductible. This is true.

But the highest deductible for an individual under the old plan was $15,000. The highest deductible under the new plan is $12,000, a reduction of $3,000. The new plan does have additional co-insurance cost; however, the plan limits out-of-pocket expenses to $14,000. The plan then pays at 100 percent.

The highest deductible for a family under the new plan is $24,000, with co-insurance that limits out-of-pocket expenses at $28,000. The plan then pays 100 percent of expenses.

The editorial points out there is no maternity coverage on the new plan but fails to mention that the new plan now covers mental health expenses. Under the old plan, mental health coverage had to be purchased with an expensive rider.

The BDN points to the reduction of one benefit, ignores the enhancement to another benefit, then characterizes the new plan as having less coverage. One can argue whether a plan with maternity coverage is more valuable than a plan with mental health coverage, but here are a few thoughts to consider.

Pregnancy can be planned; mental illness cannot. The average individual deductible in Maine prior to the recent reform was in excess of $7,000. Most maternity costs were subject to deductibles anyway.

The editorial states the new plans have more restrictions on prescription drugs, but the BDN fails to mention that the old plans had no coverage for prescriptions prior to meeting the deductible.

Finally, the editorial claims that costs may shift to older people. But the analysis by the Maine Bureau of Insurance found that, under PL 90, rates dropped substantially for those 60 and over in all but one policy.

Health insurance reform is a difficult and complicated issue, and it can be challenging to make an exact comparison between plans, since costs and coverage vary slightly. However, based on the remarkable decrease in premiums and the additional coverage now offered, PL 90 is a tremendous step in the right direction.

Joel Allumbaugh is director of the Center for Health Reform Initiatives at The Maine Heritage Policy Center and CEO of National Worksite Benefit Group Inc. in Hallowell.