AUGUSTA, Maine — Activists assembled at the State House on Tuesday to kick off an eight-state tour of the Northeast in support of health care reform.

The group, called Drive for Universal Healthcare, or “DUH,” bills itself as a “rolling demonstration” of activists in their vehicles, visiting states with pending legislation that would expand health care coverage by instituting some version of single-payer health care.

In Maine, that’s LD 1345, sponsored by Rep. Charlie Priest, D-Brunswick. His bill would transition the state slowly toward a state-run insurance system similar to those established in Canada and much of Europe.

Priest has introduced similar bills in previous legislatures. This time, he said he took his cues from Vermont, which in 2011 approved a law to slowly establish a single-payer system, and is working today toward implementing the law by 2017.

He said single-payer — which proponents say would drastically reduce the cost of health care by eliminating the private profit motivation and overhead costs associated with tracking the myriad insurance payments — was established piecemeal in Canada, and should be approached the same way in the United States.

“It’s going to happen state by state by state until there’s enough momentum for Congress to act,” he told the small group of supporters at the State House Welcome Center.

Proponents of Priest’s bill — it has 51 co-sponsors in the House — will surely be watching as Vermont attempts to implement its law. The state is attempting to bring companies that operate their own insurance plans under the single-payer system.

The U.S. Employee Retirement Income Security Act, or ERISA, says companies operating their own plans are exempt from state health care laws. Vermont needs a waiver to make those companies opt in to the single-payer system. No state has ever obtained an ERISA waiver before.

The outcome of that process will provide crucial precedent for Maine’s single-payer efforts, said Trish Riley, a senior fellow for health policy at the Muskie School.

“The biggest difference between Vermont and Maine is we have far more businesses that are self-insured,” Riley said. There’s also the question of whether a “single” payer could ever be established, she said.

“If you try to do single payer [in Maine], the question is whether Medicare will play along, because we’re the oldest state. And what do you do about self-insurers if you can’t get a waiver?” she said.

It’s feasible that even under a single-payer plan — where private health insurance companies were kicked out of the system — health care providers still could end up dealing with multiple state and federal agencies, plus the large companies that operate under ERISA, such as Bath Iron Works, the University of Maine and the Maine State Employees Union.

Rep. Richard Malaby, R-Hancock, who sits on the Health and Human Services Committee, said he opposes Priest’s plan for health care.

“Single-payer has a lot of allure in that it could minimize overhead costs, which is good, but it does not address a key component of the health care system, which is that we need more competition,” he said.

Malaby said that even though there are more than 1,000 health insurance companies in the country, only a handful operate in Maine’s small group market. Easing regulations, he said, would make Maine’s market more attractive and drive prices down.

He also said that while it’s true that Europeans operating under a single-payer system pay dramatically less for health care than Americans, that’s not necessarily a function of their payment scheme.

“I think it’s a lot to do with technology and lifestyle choices. They also make rationing choices in those countries that we are not willing to make. We spend a lot of money on end-of-life services, for example,” he said.

Malaby and other Republicans also responded to Tuesday’s event at the State House by touting Public Law 90, a GOP-supported insurance reform package approved during the Republican-controlled 125th Legislature. The law decreased regulation on insurance companies by making it easier for them to offer new plans and by allowing small businesses to band together and negotiate more favorable rates.

The bill also created a high-risk pool — or reinsurance program — to protect insurance companies from the high costs of covering patients who require the most medical care. In addition, the law allowed insurers to charge different rates based on patients’ age, place of residence and health status. Proponents have said that part of the bill is an attempt to woo more young, healthy patients into the marketplace by allowing insurers to charge them less.

Democrats and lawmakers from northern Maine have criticized PL 90 for allowing rate hikes on older and rural customers. Republicans have countered by pointing out that more Mainers have seen rate decreases since PL 90 was enacted.

Malaby said that the geographic fluctuations were rough in the first year since PL 90 but that they are leveling off and that the Republican reform bill has been a success.

“You’re getting more and more young people who can stay in Maine and afford insurance,” he said. “It used to be we never saw rate decreases at all, and now we are.”

Regardless of the political battles over PL 90 or a single-payer bill — which Gov. Paul LePage opposes — Priest said there’s always a Plan B.

“If we can’t get it through the Legislature, which is a possibility, Maine has a wonderful citizen referendum system,” he said.

Follow Mario Moretto on Twitter at @riocarmine.

Mario Moretto

Mario Moretto has been a Maine journalist, in print and online publications, since 2009. He joined the Bangor Daily News in 2012, first as a general assignment reporter in his native Hancock County and,...