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Rep. Drew Gattine is the chair of the Legislature’s Appropriations and Financial Affairs Committee. He represents parts of Saco, Scarborough and Westbrook in the Maine House of Representatives.
The letters started hitting mailboxes last summer.
Confusing, tedious and full of long sentences, the letters carried an insidious message: Get ready for massive increases in the cost of health insurance.
The headlines followed. Skyrocketting costs, soaring premiums, families and businesses — large and small — struggling to afford the insurance Mainers need to afford care.
The facts are undeniable. The cost to receive health care is growing faster than wages. Families are having to choose between heat, food and health care. Businesses are forced into a choice between providing health insurance or increasing pay and other benefits.
It’s a financial disaster on top of an already challenging affordability crisis.
Our health care system is broken. It doesn’t work for people or employers, and our entire system of care is at risk of collapse. We have to do something now.
In the coming weeks, the Legislature will consider a proposal that could make a real difference, actually reducing what we pay for health care and supporting efforts to expand access to primary care and behavioral health.
An Act to Lower Health Insurance Costs, Reduce, Barriers to Health Care and Ensure Fair Prices for Health Care, LD 2196, will be considered by the Legislature’s Health and Human Services Committee.
The proposal does four things.
It invests in primary care and behavioral health by forcing insurance companies to pay at least 110% of Medicare’s price for those services.
It tells hospitals that they can’t charge Mainers more than more than 200% of what Medicare charges and sets a limit for how much hospital prices can grow each year.
It reduces administrative barriers for Maine people and doctors by expanding common-sense limitations on prior authorizations.
And it would save Maine people and employers money by reducing the growth of health insurance premiums.
The bill would make hospital prices fairer and more transparent across the state, while also protecting critical access hospitals and hospitals that are facing significant financial challenges.
More than half of Mainers report difficulty affording health care in a recent study, and nearly half of Mainers delayed or skipped seeking care when they needed it because of concern about cost.
Hospital spending makes up the largest portion of all health care expenditures in Maine, and the growth in Maine’s hospital spending has significantly outpaced inflation and the household income of Maine families.
Most Maine hospitals are charging commercial insurance companies more than 250% of what Medicare has determined is a fair price for services. And that has translated into higher insurance premiums for employer-sponsored insurance, which have risen almost 47% over the past decade in Maine.
State residents are feeling the pinch. A recent survey of more than 500 registered voters in Maine found that voters overwhelming support action to rein in costs: nine out of 10 Maine voters support placing limits on hospital prices, with six out of 10 strongly in favor when the savings are used to expand access to primary care, mental health services, or to lower health insurance premiums.
Similarly, eight out of 10 respondents support allowing the state to set limits on hospital prices, including four out of 10 who strongly support such measures.
Survey participants overwhelmingly believe that high hospital prices are a major contributor to the overall costs of health care and health insurance in Maine. Seven out of 10 voters say hospital prices add a good amount to total costs, while three out of 10 say they add a lot.
Health care policy is complicated, and there are no easy answers. Placing reasonable limits on what large hospitals can charge for care is one way for the state to reduce insurance premiums and expand access to quality, affordable health care.
The price of inaction would be devastating for families and businesses.