To: State House Press Corps

From: Consumers for Affordable Health Care

Date: May 3, 2011

RE: LD 1333- American Cancer Society’s Blast Email

The American Cancer Society (ACS) sent out an email on May 2nd regarding the revised amendment to LD 1333 dated April 28, 2011. The
Speaker’s Office of the Maine House of Representatives today (May 3rd) issued a Press Release, which stated that there were "a series of
inaccurate statements" in the ACS email. Below, Consumers for Affordable Health Care takes each of the points made in the Press Release put
out by the Speaker’s Office and uses the language of LD 1333 as amended to show that the ACS email was accurate.

Our effort is to promote a rational analysis of LD 1333 as amended that relies on the text of the actual amendment to address claims made by
its proponents or opponents.

ACS Statement Speaker’s “Facts” CAHC response based on analysis of LD 1333 as amended

The Maine legislature is FACT: LD 1333 explicitly • There is no provision in LD 1333 as amended that "explicitly forbids
about to vote on a bill forbids insurance carriers insurance carriers from denying coverage." We would ask that the
that would be from denying coverage. proponents identify the specific provision in the bill as amended that
devastating for cancer Every Mainer has "explicitly forbids" such denials.
patients. It would allow guaranteed access to
health insurance individual health insurance • There is nothing in the bill as amended that supports the second "FACT"
companies to: plans. statement: "Every Mainer has guaranteed access to individual health
insurance plans." As shown below, access is only guaranteed to "coverage
Deny coverage for issued through the Maine Guaranteed Access Plan Association." We would
cancer survivors due to ask: "Will every Mainer have guaranteed access to any insurance product
“pre-existing that is offered in the individual market regardless of whether it is issued
conditions” through the Maine Guaranteed Access Plan Association?"

• Sec. B-6 amends 24-A MRSA sec. 2736-C, sub-sec 3. See pg. 6 of the
attached revised amendment. The amendment limits our current guaranteed
issue requirement to "coverage issued through the Maine Guaranteed
Access Plan Association established pursuant to chapter 54-A." In other
words, currently an individual can choose ANY individual insurance
product offered or sold on the market. This provision limits the guarantee to
the high risk pool products.

1
 • In Part B of LD 1333 as amended, §3958, sub-§1 explicitly provides for the
involuntarily termination of a policyholder's medical coverage. If no one
can be denied individual health insurance coverage based on health
status, why does §3958 state that "Any person whose medical insurance
coverage under an individual health plan is involuntarily terminated
for any reason other than nonpayment of premiums may apply for
coverage under the plan?" Who would "involuntarily terminate" a
policyholder's coverage? What reason or reasons could be used to
"involuntarily terminate" a policyholder's coverage? See §3858(1) below.
§ 3958. Requirements for coverage

1. Approved coverage. The association shall approve a choice of 2 or more

coverage options for which reinsurance is available through the plan. The requirements of
this plan become effective January 1, 2012. Policies approved by the association must be
available for sale beginning July 1, 2012. Any person whose medical insurance coverage
under an individual health plan is involuntarily terminated for any reason other than
nonpayment of premiums may apply for coverage under the plan. If such coverage is
applied for within 90 days after the involuntary termination and if premiums are paid for
the entire period of coverage under the plan, the effective date of the coverage is the date of
termination of the previous coverage.

• Sec. B-6 further amends 24-A MRSA §2736-C, sub-sec. 3 by adding

paragraphs E and F below:

E. A carrier may evaluate the health status of an individual for purposes of

determining eligibility for the Maine Guaranteed Access Plan Association as long as
the carrier uses the health statement developed by the Maine Guaranteed Access Plan
Association. A carrier may not use any other method to determine the health status of
an individual. For purposes of this subsection, “health statement” means any
information intended to inform the carrier or an insurance producer acting on behalf
of a carrier of the health status of an enrollee or prospective enrollee in an individual
health plan.

F. An individual may not be denied health insurance due to age or gender. This
paragraph may not be construed to require a carrier to actively market health

2

Force cancer survivors FACT: LD 1333 copies
to pay higher rates for strategies that have been
health insurance proven in other states to
reduce costs for everyone,
including the elderly and
chronically ill. Insurance
companies cannot charge
different premiums based
on health, just like current
Maine law.
Require cancer patients FACT: LD 1333 does not
living in rural areas to put any geographic
drive to Bangor, mandates on anyone,
Portland or Boston for particularly cancer
treatment patients. LD1333 does
allow patients access to
insurance to an individual 65 years of age or older.
• Paragraph E says that an insurer can use health status to determine
eligibility for the Maine GAP (high risk pool). While Idaho's law states
explicitly that the insurer must first deny coverage to an applicant based on
health status before that person can be found eligible for the high risk pool,
LD 1333 as amended uses a much less transparent approach that achieves
the same result.
• Paragraph F makes clear that the only grounds upon which someone cannot
be denied coverage in Maine under the proposed amendment are "age or
gender." If the proponents are willing to back up their claims that no one
can be denied based on health status, they should say so specifically and
agree to add "health status or claims experience" to paragraph F. We would
ask the Speaker if he is willing to make that change.
• There is no evidence to support the first "FACT" statement that the
strategies in LD 1333 as amended "have been proven in other states to
reduce costs for everyone, including the elderly and chronically ill." Proof
to support this claim is needed.
• The second "FACT" statement here is contradicted by §3958, sub-§2,
paragraph A that says: "Rates may not be unreasonable in relation to the
benefits provided, the risk experience and the reasonable expenses of
providing the coverage." Paragraph C further states: "Standard risk rates for
coverage issued by the association must be established by the association
subject to approval by the superintendent, using reasonable actuarial
techniques and must reflect anticipated experiences and expenses of such
coverage for standard risks."
• The "FACT" statement is accurate that "LD 1333 does not put any
geographic mandates on anyone, particularly cancer patients."
• LD 1333 as amended removes the geographic access requirements in statute
and rule. By removing the requirement of 24-A MRSA §4303, sub-§1 that
carriers "consider the geographical and transportational problems in rural
3
 local care, but removes
restrictions that deny
patients access to more
affordable care in other
parts of the state. This will
reduce premiums charged
to businesses and
individuals in rural areas.
“More uninsured FACT: LD 1333 will
cancer survivors.” provide more access to the
130,000 Mainers currently
without coverage, by
offering lower-priced
health insurance plans,
especially to the most
vulnerable.
“Less access to cancer FACT: LD 1333 provides
treatment.” wider access to cancer
treatment, both through
removal of geographic
monopolies and through
lower health insurance
premiums.
areas," carriers would be permitted to require policyholders to use the
services of providers who may be located at distances far from the
policyholder's community.
• There is no evidence current laws regarding geographic access standards
"deny patients access to more affordable care in other parts of the state."
The current statute and rule allow insurers to require policyholders to use
health care providers outside of their local community if the insurer can
show that doing so would permit "better quality services" and the quality
improvements outweigh any detrimental impact to the covered persons
forced to travel longer distances. See 24-A MRSA §4303, sub-§1,
paragraph B, sub-para. 5
• There is no evidence to support the "FACT" statement that "This will
reduce premiums charged to businesses and individuals in rural areas." We
would ask that evidence be provided.
• There is no evidence to support the "FACT" statement. No analyses have
been conducted on the bill as amended. No financial analyses regarding
projected enrollment, projected premiums, or projected claim costs have
been undertaken or offered by the proponents. Opponents have requested
this information, but none has been provided.
• There is no evidence to support the "FACT" statement that LD 1333 as
amended will provide "wider access to cancer treatment." Again, current
law allows insurers to require policyholders to travel further to obtain care.
In addition, insurers can approve the use of services outside of the network
under current law.
• LD 1333 as amended could reduce access to cancer treatment if the insured
is denied an individual insurance product and the only coverage offered is
issued through the high risk pool called the Maine GAP Association, which
allows the insurers who make up the association to determine what
4
 coverage options will be provided.

• While insurers in the Maine GAP Association could not place lifetime or
annual maximum aggregate dollar amounts on claims in the coverage
options under current Maine law (see 24-A MRSA §4317(1)), insurers can
offer health plans that limit benefits under the health plan for specified
health care services on an annual basis (see 24-A MRSA §4317(2)). For
example, insurers in the Maine GAP Association could limit cancer
treatments to 30 days worth or 2 visits or treatments per year. So, just as
Idaho limits the benefits under the plans offered to people in Idaho's high
risk pool, so could Maine insurers in the proposed high risk pool.

“Unreasonable and FACT: LD 1333 allows • No analysis has been offered by the proponents from the Maine Bureau of
unaffordable rates for more competition and a Insurance that demonstrates that the plan in LD 1333 as amended "will
health insurance.” wider array of products for reduce health insurance premiums across the board." We would ask that the
all Mainers. LD 1333 is proponents provide such analysis of LD 1333 as amended.
modeled after the Idaho
guarantee issue
reinsurance plan. By
comparison, a 40 year old
in Maine pays $897 a
month for the same plan
that would cost $222 a
month in Idaho. According
to the Maine Bureau of
Insurance’s own analysis,
this plan will reduce health
insurance premiums across
the board.