|February 26, 2020
A slate of health care reform bills went before the Maine Legislature’s Committee on Health Coverage, Insurance and Financial Affairs this week for public hearing. The MMA supported two of the four bills and would support a third with appropriate amendments from Patients First health care reform package sponsored by Democratic Legislative Leadership. Unfortunately, not all the bills included physicians, hospitals or health systems during the development or drafting phase. In fact, the MMA and Maine Hospital Association knew nothing about the operational concepts from two of the bills (LD 2110 and LD 2111) until they were released to the general public.
Fortunately, MMA Legislative Co-chair and Immediate Past ACEP President, Jay Mullen, M.D., was instrumental in assisting House Speaker Sara Gideon (Freeport) and her staff in drafting LD 2105, An Act To Protect Consumers from Surprise Emergency Medical Bills. The bill would amend current balance billing laws to include emergency services and would establish an independent dispute resolution process to balance billing conflicts between out-of-network providers and insurance carriers within the Department of Insurance. Dr. Mullen’s written testimony can be found here and his verbal presentation can be viewed on the MMA’s Facebook page.
Another bill the MMA supports from the package was also introduced by Speaker Gideon. LD 2096 which would mandate that an insurance carrier that provides coverage for prescription insulin drugs may not impose a cost-sharing requirement on the enrollee that results in out-of-pocket costs to the enrollee in excess of $100 per 30-day supply of insulin. The MMA is also concerned when patients struggle to secure a basic medicine like insulin and we commend the Legislature’s attempt to make make sure patients aren’t being exploited with unaffordable costs. Not to mention, insured patients are also directly impacted by high insulin prices when they are still in the deductible period, not covered by their insurance or when a nonpreferred formulary status for a particular insulin product leads to a higher patient cost-share.
LD 2111, An Act To Establish Patient Protections in Billing for Health Care is sponsored by Senator, and retired physician, Ned Claxton of Auburn. The MMA has supported a number of billing transparency bills and while we appreciate Senator Claxton’s, and his co-sponsoring colleague’s’ effort to increase the availability of useful information for patients, including their individual cost-sharing liability prior to care, the bill imposes some concerning and administratively burdensome requirements for physicians. The bill as drafted would require MMA members to provide a cost comparison within 5 days of scheduling a service if it’s one the 25 highest cost services. It would have to include the average cost of the procedure statewide, the location of the highest cost provider in the state along with the price and the same for the lowest cost provider before providing their own average cost. The MMA supports and amendment proposed by the Hospital Association (MHA) directing patients instead to the Maine Health Data Organization. There was also some uncertainty to a bill stipulation prohibiting “new patient fees.” Few organizations are sure what defines a new patient fee, however, the MHA and MMA are advocating to exclude new patient CPT codes.
The MMA strongly opposed LD 2110, An Act To Lower Health Care Costs, along with the Hospital Association, Northern Light Health and MaineHealth. The bill attempts to form the Maine Commission on Affordable Health Care modeled after the existing Massachusetts Health Policy Commission. The Director of the Massachusetts Commission presented last week to the Committee and stressed its success with cost containment, however, rarely made any mention of better care being provided since the Commission’s origins in 2012. Massachusetts’ Legislature tasked their Office of the State Auditor to review impacts of the law. What their review showed is that despite meeting cost growth benchmarks, nearly all measures of quality remained stagnant or declined. The most recent 2018 review report can be reviewed here. We opposed the bill because although well-meaning and with admirable goals it is just simply too complex and has too many quality of care questions to be addressed before all bills are required to be voted on by March 6th by Legislative rule.
All four bills are scheduled for votes before the end of this week. The bill were also reported on by the Portland Press Herald in which quotes by Dan Morin were included on LD 2110.
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