In which I style myself as a member of the press

Well, not really. (But I do have a press release on which to report! It was even embargoed for publication until just now, so this is breaking news!)

Anyhow, over lunch I attended a press conference at the capitol rotunda in support of a new state bill being introduced by Rep. Sharon Treat, who happens to be my representative. (The conference was organized by Consumers for Affordable Health Care, and was supported by the Kennebec Valley Organization, on whose executive council I sit.) In a nutshell, the bill (described as a Health Care Bill of Rights) would mandate that insurance carriers in the state make available online detailed information about which services are covered by their plans.

This is such a no-brainer, of course it must not actually be happening already. Currently, if one is purchasing insurance in the free market (or even selecting from employer-sponsored plans), one has to guess which services are paid for. For example, "pregnancy services" may be listed as "covered," but the actual costs of the delivery itself may not be. Often, the first time a person learns to what degree services are paid for is when they receive a bill. This bill (as in "prospective law," not "pay us now") is meant to be a corrective by allowing consumers to actually see what they're paying for before they purchase it.

I have seen both sides of this problem. Both the Better Half and I have gotten care (in-network) for a variety of benign health care issues, and we never fail to receive a much larger bill than expected for services that were ostensibly covered, including services for which we had gotten prior approvals. Being relatively financially stable, we just paid the damn bills, but if our budget were tighter we'd have been in trouble. Conversely, our office frequently fields calls from parents whose children have received services (including vaccines) which were not covered, or who have found out that their insurance suddenly no longer covers a medication that they've been on for months or years. While greater transparency won't actually get these services covered, it will at least let people know what they were paying for.

An additional reason I support the bill (as does the Maine Medical Association) is that it would provide greater transparency for why medical providers are ranked by insurance companies the way they are. Right now, providers are ranked in "tiers" of preference, with no information provided as to why Doctor X is third-tier provider. Does she have poor medical outcomes as measured by certain benchmarks, or does she simply deliver care that the company deems too expensive? Right now, there is no way of knowing, and no manner by which providers can appeal the rankings. This bill would provide for it.

On a related note -- One woman shared her story of spending $300 per month on insurance for her family, thinking they had to meet a $10,000 deductable before their insurance would "kick in," only to find that it was $10,000 per person for herself, her husband, and her daughter. Insurance that costs over $33,000 before anything is covered is no kind of insurance at all, and only serves to illustrate why high-deductable plans are lousy.

Update -- a wee bit more information here.


  1. Did you park in the "Press Only" area at that State House? :)

  2. You have illustrated the problem with private insurance for health care access. The insurance industry makes its profits on the whole idea that catastrophes are rare occurrences. We should be focusing not on insurance for health care, but actual provision of medical care for individuals as a cooperative, i.e. single payer, universal access.