Maine Democrats recently introduced a package of bills to reduce health care costs, curb some of the health care industry’s most egregious billing practices and ensure access to critical lifesaving medicine.
The suite of bills known as the “Patients First” package includes four pieces of legislation that draw from the experiences of other states to address some key barriers Mainers face in getting the health care they need.
Capping insulin prices will make the lifesaving prescription more affordable
LD 2096, sponsored by Speaker Sara Gideon of Freeport, would limit monthly out-of-pocket costs for patients who use insulin. The bill would institute a $100 monthly cap to what insurers can charge patients who use the lifesaving drug to manage diabetes.
Insulin can be extremely expensive, and prices have been increasing rapidly in recent years. The Maine Health Data Organization reports that some forms of insulin are among the most expensive prescription drugs in the state. LD 2096 would cap annual out-of-pocket costs for diabetics in Maine at $100 per month — an annual cost of $1,200, compared with the current high cost of between $2,300 and $6,200 annually.
The cap will help contain costs that, in some instances, are rising rapidly. According to MHDO, The annual cost of Trulicity increased from $4,725 to $5,555 last year, while the price of the Tresbia Flextouch increased from $4,484 per year to $6,235.
Eliminating ‘surprise’ medical bills will make health care costs more predictable
Surprise billing can be a financial bombshell for Maine families. Mainers who need care, such as from an emergency room or walk-in clinic, don’t always have time to navigate the complexities of which doctors and services are in- or out-of-network for their insurance provider.
Emergency departments are more likely than other hospital departments to make use of outside physicians to provide certain services. So even though a hospital might be in-network for your insurer, you might be treated by an anesthesiologist who isn’t directly employed by the hospital, and not be aware until you get a large bill in the mail.
These surprise bills are particularly harmful for the nearly of half Maine families who don’t have the funds to meet an unexpected $400 expense. An unexpected, expensive medical bill can throw off a family’s budget for weeks, months, or even years.
LD 2105, also sponsored by Speaker Gideon, would put the responsibility for surprise bills onto insurers – not patients. The bill would require insurers to charge only regular in-network copayments to Mainers who unknowingly receive care from an out-of-network provider. The bill also provides a mechanism for patients to dispute surprise bills with their insurers.
LD 2111, sponsored by Senator Ned Claxton of Auburn, would empower patients with more information about costs before they undergo treatment. It would require health care providers to disclose the cost of certain procedures in advance, as well as ways to compare their price to other providers in the state. The bill also requires insurers tell patients if they are being referred to an out-of-network doctor and limits the use of hospital fees or fees for transfers between providers.
Proposed commission would create accountability for runaway costs
Last year, Maine established a new Prescription Drug Affordability Board, to monitor the cost of prescription drugs in Maine and to publish an annual report on the drugs with the largest year-to-year increases.
The final bill in the Patients First package —LD 2110, sponsored by Senate President Troy Jackson of Allagash — would follow-up on the board’s work by creating a new Commission on Affordable Health Care to monitor the increasing cost of health care for Mainers and hold Maine’s health care industry accountable for unreasonably high costs.
When prices for treatments or prescriptions grow faster than the state economy overall, the Commission will have the power to call witnesses and hold public hearings to determine the cause of rising costs. These oversight powers would be similar to those held by the Public Utilities Commission, which oversees electricity companies in Maine, or the Bureau of Insurance, which regulates private health insurance rates.
The Maine commission is modelled on similar commissions in Vermont and Massachusetts. Activities by these commissions have saved Vermonters $7.3 million this year, while Bay Staters saved $7.2 billion between 2013 and 2018.
The creation of this commission will bring accountability to the health care industry, where runaway costs have made good health unaffordable for too many Mainers.
Conclusion
Health care costs continue to be a huge financial burden for Mainers, especially low-income Mainers. The ever-increasing cost of care is one source of economic stress, and it is made worse by unfair billing practices that leave ordinary Mainers with little recourse against a byzantine insurance system and multimillion-dollar hospital systems.
The need for government action to rein in the health care system and some of its most harmful practices is clear. The Patients First package moves in the right direction.
