Maine employers today are facing double-digit health insurance premium increases. This is forcing many employers to drop or reduce coverage—or require employees to pay larger co-pays and deductibles. At the same time, individuals who purchase their own coverage are finding it more and more difficult to afford coverage. Maine’s escalating insurance premiums are likely a result of a multitude of reasons such as initial territorial pricing by managed care companies, adverse selection (guaranteed issue), other health insurance reforms, medical inflation, cost-shifting, consumerism and administrative burdens. In addressing health insurance premiums, a distinction must be drawn between those factors affecting premium that pertain to underwriting, pool size and other rating factors versus those factors that are relative to direct health care costs and increasing utilization.
Meaningful and expanded access to Maine’s health care delivery system is dependent on success in expanding access to health insurance coverage and improving cost efficiencies while maintaining excellence in quality medical care. The public/private partnership must be strengthened to ensure that public payers are paying their fair share. Medicaid and Medicare must pay for the costs of caring for their enrollees. We must identify opportunities to improve the affordability of commercial health insurance to maintain and increase employer-sponsored plan. A greater percentage of the health care dollar must be spent on direct care and less on administration. Health care planning must be based on community health needs. Health care decisions must be focused on outcomes-based research to improve the quality of care, to reduce inappropriate utilization, and to improve health status.