What’s wrong with healthcare in Maine?

Just about everything. A “poor” woman and a “middle-class” man tell you why

"A doctor's voice on MaineCare." By Sam Pfeifle.
"Political perspective." By Caitlin Shetterly.
According to government definitions, one of these writers is poor, and the other is solidly middle-class. But they both find that for different reasons their healthcare service is bad, in different ways.

If you’re lucky enough to have health insurance, and 10 percent of Maine’s population doesn’t, there’s a good change you’re not very happy with the coverage you have. In stoic moments, you may decide not to complain, because, hey, you have health coverage. But so many people are dissatisfied with what they have that it’s truly a wonder there isn’t more of a push to change, both in the private-insurance sector and in the government-provided care industry.

Some of this is undoubtedly because Maine’s healthcare “system” is largely a duopoly, with most people covered either by the government (in the form of Medicaid or Medicare) or by Anthem Blue Cross/Blue Shield, a for-profit insurance company that has posted record profits in recent years. (There are a few other private insurance companies offering coverage to Mainers; Anthem is far and away the biggest.)

But some of it is because the system itself is extraordinarily and unnecessarily complex, no matter how many companies compete to come up with better ideas for service.

The state’s latest-and-greatest idea, Dirigo Health, just stopped accepting new members, having run short of cash to care for the 14,000 people who actually did enroll in the plan, which was ostensibly aimed at getting all Mainers on some form of health insurance, but priced far above what uninsured Mainers could pay.

Even the uninsured have some access to medical care, but it’s pretty limited. Under federal law, hospitals cannot refuse to treat a person for a life-threatening emergency based on their inability to pay, and Maine law requires hospitals to offer free care to people whose income is below certain levels (depending on their family size). For anything else, uninsured people are on their own.

And doctors — and other medical providers, like physical or occupational therapists — can decide whether to accept payments from Anthem or the other private insurance companies, and whether to accept Medicaid and Medicare patients. Doctors’ decisions are based in part on reimbursement rates, which are set by the insurance company or the government.

Also a factor for MaineCare providers since January 2005 has been the snail’s pace at which reimbursement payments have been processed, because of major problems with the state’s computer system handling the payments. (See “System Breakdown,” by Sara Donnelly, October 7, 2005.)

Having health insurance in Maine is very expensive: Mainers who are insured through their jobs pay higher percentages of their premiums than the national average (22 percent as opposed to 18 percent for single people), and the total premiums themselves are higher than the national average ($4116 versus $3705, for single people) according to 2004 data from the Kaiser Family Foundation, a nonprofit that monitors health-insurance information nationwide.

For all that cash, we are only slightly better than the national average in general health data, such as deaths due to heart disease and stroke, and the rate of obesity. We actually have a slightly higher overall death rate than the national average, and the third-highest cancer rate in the country.

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  Topics: Lifestyle Features , Maine Department of Health and Human Services, Politics, Health and Fitness,  More more >
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