Maine Versus Vermont

Vermont has gotten a fair amount of attention lately for enacting the nation’s first “single payer” law.  But nearby Maine, has taken a dramatically different approach.  Each state has a new governor, and each has a legislature of the governor’s own party, so the political conditions are ripe for this kind of experimentation. But the differences couldn’t be more profound.

Vermont’s action is driven by ideology, specifically the slogan “Health Care Is a Right!” Mother Jones reports:

… the governor made history, signing a law that sets Vermont on a course to provide health care for all of its 620,000 citizens through a European-style single payer system called Green Mountain Care. Key components include containing costs by setting reimbursement rates for health care providers and streamlining administration into a single, state-managed system. To move to single-payer, the state will need a waiver from the federal government, which under the federal health care reform law would become available by 2017; Vermont is asking the administration to let it get there even faster, by 2014.

John McClaughry of the Ethan Allen Institute reviews the long and twisted history that led up to this moment in Vermont here.

Maine’s approach could not be more different. After being one of the cutting edge states in “health reform” with its Dirigo Health program, which was a dismal failure, it decided to go in another direction.

As the Portland Press Herald describes it, the reform will:

• Overhaul the health insurance market for about 40,000 people — those who buy independently or through employers whose companies have 50 or fewer workers.
• Affect almost every policyholder in the state because it would be funded by a tax on premiums of as much as $4 per person per month.
• Allow companies from every other New England state except Vermont to sell insurance in Maine. (Current law prohibits out-of-state companies from selling insurance here.).
• Give insurance companies more leeway in how much they can charge policyholders, based on age and place of residence.
• Lower premiums for young people, (but) by next year older people could be paying three times more for their policies than young adults. Current law limits the ratio to 1.5 to 1.
• Prohibit insurers from rejecting people for pre-existing conditions. Those people could get the same insurance plans as everyone else.

In his weekly radio address, Governor Paul LePage says that the bill will move away from Maine’s current reliance on a near-monopoly insurance provider (Anthem BCBS) and allow carriers from other New England states to participate in the Maine market. He explains:

Mainers pay more for health insurance than equivalent individuals in New Hampshire — a lot more. For example, a 20-year-old in Maine pays more than $350 per month for an Anthem single plan. In New Hampshire, that same 20-year-old pays $136. A 50-year-old Mainer pays about $475 compared to a $340 premium in New Hampshire.

Other legislators have been working to explain the new law in op-eds throughout the state, including one from Sen. Debra Plowman, assistant majority leader and another by Rep. Jonathan McKane.

This latter piece is especially interesting for showing the lengths some organizations will go to frighten and deceive voters. In this case the American Cancer Society is sending out e-mails to cancer patients warning them that Maine’s new legislation will “deny coverage to cancer survivors,” and “force cancer survivors to pay higher rates for health insurance.” None of this is true. Could there be a crueler trick to play on vulnerable people?

In any case, we now have a terrific opportunity to compare and contrast two fundamentally different approaches to reforming health care financing. I’ve got a pretty good idea which will come out the winner.

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