The Sun Journal’s editorial of April 14 stated that the main health insurance bill, L.D. 1496, brings together a number of policy prescriptions for lowering health-care costs, but the goal of the legislation, lowering the cost of health insurance and expanding coverage, is unlikely, and the chances of doing real harm to the state are great.

Actually, the harm has long since been done. The “reforms” of 1993 destroyed the health insurance industry and threw premiums into the incredible “death-spiral” we are witnessing today. The 1993 legislation drove around 12 insurance companies out of the state and basically created a monopoly.

Notice that car or homeowners insurance rates are not out of line with other states; in fact they may be lower.

Since Maine has some of the highest insurance health premiums in the U.S., how much worse could it get? I appreciate the recognition for good intentions, but I disagree with the assertion that success is unlikely. These principles are working in many other states, some of which never created the problem in the first place.

The Sun Journal made the following points:

“L.D. 1496 essentially deregulates health insurance.”

That is true. But it is, in fact, a good thing.

“It repeals guaranteed-issuance and community-rating laws that don’t allow insurance companies to drop sick clients or charge widely fluctuating premiums.”

That is a somewhat convoluted statement; let’s get our terms and facts straight: “Guaranteed-issue” means an insurer must sell to anyone, regardless of how sick they are. At these rates, healthy people tend not to buy.

A high-risk pool, which is only used when you first buy, accepts the otherwise uninsurable clients and massively lowers rates for people who are generally healthy. A high-risk pool replaces guaranteed-issue, making sure that no one is “uninsurable.” It should be called “universal-access.”

“Guaranteed-renewability” means the insurance company cannot drop you, regardless of health. No one is even suggesting that be changed. No one will be dropped.

“Community rating” causes everyone more or less to pay the same outrageous rates. People should get discounts for healthy behavior and wellness. All rates, including the risk pool rates, should go down dramatically.

“Older patients, women of childbearing age and people with chronic conditions could be denied coverage altogether or charged premiums out of line with what their neighbors pay,” the Sun Journal wrote

No one is denied coverage. Although there would be a variety of rate structures, no one, even high-risk people, would likely pay the exorbitant rates we have under Maine’s current structure.

The Sun Journal wrote that the risk pool would need to be subsidized by the federal and state government. That’s not true. Although there is federal money available to ensure the start up of the high-risk pool, the model we proposed is funded by the insurance companies. That is why Anthem opposed the bill.

Government funding would both cost tax dollars and be subject to the whim of the Legislature, especially in times of budget cuts – like now.

The editorial stated: “Experience in other states with such pools shows limited success.”

Their premiums are all lower than ours.

“Enrollment rates are low, costs are high and the plans tend to attract only the sickest of the sick.”

That’s the way it’s supposed to be, and that is who they are for. Generally about 1 percent of the individual market, 500 to 1,000 people.

“Reports from Washington State show that, because of high premiums, only one in every seven of those eligible signs up.”

Their risk pool premiums may be similar in cost to our standard premiums, maybe even lower. How many “low-risk” Mainers are going without insurance now for the very same reason? High cost is not a rational argument.

“The number of enrollees (Washington) is only about 2,800 … Maine experimented with high-risk pools from 1988 until 1994 and never had more than 500 participants.”

The risk pools are meant to handle only the upper extremes of those with chronic diseases, high cost consumers or those with pre-existing conditions, comprising about 1 percent of the total market.

“The pools have not reduced the number of uninsured or expanded care.”

I disagree and can back it up. Guaranteed issue, on the other hand, has seriously increased the number of uninsured, due to increased premium rates. Compared to today, we were in pretty good shape in 1993.

Many people are able to get out of the risk pool after showing a good faith effort, for example, in maintaining their doctor’s advice on blood pressure medication. There is the incentive of lower premiums to get them back into the regular insurance pool.

No one, once insured in a lower rate classification, is forced to enter either the risk pool or any other higher rate class.

“The legislation would also remove mandates on insurance coverage, such as mental health parity, minimum maternity stays and prostate cancer screenings.” The main bill, L.D.1496, removes no mandates except guaranteed issuance and community rating.

“The proposed bills would move Maine in the wrong direction on health care, undermine important consumer protections and do little to control costs. They don’t deserve support,” the Sun Journal wrote.

Actually, unless you choose to ignore most of the U.S., which has better health insurance for a fraction of the cost, I would have to disagree with the editor’s statement.

In fact, states have been progressively repealing guaranteed issue and community rating laws and enacting risk pools. As a result they have been seeing the return of competition, better coverage and lower rates.

Rep. Michael Vaughan is a member of the Legislature’s Insurance and Financial Services Committee. He represents Durham, Lisbon and New Gloucester.