High-risk pools and reduced regulations wouldn’t benefit consumers or improve health care.

In a recent op-ed commentary, Daniel Bernier (Aug. 14) paints an enticing picture of how Maine could dramatically lower its private health insurance rates for certain favored individuals – if only it would repeal regulations that guarantee full access to the individual and small group markets.

Unfortunately, Bernier omits many significant facts from his argument, and those he does include are often put into a misleading context. Nor does his piece acknowledge his actual role in the health insurance debate. Described only as “an attorney from Waterville,” Bernier is better known at the Statehouse as the lobbyist for the Maine Independent Insurance Agents. In other words, he represents those who would like to sell more policies and collect more premiums by advertising lower prices.

Unfortunately, the eye-catching rates Bernier cites for states like Kentucky and North Dakota do not represent what even young, healthy individuals actually pay. Since those states allow insurers to adjust freely for perceived “health risks,” the number of people who will actually qualify for the advertised rates are few indeed. Just about any “risk,” including food allergies and, for women of child-bearing age, the possibility they could get pregnant, are sufficient to send their rates far higher. Nor do these rates include a benefit package anything like those that are standard in Maine. As in most of life, you get what you pay for.

Unlike Bernier, I will put my cards on the table. My organization represents consumers of health care, and, from the consumer perspective, the “reforms” he suggest would devastate many family budgets and drive prices for numerous small businesses beyond what they could possibly afford for their employees.

The two policies he contends are responsible for, in his words, “destroying our health insurance market,” are called guaranteed issue and modified community rating. Guaranteed issue means that insurers must offer a policy to paying customers. This means that people cannot be denied insurance, and is an important consumer protection.

Community rating means that insurers cannot charge more than a certain amount, currently 50 percent, above their lowest-cost policy based on age, occupation or industry, or geographic location. Without such protections, insurers can, and do, charge double, triple or even higher premiums to individuals based on health status in unregulated states like those Bernier praises, making insurance impossible to afford for those who need it most.

It is true that some very healthy individuals might see lower rates without these consumer protections – while they remain healthy. But those savings will be short-lived and only at the expense of making insurance unaffordable for many people who will no longer be able to obtain or keep insurance, and whose bills will be picked up by the taxpayers and those fortunate enough to have coverage.

As it happens, we do not have to speculate about what would happen if Maine repealed guaranteed issue and community rating. New Hampshire did just that two years ago when newly elected Gov. Craig Benson convinced legislators the state would be better off without these policies.

Overnight, insurance rates skyrocketed for many small businesses, which dropped coverage after finding themselves priced out of the market. These businesses began calling their legislators, and New Hampshire soon elected a new governor, John Lynch, among whose priorities was reinstating community rating. He signed that bill into law this spring. Curiously, Bernier does not acknowledge this experience of Maine’s immediate neighbor, while describing in great detail the distant examples of North Dakota and Kentucky.

He also makes a point of recommending high-risk pools as a solution for older or chronically ill individuals. Most such pools turn out to be unsustainable, as Maine’s was, requiring extensive taxpayer and other subsidies. Nor do they insure more than a tiny fraction of the individuals who qualify for them. They are, in short, no solution at all for the long term.

Bernier’s commentary fails to acknowledge that health care insurance premiums, for public or private programs, are based on the costs of providing care, and that simply raising or lowering premiums for any one group does nothing to address the driving forces behind increased costs.

He faults the state’s Medicaid program, but curiously makes no mention of Dirigo Health, which is specifically designed to bring more individuals and small businesses into the insurance market, and is making significant progress.

Designed around the strict limitations federal law creates for state programs, Dirigo Health is bringing thousands of Mainers back into the private insurance market, and using health care savings to cover more of Maine’s uninsured and underinsured people. These savings can be achieved in part by eliminating bad debt and charity care for health care providers and ultimately reducing costs for taxpayers as well.

I serve on a working group that is calculating these savings to make recommendations to the Dirigo Health board and the Bureau of Insurance. The savings are real, and they will have the effect of reducing costs for both public and private payers. That makes a lot more sense to me than gutting consumer health insurance protections in the hope that somewhere, somehow, someone may benefit.

Maine has done well by preserving a community of nonprofit health care providers who are working with the state to try to improve the quality of care while containing costs and channeling savings back into the system, not into greater profit margins for insurers. Our health care system functions best when we work together as one community, not when we listen to those who seek to divide us against each other.

Joseph P. Ditr is the executive director of Consumers for Affordable Health Care in Augusta.