AUGUSTA — On a 21-13, party-line vote, the Maine Senate on Wednesday approved a bill that aims to reform the way Mainers buy health insurance, sending the legislation back to the House of Representatives for final approval.

The controversial Republican measure was assailed by Democrats who said it would force the price of health insurance beyond the means of many Mainers, eliminate a law that prevents insurers from forcing patients to travel too far for care and change pricing restrictions that some argued would force up costs for older Mainers.

LD 1333, if passed into law, would affect an estimated 40,000 Mainers.

Sen. Lois Snowe-Mello, R-Poland, said passage of many of the measures in the bill, including ones that would open the state’s health insurance market to out-of-state competition, were ones she had worked toward for years.

“Today is a day we begin the process of making health insurance more affordable and more affordable for everyone,” Snowe-Mello said during an impassioned floor speech. “Maine has some of the most expensive health insurance rates in the country, despite having health care costs that are aligned with other states.”

Snowe-Mello said the legislation was market-based reform that would create more competition and hopefully allow an estimated 133,000 Mainers who have no insurance to get some.

That that many Mainers were without insurance is proof enough that the state’s health insurance policies to date were a failure.

“It fails because, like a vampire, premium prices are draining precious dollars from family budgets,” she said. “It takes food from our mouths, oil that heats our homes and resources that should go toward the American dream. For too long, failure has been an option around here.”

But other lawmakers, including Sen. John Patrick, D-Rumford, said the measure contained too many unanswered questions and lacked clarity on whether patients in more rural communities would be forced by insurers to travel far from home for care. One of the objections for Democrats was the rollback of a state law that prohibits that practice.

Patrick said he had asked many experts about what was in the bill and he didn’t believe the free market was always the fair market.

“I would be one to stand up here to say I don’t necessarily think the market-based system is the best in the world because a lot of times the market-based eat their own young,” Patrick said. “When I buy gas in Rumford, it’s awful funny. I go to one station and gas is $3.99 and the next one is $3.99 and the next one is $3.99 How does that happen? It’s market-based.”

He added that he didn’t believe the Legislature had done enough analysis of the bill to pass it with any certainty that it would lower rates for anyone.

Sen. Tom Saviello, R-Wilton, said before the debate started that he was concerned about the issue of forcing patients from their local hospitals, but he was satisfied the measure passed Wednesday would not do that.

“This bill says that if I want to go to Franklin Memorial, my insurance has to cover it,” Saviello said. “My insurance company might say if I go to Central Maine Medical Center, they will pay my deductible, but I can still go to Franklin Memorial if I want to.”

Saviello said the bill allows insurers to offer incentives for patients to travel but does not force them to do so.

Senate Democrats said the legislation did not clearly spell that out and urged their colleagues to put clear language in the bill that guaranteed people could get care from their local providers.

Sen. Troy Jackson, D-Allagash, said the measure contained so many unanswered questions that he was more inclined to vote for a bill that would cede his own Aroostook County to Canada. That way his constiuents would be guaranteed to have health care coverage, Jackson said.

Jackson was among several Senators who told impassioned personal stories about friends or constituents whose lives or in some cases deaths were impacted for a lack of or loss of health care coverage.  He indicated were it not for his state employee health insurance he may not have survived a heart condition that required he have a pacemaker implanted.

But after more than three hours of debate, Senate President Kevin Raye weighed in. Raye had taken the unusual step of allowing another senator to officiate the precedings Wednesday so Raye could participate in the floor debate.

Raye praised senators for their collaboration on the bill but then chastised some Democrats for fear-mongering or playing politics with the legislation.

“If I have earned a reputation for anything, it is my passion and forceful advocacy for the people of rural Maine. It drives me every day,” Raye said. “It is absolutely false to suggest there is anything in this bill that prevents people from going to their local providers. It is false. I repeat it for the third time. It is false.”

He said the measure was in line with the federal Affordable Care Act and included provisions that protected patients with pre-existing conditions and guaranteed they would be insured. He also said the bill was intentionally timed to take effect in 2014 to keep Maine in alignment with the federal law.

Democrats did suceed in adding two amendments to the measure that clarified language protecting patients’ ability to seek care locally.

The bill will be sent back to the House Thursday for final passage before being sent to back to the Senate and then on to Gov. Paul LePage for enactment. LePage is expected to sign the measure into law some time next week.

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Key provisions of the LD 1333

* Allows out-of-state insurance companies to sell insurance here, as long as those companies are based in New England, beginning in 2014.

* Allows insurance companies to more greatly vary their rates based on a person’s age and where the customer lives, beginning in 2012.

* Allows insurance companies to offer financial incentives — such as no co-payment or a reduced deductible — to Mainers who use a hospital that the insurance company has deemed to be higher quality and lower cost than others.

* Establishes a reinsurance association that reimburses insurance companies for some of the costs associated with the health care claims of high-risk Mainers. That money would come from an assessment on insurance companies.

* Eliminates the Advisory Council on Health Systems Development, a 20-member group that administers the state health plan and reports on health insurance issues that affect Maine.

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