“I think we’ve hit rock bottom,” said Patrice Farrey, director of the Maine Lobstermen’s Association, while talking at the Fishermen’s Forum about the cost of health insurance for Maine’s fishermen. “Any relief that could be provided for the fishing industry would be a step in the right direction.”
Farrey was one of about 70 people who attended an all-day health insurance seminar sponsored by this year’s Fishermen’s Forum. Attendees got a close look at the enormous complexity of the health insurance problem, learned about an innovative solution already in place in Massachusetts, and were given details of two plans which are being proposed in Maine.
By the end of the day-long event, it was clear that obtaining affordable rates for the fishing industry will require not only a lot of work, but also an unprecedented solidarity among its varied groups – from processors to lobstermen. As Speaker of the House Michael Saxl, (D-Portland) put it, the industry needs to have a “family discussion” to decide what type of plan it wants to pursue in the immediate future, and determine if this is the same as or different from the proposal it will support in the Maine Legislature.
The important thing, all agreed, was that to gain bargaining power. Members of the industry need to act together as one group and possibly join with other groups such as farmers and timber harvesters, or even low-risk groups like accountants.
Participants learned that foremost among reasons for high rates in Maine are high medical costs, primarily because hospitals here are scattered and each must pay for its own high-priced equipment. Vast increases in medical malpractice insurance have contributed, as has approximately $165 million in uncollected fees incurred by hospital emergency rooms, which are being used in place of family doctors.
The seminar’s speakers, who included Eric Cioppa, Deputy Commissioner of the Maine Insurance Bureau; Alice Knapp, health insurance lawyer at Duane Morris; Charlene Rydell, who is on the board of the Maine Health Access Foundation; Rep. Saxl and Rep. Paul Volenik (D-Brooklin), shared some sobering statistics. Presently, 163,000 people in Maine do not have health insurance. Of these, 72 percent are working or are in working families, but cannot afford coverage. Many individuals and families in Maine carry $5,000 deductible policies, and 98 percent of these never reach their deductible. Last year, 77 percent of Maine’s small businesses covered their employees; this year, that figure is down to 68 percent.
The problem is far from being confined to Maine. The United States, despite being the most developed country in the world, is the only such country that does not provide health care, leaving 40 million Americans without coverage.
Maine’s health insurance premiums are among the top five states in the nation.
Three solutions were discussed in detail: a single-payer plan proposed by Rep. Volenik, a plan (LD 1784) developed by Saxl; and one that covers members of the Massachusetts Fishermen’s Partnership.
Volenik’s bill proposes a single-payer system with one administrative body. It might be funded by a payroll tax, with an employer paying two-thirds of the premiums, and employees, one-third. The advantage of a single-payer system, he said, lies in pooling together the entire state population (which is still smaller than a large metropolitan area) to gain purchasing power. Volenik envisions medical and dental coverage for every person in the state, and hopes that if Maine leads the way with universal coverage, other states will follow suit, paving the way for a national plan. A report on his plan is due Dec. 1, 2002. It could be voted on during the next legislative session and be implemented within 90 days, or it could be stalled by political tweaking.
Saxl’s LD 1784 would establish a group purchasing alliance sponsored by the state to help small businesses and self-employed people obtain affordable insurance. It would be administered by a board made up of workers, business owners and health care professionals. This board would conduct an actuarial study to determine cost of coverage and the amount of funding needed from the state and federal government, and would negotiate rates with providers. Saxl proposes tapping federal Medicaid funds under a provision that allows two federal dollars for every one state dollar spent to give care to people whose incomes do not exceed 300 percent of the poverty level.
The Massachusetts Fishermen’s Partnership, whose members buy health insurance through the Fishing Partnership Health Plan, is a coalition of 16 commercial fishing organizations. It grew out of a traditional, close relationship between fishing groups and the Catholic Church in Gloucester, MA. David Bergeron, who represented the group, said the Fishing Partnership Health Plan was born at a meeting organized by the Gloucester Fishermen’s Wives’ Association and the church. At the time, 40 percent of the people in the Massachusetts fishing industry had no health insurance; the majority of the rest carried high deductible insurance.
Working with Caritas Christi, a hospital network established by the Archdiocese in Boston and with the Tufts Health Care Plan, the Fishermen’s Partnership devised a comprehensive plan with premiums based on a sliding scale. Since 1997, it has covered 1,700 people at about half of what they would otherwise be paying. The plan is made affordable through subsidies from the federal government, which contributed $2 million for the pilot program, and the state, which pledged $10 million over five years. Bergeron says studies have shown that every dollar the state has spent subsidizing the plan has saved two dollars in state money previously spent to pick up unpaid emergency room care bills and bills for catastrophic care, which have been avoided because fishermen and their families are receiving regular preventive health care.
Bergeron suggested the Maine fishing industry, although it lacks the connection with the Catholic Church that provided the impetus in Massachusetts, might find an ally in the recently formed Maine Health Access Foundation (MHAF). This organization is charged with managing $88 million received by the state when Blue Cross and Blue Shield of Maine (non-profit) was sold to Anthem Blue Cross and Blue Shield (a for-profit insurer). MHAF is mandated to use these assets to “assess health care needs of Maine’s residents” and “improve access to quality health care for medically uninsured and underserved residents of Maine.”
Any plan proposed raises questions, such as who will be covered, how programs will be funded, who will be the “gatekeeper” to oversee costs, and what will be the cost to the insured. Participants at the seminar agreed there are holes, administrative problems, unattractive aspects of each, but all agreed, too, that something must be done, however imperfect, and problems be solved as they arise.
As far as the working waterfront is concerned, one message was clear: the industry’s challenge is to present a united front, to become better informed through industry associations, decide what plan seems to be the best alternative, and move forward. “It’s something we really don’t want to drop the ball on,” said Yvette Alexander, president of the Maine Fishermen’s Wives Association.
Farrey noted that one thing she took home from the seminar was an awareness of the complexity of the issue. “Ultimately, people will have to compromise,” she said. “You can’t please everybody on this.”
For further information, contact the MA Fishermen’s Partnership: www.fishermens-partnership.org, or the Maine Health Access Foundation, Inc., 1 Community Drive, Augusta, ME 04330.
Rep. Michael Saxl can be reached on the internet at janus.state.me.us/house/spk_main.htm
Rep. Paul Volenik’s toll-free number is 1-800-423-2900.