Insurance Space

One of the strongest supporters of a bill to prohibit health insurance companies from setting annual and lifetime limits on the amounts they will pay couldn’t be at a legislative hearing on the measure Wednesday because he has cancer and was getting a blood transfusion.

Since Richard “Rocky” D’Andrea’s cancer was discovered in 2008, the 63-year-old Limerick man also found out that his insurance policy carried a $250,000 lifetime cap, his wife Theresa told the Insurance and Financial Services Committee. Now the couple are struggling to keep their house. Their credit cards are maxed and they’ve spent all of their savings and retirement, she said.

After paying a combined 60 years in taxes and years of insurance premiums, “we are in financial ruin,” D’Andrea said. “We are asking ourselves who will answer our call for help.”

Theresa D’Andrea joined others in asking the committee to endorse a bill similar to one of the major health insurance proposals under consideration in Congress. Insurance companies say eliminating the caps will have a cost that would be reflected in higher premiums.

Officials with the National Conference of State Legislatures were not aware of similar bills in any other states. No vote on the Maine bill was expected until further committee review.

House Majority Whip Seth Berry, the bill’s sponsor, told the committee that the D’Andreas are not alone in their plight.

“No family in Maine should ever, especially in these tough times, risk losing their life savings” due to a catastrophic disease, the Bowdoinham Democrat said.

His bill has nearly 50 legislative co-sponsors, as well as support from the state Insurance Bureau, medical and residents’ groups, the American Cancer Society and church organizations.

Removing caps on payments would also address a core fear of consumers — that they won’t have insurance coverage when they need it the most, said Andrew MacLean, representing the Maine Medical Association.

“The whole purpose of insurance is it will cover you when you are sick,” said Brenda Akers of the nonprofit Maine People’s Alliance.

Opponents, including Anthem Blue Cross and Blue Shield of Maine, Maine’s largest insurer, say that health insurance costs are increasing because of the skyrocketing costs of medical care and that barring caps will further drive up costs.

Anthem’s Kristine Ossenfort told the committee that without caps, premiums will rise, making insurance less affordable.

Also, she said, the number of its Maine enrollees whose coverage has been affected by caps is tiny. No one enrolled in Anthem’s individual or small-group policies has had claims exceeding the company’s $3 million cap since 2003, the earliest year for which figures were available, she said.

But Mila Kofman, insurance superintendent in the administration of Democratic Gov. John Baldacci, said the cost of caps “is minimal and absolutely justifies this kind of public policy.”

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Tags: Health insurance, Insurance