Faced with already high health care costs and steep inflation in health care premiums, Maine Republicans have used their legislative majorities and control of the Blaine House to change course.

Their policy has relied on dropping coverage for people on MaineCare, fighting national health care reform in the State House and in court, and changing regulations that reduce risk for insurance companies and shift it onto consumers.

We have opposed all of those strategies, and while the MaineCare cuts and court battles have not yet been resolved, we are starting to see the results of the insurance reform that was passed on a partisan vote in 2011.

According to a study by Consumers for Affordable Health Care, the insurance reforms called Public Law 90 have not stopped overall increases in the insurance premiums, but it has redistributed them.

The new rates are hardest on older rate payers and those who live in rural areas. This will benefit young people in southern Maine and will reduce risk for insurance companies but will not do much to promote the health and economic well-being of the state as a whole. For a sign of a path that could have been taken instead, Mainers can look to Arkansas, another small state with a large poor population and Medicaid shortfalls, where lawmakers have embraced reform as a way to lower costs.

In Arkansas, state officials are working with federal counterparts, private insurance companies, hospitals and doctors to move the state off fee-for-service compensation to a primary care system designed to improve outcomes.

According to a report Friday in The New York Times, Arkansas patients will work with a primary-care physician, who plays the role of “quarterback” in care management. The doctor’s practice will be compensated on a per-patient basis instead of by the procedure and will have financial incentives to avoid overuse of diagnostic tests and to prevent complications.

In Maine, if a health care provider makes a mistake and a patient has to be readmitted to a hospital with an infection, that provider gets paid twice. In Arkansas, the second hospitalization would be on the provider’s tab.

The difference in the approach to health care reform between the two states is stark. In Arkansas, they will try to reduce costs by making people healthier. In Maine, we are trying to reduce costs by letting insurance companies charge some people more.

Mainers should question whether this obstinate refusal to look for creative solutions to the health care cost crisis is really in our best interest.

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