Maine Gov. Paul LePage was elected last year in a three-way race with just 38% of the vote, which he interprets as his ticket to roll back consumer, worker and child protections. He ordered a historical mural of workers removed from the state Labor Department,  refused invitations by the NAACP, saying they "can kiss my butt" and is trying to weaken state child labor laws, among other things. His latest move is to put the insurance and medical industries in charge of the largest single consumer benefit of the federal health reform.

What's going on in Maine is so bald-faced that it would be hilarious if less were at stake. But other, bigger states including California have problems with their Exchange boards that are more subtle, thus even harder to change. 

Maine's Bangor Daily News tells us that "a new nine-member committee charged with developing Maine’s federally mandated health insurance exchange is made up almost entirely of health care and insurance insiders." The paper doesn't point out that at least four of the nine are industry lobbyists.

For instance:

• the state's chief Anthem Blue Cross lobbyist;
• the top lobbyist for health insurance brokers;
• an executive of a regional insurance company;
• president of the state's hospital trade and lobbying group;
• CEO of a large for-profit doctor group;
• CEO of a pharmacy chain;
• an ultraconservative think tank associate;
• a small business lobbyist. 

The only non-industry representative is a representative of Native American tribes, with no general commitment to consumers.

This is the group that is supposed to build and set the rules for the Maine Health Insurance Exchange, which starting in 2014 will pool insurance purchasers together to pull down prices, protect consumers and distribute federal insurance subsidies for the poor to middle class.  It's the least government can do when it's requiring all of us to purchase health insurance. 

However, Maine's advisory board is like the fox asked to guard the henhouse: helpless to quell its basic nature.

Consumer groups in Maine are apparently so demoralized that they couldn't even protest this LePage stunt: The state's chief health care advocacy group responded, “We feel all the people appointed have a lot to offer,” even though LePage spurned the group's request for representation on the board.

California's five-member Exchange governing board, a more permanent body, at first glance looks much more protective. By law, no member can be employed by insurance or related industries. The board is intended to represent California's cultural and ethnic diversity. And so on.

However, at one of the Exchange's first meetings a couple of weeks ago two industry-friendly appointees of former Gov. Arnold Schwarzenegger rammed through, in one of the Exchange's first substantive acts, an industry-demanded request that the board be exempted from pending legislation for health insurance premium regulation. Over the objections of the state's consumer groups and the state insurance commissioner, three of the five members of the California Health Exchange (Schwarzenegger's former aides and a rep of a business purchasing group) voted at the request of the health insurance lobby to stop premium regulation from applying to its insurance policies, and refused even to delay the vote until it had more information.  In doing so, the California Exchange may have made the best argument for why premium regulation should apply to it.

Maine is the easy case. There's little doubt where consumer protection will stand after Maine residents are required to purchase private health insurance. Other states may look better, but they all have a lot to prove to the people they're supposed to help and protect.

**********

Members of the Maine health Insurance Exchange advisory board:

• Joe Bruno (chairman), pharmacy chain owner, former GOP state chair  and vocal opponent of federal health reform
• Dan McCormack, CEO, Intermed
• Steve Michaud, president, Maine Hospital Association
• Kristine Ossenfort, director of government relations, Anthem Blue Cross Blue Shield of Maine
• Joel Allumbaugh, CEO, National Worksite Benefit Group and health policy director, Maine Heritage Policy Center
• Dan Bernier, insurance lobbyist
• Edward Kane, vice president for Maine, Harvard Pilgrim Health Care
• David R. Clough, Maine State Director, National Federation of Independent Businesses
• Jamie Bissonnette Lewey, chairwoman of the Maine Indian Tribal-State Commission. 

Members of the California Health Insurance Exchange governing Board:

• Susan Kennedy, former chief of staff to Gov. Schwarzenegger
• Kim Belshe, Schwarzenegger appointee to state Dept. of Managed Health Care
• Paul Fearer, bank executive and head of Pacific Business Group on Health
• Diana Dooley, Gov. Jerry Brown appointee to state Dept. of Health and Human Services
• Robert Ross, President and CEO of the California Endowment