The Future of Healthcare in Maine

The Affordable Care Act, sometimes called Obamacare, has done great things for Maine by eliminating some of the very worst practices of private insurance companies. So far in Maine 7,329 young adults have gained insurance coverage on their parent’s plans, 12,865 seniors on Medicare received a $250 rebate check to cover the cost of prescriptions, 187,251 people with Medicare received free preventative services or a free annual wellness visit with their doctor, and 226,000 people with private health insurance gained preventative service coverage with no cost-sharing.

The biggest way the Affordable Care Act (ACA) is expected to increase coverage is through state-based insurance exchanges. Exchanges are intended to give individual consumers and small businesses an easier way to shop for private insurance, and also negotiate and regulate with insurance companies on behalf of individual and small businesses. The exchange was a conservative idea; it was originally proposed by the Heritage Foundation and was implemented in Massachusetts by then Governor Mitt Romney. And, in Massachusetts, it is working. The number of uninsured has decreased (but not to zero), and it is costing the state less than it was expected to cost. 

Establishing a Health Exchange in Maine

Even though the concept of a health exchange was originally a conservative one, the implementation of an exchange in Maine is running afoul of Republicans in the Statehouse. 

Today’s political climate has made Republicans afraid of their own idea simply because it was implemented nationwide by President Obama. We are seeing the effects of this partisan extremism here in Maine as well.

At the beginning of this legislative session there were two bills in front of the legislature to create a state-based exchange. One, sponsored by Republican Jon McKane, grossly favored the insurance industry. The other, sponsored by Democrat Sharon Treat, would have set up a straightforward exchange focus more on benefitting Maine people. LD 1498, the bill sponsored by Representative Treat, failed to receive the votes of Republicans necessary in order for it to pass.

McKane’s bill, LD 1497, changed several times during the session, with the biggest change coming at the end of the session when the entire bill was edited down to just one provision about “navigators,” who are supposed to help people obtain affordable health insurance. 

The bill in this form passed along party lines in the House and Senate.  The bill does not set up a state-based exchange, which means that if nothing further is done by January 1st, 2013, the federal government will set up an exchange for Maine, giving the state almost no control or ability to adjust and improve the exchange in the future. 

Unfortunately, much of the debate about what to do about an exchange has not focused on what policy would be best for Maine people, but rather on partisan politics. Republicans, like McKane, refuse to do anything that might be construed as supporting the Affordable Care Act, even when inaction hurts Maine people. They hope that a Supreme Court ruling in June will nullify the entire law. 

The Supreme Court Ruling

The Supreme Court heard testimony about the constitutionality of the ACA for 3 days in March, shortly after the 2 year anniversary of the law.

The Supreme Court heard arguments on four different parts of the law, including the most important part – the individual mandate. The individual mandate is important to the success of the law. Insurance works by spreading risk out, so if only people who have a high need for insurance are covered, the insurance will not be making enough money from healthy, low cost people, to cover the expenses of those who need to use the system. With the individual mandate, insurance companies are no longer allowed to deny coverage because of pre-existing conditions, and can no longer drop people if they become sick. If the Supreme Court rules that the individual mandate is unconstitutional, it must then also rule whether or not that strikes down the entire law or whether the rest of law can stand (a concept known as severability).  

The good news is that no matter what the Supreme Court decides, there is a clear path to a universal single payer health care system. 

If the Affordable Care Act is upheld, Maine can move to expand coverage in 2017 by setting up our own system that covers everyone and is paid for publicly, much like Medicare or Social Security. Vermont has already passed legislation to move in this direction, and we will be watching their progress closely.

If the Supreme Court rules that the individual mandate is unconstitutional, the federal government could move toward expanding Medicare to cover everyone. The constitutionality of the individual mandate is in question because it requires that we purchase insurance through private companies, but collecting taxes to provide a service is already done with Medicare, Social Security, and other programs. Private insurance companies have proven that greed and profits only lead to higher costs, and more deaths. It is time to take profit out of health care and to end bankruptcy due to medical costs. It is time to give everyone the coverage and the care that they need.