AUGUSTA – Though Maine has not embraced all of the components of the federal health care overhaul, the state is still ahead of most others preparing for changes coming next year, an analysis shows.
Maine is one of 11 states, including New Hampshire and Vermont, to approve at least some of the Affordable Care Act’s so-called market reforms, according to the Commonwealth Fund, a private group that promotes improved health care.
But Maine has been unwilling to go along with one of the biggest changes under the law: expansion of Medicaid, the federal-state program health care program for low-income families and others. The federal overhaul calls for expanding coverage to people who earn up to 138 percent of the federal poverty line, about $32,000 for a family of four or $15,400 for a single person. The federal government would pay 100 percent of the cost of expansion for the first three years and reduce its share annually after that, eventually down to 90 percent.
Gov. Paul LePage had declared that Maine simply cannot afford the expansion. That has drawn criticism from those who say the state would miss out on the federal subsidies.
“There’s no guarantee that match rate would be in effect for three years,” said LePage spokeswoman Adrienne Bennett, adding that Maine has already seen the federal government lower its Medicaid funding significantly in recent years.
But that decision has yet to play out in the Legislature, pointed out Democratic state Rep. Sharon Treat of Hallowell, chair of the Insurance and Services Committee.
“It’s the early days (of the session) and there’s no ticking clock as to when that decision has to be made,” said Treat, who supports the law.
In another major part of the law, the state has apparently decided to cede to the federal government at least part of the creation of an online marketplace where consumers can shop for insurance.
States had a Friday deadline to declare their intentions to create their own exchanges. Maine can still either join the federal exchange or partner with the federal government on an exchange. But Treat said that despite the deadline, there’s still a chance of Maine working in partnership with the federal government on an exchange before one has to be set up by October to be in place for 2014.
Maine laws already conform with five of seven major changes due to take effect in January:
• restrict the use of health status in setting consumers’ insurance rates;
• bar the exclusion of people from coverage based on pre-existing conditions;
• require coverage of a minimum of 10 essential health benefits;
• require insurers to limit annual out-of-pocket costs;
• and require them to cover 60 percent of the total costs under each plan.
The study says the state has yet to act on two other items: requiring insurers to accept every individual and employer that apply for coverage and barring insurers from imposing waiting periods that are longer than 90 days before coverage.