The Affordable Care Act has a new fan: Gov. LePage.

In explaining why he rejected $350 million a year from the federal government to insure 70,000 low-income workers, the governor has repeatedly said that they would be better off as a result, because they will be able to buy subsidized private insurance on the ACA marketplace, known as the exchange.

The governor’s sudden enthusiasm for the exchange is odd, because he pushed the state into a lawsuit that sought to have the entire health care law declared unconstitutional. He also obstructed the creation of a state exchange that would have been tailored to the needs of the state; instead, he put Maine on a federal exchange that had a notoriously slow start.

But the real problem with the governor’s new love of the ACA is not that he has “evolved” on the issue. It’s that it will not work.

The affordable plans on the exchanges were not designed to help working people on the edge of poverty, who were intended to get coverage under an expanded Medicaid. People in the income range that would have been covered under the expansion – people who make less than $16,000 a year – would be able to afford the very low premiums available to them, but they could not pay the out-of-pocket costs, making their insurance unusable for all but catastrophic emergencies.

The same economic barriers to seeking preventive care and early intervention would remain, and the government subsidy would be wasted.

Advertisement

A 35-year-old single man who works full time for minimum wage is not covered by Medicaid now; if he doesn’t have insurance through his employer and has to get it from the exchange, he would have to pay for his treatment out of the $15,600 he earns every year.

This is the kind of person who would qualify for the MaineCare program at the federal government’s expense if Maine would expand eligibility.

If low-income workers were to buy insurance on the exchange, the governor is right about one thing: After tax credits, the premiums would indeed be affordable, a mere $1.57 a month. But doctor’s visits would require a $45 co-pay, and patients woud have to pay half the cost of most procedures until they reached a $5,000 deductible. Anyone who’s scrutinized a medical bill knows how quickly the costs could add up.

Insurance like that is not much better than no insurance at all. The plans cover some services such as checkups and immunizations at no cost, and they would cover serious illness and injuries that require long hospital stays. But most services and medications are not covered unless the patient can come up with a lot of cash that people in this income group do not have.

Pushing people onto the exchanges when they can’t afford the out-of-pocket costs is not a strategy to extend coverage – it’s a debating tactic. The governor should stop hiding behind the exchanges that he once tried to outlaw and explain why he is standing in the way of life-saving health care for up to 70,000 Maine people.


Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.