Friday, April 18, 2014
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With the health insurance marketplace open for business, Outreach Specialist Libby Cummings, at Portland Community Health Center, answers questions on the phone about the new system on Oct. 1.
2013 Telegram file/Carl D. Walsh
Gov. Paul LePage
The Obama administration has an incentive to approve the alternative plans, experts add, because doing so helps the administration meet the overall goals of the health care law, to provide benefits to previously uninsured low-income residents.
“The (U.S. Centers for Medicare and Medicaid Services) is being really flexible with the states, really actively engaged with them to make it work,” said Sonya Schwartz, a research fellow at Georgetown University’s Public Policy Institute. Schwartz said she expects the lure of additional federal funding will be too enticing for states, and that most if not all states currently not part of the expansion will sign up either for Medicaid expansion or a state-designed alternative in the next few years.
While Republicans have been skeptical of the life of federal subsidies, Democrats have argued that it’s foolish to refuse federal money that would provide more health care for Maine residents.
Republican state Sen. Roger Katz of Augusta, who failed in his efforts to broker a less sweeping Medicaid compromise last spring, said the other states could show a way forward.
“I have to think there’s some middle ground here,” said Katz, who consulted with state officials and lawmakers in Arkansas and Iowa about their states’ plans at a recent health policy conference. “We ought to take a hard look at these alternatives.”
In Arkansas, a Republican-leaning state with a Democratic governor and Republican-controlled legislature, the federal government a few weeks ago granted a first-in-the-nation waiver allowing the state to implement its own system.
Iowa – with a Republican governor and Democratic legislature – is not far behind, and is awaiting final approval from the federal government.
Maine Equal Justice Partners, an advocacy group that staunchly supports Medicaid expansion, is willing to consider a compromise plan such as those developed by Arkansas and Iowa, said its executive director, Sara Gagne-Holmes.
“We are not dug in that this has to be done a certain way,” Gagne-Holmes said. “We need to be creative and think about what would work in Maine.”
‘BETTER THAN DOING NOTHING’
But she said that while other states should be studied, she is concerned about systems that potentially could be too pricey for low-income residents.
In both Arkansas and Iowa, the Medicaid money would not fund expansion but would instead flow into generous subsidies to help low-income residents buy health insurance in the marketplaces that opened Oct. 1 as part of the Affordable Care Act. The subsidies would almost entirely cover insurance premiums, making it similar to being on Medicaid, experts say. However, Iowa’s proposal would require slightly higher cost-sharing for some individuals.
In Iowa, while all who would be eligible for subsidies are low-income, those with incomes at the higher end of the threshold would pay a $20-per-month premium. However, the premium would be waived if patients undergo an annual physical, screenings and complete medical assessments. Iowa also would charge patients who use the emergency room when it’s not an emergency. The idea is to improve the health of the population, which should lower health care costs.
Katz said the Iowa plan, especially, more closely jibes with conservative principles of providing a financial incentive for people to alter unhealthy behavior.
“I think the idea of personal responsibility is important and ought to be part of what we are considering. The individuals should have some skin in the game,” Katz said.
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