June 30, 2012

Decision's impact stretches across Maine

(Continued from page 4)

SCOTUS POST
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Opponents of President Obama’s health care plan, tea party activists Jenny Beth Martin of Atlanta, rear left, Keli Carender of Seattle and David Walls-Kaufman of Washington, get in a heated discussion with health care supporter Michael Paysour of Washington in front of the Supreme Court after the ruling on the Affordable Care Act was announced upholding most of the plan.

Washington Post photo by Katherine Frey

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IMPACT OF THE AFFORDABLE CARE ACT IN MAINE

9,000: The estimated number of young adults who now have health insurance due to a provision in the law that requires insurance companies to provide coverage to young adults up to age 26 on their parents’ health insurance plans.

187,251: The number of people with Medicare who in 2011 received free preventive services – such as mammograms, colonoscopies and annual wellness visits with their doctor.

$11 million: The amount that people on Medicare have saved on prescription drugs since the law was enacted.

$2,579,922: The total value of rebates that will go to 5,600 families with private health insurance this summer due to a provision in the health care law that requires insurance companies to spend at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing.

$463: The average rebate to each family.

41: The number of previously uninsured residents of Maine who as of April 2012 were locked out of the coverage system because of a pre-existing condition and are now insured through a new plan for such people created under the new health reform law.

Source: U.S. Department of Health and Human Services

 

"I also believe we should go further in ensuring that Americans don't have to choose between health care and bankruptcy, through better cost controls, increased reliance on preventive care, decreased reliance on fee-for-service models, and, ultimately, a universal single-payer system," Dill said.

For senior citizens, a burden of worry is finally removed

Stan Cohen said he knows a lot of seniors who are feeling relieved today.

Cohen, who is 83 himself, is a volunteer Medicare counselor in the Bridgeton area. Some of his clients have been worried about the Supreme Court decision.

"If they had struck it down, it would have hurt a lot of people on Medicare," Cohen said.

The law's benefits for seniors on Medicare include 100 percent coverage of preventive care.

It also includes subsidies for seniors with high medication costs who have had to pay the full price for their drugs when they reach a coverage gap known as the "doughnut hole."

In 2011, some 11,892 Mainers saved an average of $530 in discounts -- $6.3 million in all, according to the federal Department of Health and Human Services. Maine seniors have saved $11 million on prescriptions since the law was enacted, it says.

"For some (seniors), what they used to have to pay out of pocket put them in a position where they simply couldn't afford their medications and didn't take them," Cohen said. "I have clients who now are back taking their medicine" because of the discounts.

Expanded coverage of preventive care actually affects everyone who has insurance. It's the reason that routine exams and screenings no longer require copays or deductibles.

The general goal behind the enhanced preventive coverage is to avoid costly illnesses, keep patients healthier and gradually bring down medical costs and health insurance premiums across the board.

For seniors enrolled in Medicare, the enhanced preventive coverage also now includes an annual health assessment by a doctor.

"I can sit down with my health care provider and talk about a long-range plan for my health. That wasn't available before," Cohen said.

For women, enhanced preventive coverage includes screenings such as mammograms and pap smears, as well newly covered services such as contraception, breast-feeding supports and screening for gestational diabetes, domestic violence and sexually transmitted diseases.

Cohen, meanwhile, said he is looking forward to sitting down with some relieved seniors at his next counseling sessions.

Physicians ask what will happen with MaineCare

Maine's physicians generally welcomed the court's ruling Thursday, although doctors and others said they fear that Maine can refuse to go along with a planned expansion of MaineCare coverage.

The Maine Medical Association, which represents more than 3,600 physicians, supported the law as a way to expand insurance coverage and allow more people to get preventive care.

"That's the most important thing to our members -- to get everybody covered. Once you do that, then you can start focusing on controlling costs," said Gordon Smith, vice president of the association.

"By having insurance, people can focus on preventive care rather than having to go to the emergency room because they don't have health care coverage," said Dr. Nancy Cummings, president of the association and an orthopedic surgeon in Farmington.

They said they were less happy with a part of the ruling that allows Maine and other states to opt out of an expansion of MaineCare -- Maine's Medicaid program -- in 2014 without losing federal funds. The expansion, if Maine goes along with it, will bring thousands more residents into MaineCare.

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