Friday, December 6, 2013
Ruling is a boon to some uninsured, an irritant to others
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
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
Rachel Sukeforth of Litchfield is one of about 125,000 Mainers -- 10 percent of the state's population -- without health insurance.
In 2014, under the Affordable Care Act, the number will drop dramatically.
Some uninsured Mainers could be added to MaineCare, Maine's Medicaid program, because of expanded eligibility rules. Some could be added to employers' coverage plans because more businesses will be required to provide them. And many will be required to buy their own private insurance through a new government-run exchange that will provide subsidies for people who qualify.
Sukeforth, for one, is looking forward to being insured again.
Sukeforth works as a lab assistant for a small business that does not offer insurance coverage. She can't afford hundreds of dollars a month for private insurance now, but hopes the coverage mandate will bring costs down.
"I was a little worried that they were going to strike it down," she said. "I'm 27. My generation is struggling to find jobs and starting families and the fact that we're going to have access to affordable insurance, hopefully this will make things easier for us."
Ethan Francine of Topsham, on the other hand, was disappointed Thursday.
The 25-year-old college student is currently on his parents' plan, but may soon be uninsured. He had hoped the law would be struck down because he doesn't want to be forced to buy health insurance.
"It seems like it's taking away from freedom and the American way of life," he said.
Bringing coverage to the uninsured is the basic goal of the law and perhaps the most important way it could ultimately reduce the cost of insurance, advocates say.
That's because the uninsured tend to avoid doctors and preventive care, waiting until they are so sick they have to go to the emergency room for expensive acute care.
Much of the cost of emergency room care is paid for by everyone else through higher medical fees and higher insurance premiums. Maine's medical community estimates the cost of caring for the uninsured adds as much as 30 percent to the cost of health care in the state.
Political fallout over court decision has already begun
The fallout from the Supreme Court decision is sure to stir up the partisan battles over health care in Maine's state capital.
In fact, it started within hours of the ruling Thursday.
Democratic legislators hailed the decision and said it will prevent Maine from going through with plans to cut off some 27,000 from coverage by MaineCare, the state's Medicaid program.
"These were all people who were going to lose their health care if the Affordable Care Act went down, no questions about it," said Rep. Sharon Treat, D-Hallowell. "We're really lucky in Maine that this law was upheld."
While the Affordable Care Act allows for waivers to make cuts in special cases, it requires states to continue with existing levels of coverage. Democrats said that leaves a $10.7 million hole in the Maine budget for the fiscal year that starts next week.
The LePage administration had a different view -- and a different interpretation.
Gov. LePage blasted the decision in a written statement.
"This is a massive overreach by the federal government, and is infringing upon the individual choices that we, as Americans, have in pursuing our own American Dream ... This massive tax hike will only destroy the American economy as it forces us over the financial cliff," said LePage.
Meanwhile, Department of Health and Human Services Commissioner Mary Mayhew released a statement saying the administration would move forward with the MaineCare cuts. It will notify the federal government about the changes, but it won't seek special waivers, a spokesman said.
"The language of the Supreme Court decision affirms that Medicaid expansion cannot be mandated and that states have the flexibility to manage their Medicaid program without risking the loss of existing matching federal funds," Mayhew said.
The dispute centers on a section of the ruling that says states cannot be required to expand their Medicaid programs in 2014, as the law had required. Under the law, states could have lost huge amounts of federal health care funding if they refused to expand their Medicaid programs in 2014.
Democrats argued Thursday that the ruling only applies to future expansions. The Lepage administration took the position that it also allows the state flexibility to change existing coverage levels.
Republican Attorney General William Schneider said the protection of states' rights was a positive piece of an otherwise diappointing decision. But he carefully avoided taking a position on the pending budget cuts in a statement released after the ruling.
"The expansion of Medicaid on the backs of state budgets through all-or-nothing bullying tactics was rejected by the court," he said. "We are carefully reviewing the decision to evaluate how this will specifically impact Maine."
Business sector has mixed reaction to health care ruling
The Supreme Court's decision to uphold the Affordable Care Act drew mixed reaction from Maine's business community, but some business owners interviewed said they were glad to have the law's legal status resolved.
"Nothing really has changed. What was the law yesterday is the law today," said Peter Gore, vice president for advocacy and government relations for the Maine Chamber of Commerce. "A lot of employers went into a holding pattern, waiting for what the court would do. Employers will now begin to see how the law will affect them and can make choices."
The biggest impact, business owners said, is that the law requires businesses with 50 or more full-time equivalent employees to provide health insurance for all workers by 2014 or face penalties. Businesses with fewer than 50 employees -- about 29,400 in Maine, more than 97 percent of all businesses in the state -- are exempt.
In Maine, 47 percent of residents get their health care coverage through their employers, just below the national rate of 49 percent, according to the Kaiser Family Foundation.
Small businesses will be able to shop for less expensive health insurance on state exchanges, but some with 25 to 50 employees might think twice about expanding so they don't have to provide insurance plans.
"If a business is threatened by extinction by this, there will be a backlash," said Dick Grotton, president and chief executive of the Maine Restaurant Association. "There are some people who will say 'I have 49 employees and I'm never going to hire again.' That's an emotional reaction. We need to wait another year and a half to see how this all pans out."
Grotton said the average restaurant employs about 40 to 45 employees, but a restaurateur who owns more than one establishment would probably qualify as a larger business and be required to provide health care coverage for all workers.
"This presents burdens and challenges for all small businesses, especially the mandate for larger small businesses to provide health care," said David Clough, director of the Maine chapter of the National Federation of Independent Business. "We've been trying to recover jobs since the worst recession since the 1930s. The new requirements could slow down job recovery and stunt growth."
For young patient on parents' plan, a feeling of relief
The Drew family of Scarborough watched television coverage of the ruling from Ashley Drew's hospital room in Boston.
"We were pleased. It was a big relief," said Tom Drew, Ashley's father.
Ashley Drew is one of an estimated 9,000 young adults in Maine 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. The coverage for adult children has become one of the most popular provisions of the act, and might have survived even if the rest of the law did not.
Three of the five companies that offer insurance in Maine had already pledged to continue offering coverage to young adults up to age 26, regardless of the Supreme Court decision.
Now, it remains a federal law.
The provision was a life-saver, maybe literally, for Ashley Drew, her parents said.
Drew was born with cystic fibrosis, a genetic condition that leads to life-threatening lung infections. Drew's condition worsened in her 20s as she worked toward a master's degree in music education at the University of Maine in Orono.
She was repeatedly hospitalized, left school and was on a waiting list for new lungs. She turned 25 while she was waiting, but the federal law ensured that she could stay on her parent's insurance. Drew finally got her lungs June 8 and continues what will be a long recovery.
"She has insurance now until she turns 26 (in August). Then we've got options," Tom Drew said.
The family has options because the law prevents insurance companies from turning down people with pre-existing conditions, he said. Also, the federal law, along with state law, prevents lifetime limits on insurance claims.
When Ashley Drew was waiting for her transplants, she was featured in a video posted online by the Obama administration talking about how the Affordable Care Act helped her family and took away the stress of possibly losing insurance coverage and having to pay for the expensive operation and care.
While she was not comfortable enough to comment for this story, her father said, the news Thursday morning put a smile on her face.
"It takes a lot of worry out moving forward. It gives us options," Tom Drew said. "When you're going through all the things that she's going through, the last thing you need to worry about is 'Am I going to lose my insurance coverage?"'
'Oh, my God, that makes me almost want to cry'
Theresa Blankenship of Limerick was waiting for the Supreme Court decision Thursday morning when the tension became too much. She left the television and went downstairs to do laundry.
"Oh, my God, that makes me almost want to cry," she said, when told of the decision. "I was so worried that all of the work that we had done and all of the effort that we had put in had been for naught. All of the dedication that Rocky put into this. I'm beyond words. I am beyond words."
Blankenship is still paying hospital bills and trying to rebuild her credit more than two years after her husband, Rocky D'Andrea, died from cancer in March 2010. Her husband's health insurance coverage was cut off when he hit a $250,000 lifetime cap on claims, leaving Blankenship with about $60,000 worth of bills she could not pay.
Before he died, Rocky D'Andrea became an advocate for health care reform, testifying in Augusta in a favor of a successful bill to ban lifetime insurance caps in Maine. The federal Affordable Care Act, signed a day after D'Andrea died, banned lifetime caps nationwide.
Blankenship was publicly thanked by President Obama when he came to Portland days later.
"It felt so good to know that other people wouldn't have to go through what we went through," she said.
Blankenship has since been working with the Maine Parent Federation on health insurance issues, and she was afraid the Supreme Court might strike down the law.
"I was very worried that people who are now receiving care and could take a deep breath and focus on their families would be reverted right back to the financial disaster that I went through. I was sick to death that would happen," she said. "I'm just so pleased."
Political candidates take partisan lines on court decision
Mainers probably haven't heard the end of the political posturing over the controversial health care law.
Candidates for Maine's U.S. Senate and two U.S. House seats are likely to continue debating the perceived merits and pitfalls of the controversial law. And whoever represents Maine in Congress next year might vote on attempts to repeal the law, depending on which party controls the White House and the two chambers after the November election.
As with Maine's sitting representatives and senators, candidates' reactions to the court ruling fell along partisan lines.
Secretary of State Charlie Summers, Senate President Kevin Raye and Sen. Jonathan Courtney -- all Republicans -- said they were disappointed with the ruling. Summers is running for retiring Olympia Snowe's U.S. Senate seat, Raye is challenging Mike Michaud in Maine's 2nd Ddistrict, and Courtney, a state senator from Springvale, is running against Chellie Pingree in the 1st District.
Pingree is married to S. Donald Sussman, majority share owner of the Portland Press Herald/Maine Sunday Telegram.
"Today's Supreme Court decision makes this Senate race more critical than ever," Summers said in a statement. "The court's ruling makes it clear that the president's plan amounts to a massive tax increase. Maine people need a senator who will provide a voice for businesses and families as we address this critical issue."
Raye called on Congress to work on bipartisan reforms that would allow individuals to purchase health insurance across state lines and enable small businesses to pool together to buy insurance at lower rates, among others.
Courtney said he was confident that it would be a campaign issue and said he planned to ask "people on Main Street" for their ideas on ways to move forward with health care reform.
"I think you have to repeal it and start over ... and do it in a bipartisan way," Courtney said.
Sen. Cynthia Dill, the Cape Elizabeth Democrat seeking Snowe's seat, said the Affordable Care Act is already lowering prescription and health care costs for seniors and prohibiting insurance companies from denying coverage due pre-existing conditions. But Dill said other reforms are needed and repeated her calls for a so-called "single-payer" health care system.
"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.
The expansion would be paid for almost entirely by the federal government. But advocates fear that opponents of the law will fight the expansion in Maine and other states.
Opponents of the law in Maine, including Gov. Paul LePage, did not say Thursday whether they will oppose the MaineCare expansion in 2014.
Maine Republicans made it clear, however, that they don't believe that expanding taxpayer-funded insurance programs -- whether with federal money or state money -- will lower costs.
Sen. Rodney Whittemore, R-Skowhegan, who co-chairs the Legislature's Insurance and Financial Services Committee, said he was disappointed that the law was upheld Thursday because it doesn't do anything to stop health care costs from rising.
"There's nothing standing in front of that freight train, as far as I'm concerned," he said.
Attorney General William Schneider said it was an important victory for states to have the ability to opt out of the expansion.
"The expansion of Medicaid on the backs of state budgets through all-or-nothing bullying tactics was rejected by the court," he said in a written statement.
-- Staff Writers John Richardson, Kevin Miller and Jessica Hall contributed to this report