WASHINGTON — Now that technical fixes to the health insurance marketplace website are mainly accomplished, it is time to assess how the Affordable Care Act will affect people across the nation in the months ahead.

For most individuals and families in Maine, the new law will make health coverage better and more affordable. Inevitably, however, there will be problems, such as the recent insurance cancellation notices that were sent to recipients of substandard plans. Let’s take a thoughtful assessment of the realities of the new health care law to see these issues in perspective.

In Maine, there are 590,000 non-elderly people with diagnosed pre-existing conditions – asthma, diabetes, high blood pressure, a history of cancer or other serious health problems. And many more Mainers could be diagnosed with one of these conditions in the near future.

Maine is one of only five states that had moved forward to protect consumers with pre-existing conditions from discrimination by insurance companies in the private, non-group insurance market. Indeed, Maine has been a leader state for the rest of the nation and a model for the Affordable Care Act.

Starting Jan. 1, almost 123,000 Mainers will also become eligible for substantial tax-credit subsidies that will make insurance premiums much more affordable. These subsidies will be available for many in the middle class as well as those with moderate incomes: Eligibility extends to 400 percent of the federal poverty level ($94,200 in annual income for a family of four, $46,000 for an individual living alone). For family coverage, the average annual subsidies, according to the Kaiser Family Foundation, will be $5,548.

In every state, women, especially those of childbearing age, will not be charged discriminatory higher premiums that often make their health coverage unaffordable.

Young adults, the age group most likely to be uninsured today, will disproportionately benefit from the Affordable Care Act. This is because the tax-credit premium subsidies are provided on a sliding scale – those with the lowest incomes (like young adults) will receive the most financial help.

Young adults have incomes that are the lowest of all age groups, largely because they are continuing their education, do not have a job yet or are in entry-level positions. Because they will receive the largest subsidies, insurance coverage will be of much greater value to them.

But let’s be clear. These notable, indeed historic, achievements do not belie the need to address the concerns of people who have received termination notices from their insurance companies. Those notices were sent to people with private non-group (individual) insurance policies, many of which are substandard – they fail to meet new consumer protection standards.

For example, many of these substandard plans place arbitrary limits on how much they will pay out in claims in any year. Many consider these plans “Swiss cheese” insurance – insurance that doesn’t really insure.

But here is where a thoughtful perspective is most needed. Let’s keep in mind that the vast majority of people receiving these termination notices will not only be able to obtain better coverage, but will also qualify for financial help in paying for their new premiums.

In Maine, for example, most of those in the individual insurance market today – 71 percent – have incomes below 400 percent of the federal poverty line and are therefore eligible for substantial premium subsidies. Once they enroll in new health coverage through the Affordable Care Act, they will be better off than they were before.

And let’s remember how small this potentially vulnerable group is. To begin with, most people with health insurance receive it through their employers, and not many people have individual (non-group) insurance coverage today. Only 5.1 percent of the non-elderly in Maine currently have individual insurance plans, and not all of them received termination notices.

Research shows that most of these individuals would have moved on to more traditional plans after a year (for example, an employer’s plan), as they did prior to the Affordable Care Act. As a result, only 0.5 percent of Mainers are at risk of staying in the individual market and not receiving a robust premium subsidy under the new law.

This does not mean that addressing the problems of plan cancellations is not important. It is. But it is equally important for all of us to keep a balanced understanding of the benefits and challenges of the Affordable Care Act. When we do this, we can state the obvious: The new health care law will be an enormous improvement for the vast majority of Mainers.


— Special to the Press Herald

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