Friday, September 6, 2013

ACA in Maine: Q&A with Mitchell Stein, CAHC Policy Director

Every day we get one step closer to enrolling thousands of Mainers in the ACA Marketplace, an exciting and historic moment for Maine.  Our greatest challenge is in helping consumers understand the law, what it means for them, and how to get information when they need it.  This brief Q&A with Mitchell provides the answers to some of these questions.

What is the Affordable Care Act?
The Affordable Care Act is the law of the land.  One of its major goals is to provide access to affordable health coverage.  In the first year millions of additional people will gain affordable health care coverage, and thus access to health care. 

The ACA also aims to improve the quality of our health care, bringing down the cost of care for everyone; it provides basic insurance regulation at the federal level (setting a floor for minimum requirements across the country) and train more health care workers to meet the growing demand for health care services.  The importance of these items can’t be overstated.  While in the short-term, providing access to health care will be the most visible part of the law, over the long-term improving quality and lowering cost are just as important.     

Many parts of the law are already in effect, but the most significant ones begin soon.  October 1, 2013 is the beginning of the first open enrollment period for the Maine Health Insurance Marketplace (also known as the Exchange).  Through the Marketplace, subsidies will be available to low and middle income individuals and families to help them purchase health coverage.  Beginning on January 1, 2014, all individuals must have coverage, either through an employer, public programs like Medicaid and Medicare, or by purchasing a plan on their own. 

While the road to full implementation of the ACA may have some bumps, it will provide health coverage to tens of thousands of our fellow Mainers and to millions of people across the country.
Why do we need it?
Our country spends more on health care than any other – often almost twice as much (when measured as a percent of GDP).  But even though we spend all that money by all measures of quality we don’t do very well.   People in other countries live longer and are healthier.  Also, for all that money, about 15% of our population is uninsured, that means almost 50 million people don’t have coverage.  As a result, they may delay or forgo needed care altogether, until they can no longer wait and then seek care in the Emergency Department, where treatment is much more expensive.
What aspects of the law are creating the most confusion?
Many people are not aware of the basics of the law so are worrying unnecessarily.  If you are covered at work, things won’t change much and there is no action you need to take.  Also, if you are covered by Medicare, other than some improvements like the closing of the “donut hole” in your prescription drug coverage things won’t change at all – you don’t need to go to the Marketplace or do anything different than you’ve done in the past.

There are also benefits available to small businesses that aren’t well known  – tax credits for those with less than 25 employees and the chance to shop on the Marketplace for those with less than 50 employees.

How will Maine's rollout of the ACA differ from other states? What's unique here?
When the Supreme Court found the law constitutional, they said that the proposed changes to Medicaid (MaineCare) enrollment are optional for each state.  The legislature passed a bill to make the changes but it was vetoed by the Governor.  This will leave about 80,000 people in our state that will be uninsured and will not be able to benefit from the law.  It also means we are leaving $250 million in federal funds that have already been set aside, that could help to boost our economy by creating jobs.

Also, here in Maine our Marketplace (or exchange) will be run by the federal government.  This will not have a big impact on people who go to the Marketplace, but there are some states that are running their own marketplaces. 
One tip you'd give consumers who are trying to make sense of all this?
Relax and take a deep breath.  The sky is not falling, and your doctor is not now working for the IRS.  Oct 1 is the start of open enrollment for the Marketplace, but it will go on for six months – there is time to figure this out.  If you’re one of the vast majority of people already covered by your employer’s plan (or as a dependent), Medicare or other program such as the VA, you don’t need to take any action.  If you are currently uninsured or purchase individual coverage, go to for more information – remember, help with your premiums is available for people with low to moderate income, including those in families of four with incomes up to 94k (400 percent of the federal poverty level), so many people will qualify for help. 

If you have 3 minutes you can check out our new youtube video about the Marketplace!


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