Maine Health Care

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Obamacare in Maine

"RE: Changes to the 2014 Verso Health Benefits Program," a memo sent to all employees of Verso Paper from Kenny D. Sawyer, V.P.Human Resources.

The VP explains "...our benefits team has worked closely with our health care providers to mitigate increased costs..." of the Affordable Care Act of 2010. Let's savor that phrase for a moment—"mitigate increased costs."

Here are some other key phrases in the document:
"...implement a resulting premium increase..."
"...decreasing our health care offerings..."
"...co-insurance payments will be adjusted from 90% to 80%..."
"...increase in out-of-pocket maximums..."
"...you will see a premium increase around 3.5%..."

In summary, for Verso Paper employees Obamacare means increases and decreases. The increases are all about their cost; the decreases are all about their coverage. On another front, NBC News tells us that Loren Goodridge, who owns 21 Subway franchises, including one in Kennebunk, is cutting hours for 50 workers to no more than 29 hours a week to avoid triggering the Obamacare provision mandating health insurance coverage to employees who work 30 hours or more per week. Mr. Goodridge has this to say: "To tell somebody that you've got to decrease their hours because of a law passed in Washington is very frustrating to me."

The TV network reports the Subway magnate's experience as typical "Employers around the country, from fast-food franchises to colleges, have told NBC News that they will be cutting workers' hours below 30 a week because they can't afford to offer the health insurance mandated by the Affordable Care Act, also known as Obamacare."

Joseph Hansen, president of the United Food and Commercial Workers union (UFCW) has this to say: "You'll see tremendous impact as workers have their hours reduced and their incomes reduced. The facts are already starting to show up."

Hansen, along with the Teamsters, and UNITE-HERE presidents have sent a letter to Harry Reid and Nancy Pelosi which begins: "When you and the President sought our support for the Affordable Care Act (ACA), you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat. Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class."

The UFCW claims 1.2 million members including those in Local 791, which covers Maine, Massachusetts, and Rhode Island. UNITE HERE represents 251,000 workers in the hotel, gaming, food service, manufacturing, textile, distribution, laundry, and airport industries throughout the U.S. and Canada, including members of Locals 406 in Saco and 486 in Bangor. The Teamsters claim 1.4 members, including those in Local 340 in Portland.

Jason Furman, chairman of the president's Council of Economic Advisors, dismisses all such "anecdotal evidence." He sees "no systematic evidence that the Affordable Care Act is having an adverse impact on job growth or the number of hours employees are working. ... " He boldly asserts that "nearly 90 percent of the gain in employment has been in full-time positions."

In contrast Keith Hall, a senior researcher at George Mason University's Mercatus Center, reports that "Over the last six months, of the net job creation, 97 percent of that is part-time work," The Bureau of Labor Statistics (BLS) Household Survey shows 963,000 more people reporting that they were employed, and 936,000 of them reported they're in part-time jobs. Hall ran the US Department of Labor's BLS, which puts out monthly job reports, from 2008 to 2012.

Who to believe? I'm taking no position other than to suggest that readers ask around among businessmen they know. There's a point when anecdotal evidence (a.k.a., "experience") grows to a volume that transform it into data.

 (Professor John Frary of Farmington is a former congressional candidate and retired history professor, a board member of Maine Taxpayers United and publisher of www.fraryhomecompanion.com and can be reached at:jfrary8070@aol.com.)


MAINE House Sustains LePage’s Medicaid Expansion Veto

lepage (1)

AUGUSTA – The Maine House of Representatives voted on Wednesday to sustain Gov. Paul R. LePage’s veto of the controversial expansion of Medicaid proposed under President Barack Obama’s sweeping healthcare overhaul.

Medicaid expansion was originally mandated under the Affordable Care Act (ACA), more commonly known as Obamacare. However, the 2012 decision of the U.S. Supreme Court found the mandate unconstitutional, giving states the freedom to choose whether to expand the welfare program, which is known in Maine as MaineCare.

Following House lawmakers 97-52 vote to sustain the governor’s veto, House Democrats immediately proposed a reconsideration and, after some uabbling between House Speaker Mark Eves (D-North Berwick) and House Minority Leader Ken Fredette (R-Newport), tabled the motion.

While the vote to override the veto required a two-thirds majority, the subsequent votes to reconsider (93-56) and table (94-55) required only a simple majority. So despite two roll call votes sustaining the veto, Democrats’ procedural moves have kept the proposal on life support.

On the day of the vote, Department of Health and Human Services (DHHS) Commissioner Mary Mayhew urged citizens and lawmakers alike to consider the long-term implications of expanding Medicaid.

“We should not consider building on the current Medicaid program. Its financial foundation is crumbling and unstable,’’ said Mayhew. “We must fix the existing program and work with the federal government to create more flexibility, care for priority populations and to strengthen the financial foundation of this costly and unsustainable program.”

LePage said that over the last decade, Maine’s Medicaid program has grown rapidly and has moved away from its original intent to provide services for Maine’s most vulnerable.

“Maine’s Medicaid enrollment has gone from nearly 200,000 people in 2002 to 336,000 today and the total spending in Maine’s welfare program has increased by one billion dollars since 2002,’’ he said.

LePage denied a critical part of Democrats’ argument in favor of expansion, noting that Maine’s uninsured numbered 136,000 in 2001 and stood at 133,000 in 2011, despite a significant expansion of Medicaid in the interim.

The governor also stressed rising provider costs and shrinking reimbursement rates as a reason to oppose Medicaid expansion. Medicaid rates for healthcare providers have been repeatedly cut to address the ongoing financial shortfalls in Medicaid because of increasing enrollment and utilization, he said. The effect of decreased reimbursement rates, he said, has been a reduction in access to primary care services, as more and more physicians close their practices to Medicaid patients.

LePage’s veto of the Medicaid expansion bill (L.D. 1066) follows a sustained attempt to negotiate with the federal government for an expansion arrangement that was viable in the long-term for Maine and did not penalize Maine for prior Medicaid expansion. Central to these negotiations were the more than 3,100 elderly and disabled individuals on waiting lists waiting for critical services.

“Adding non-disabled individuals to our welfare program when we are failing to provide core services to thousands of disabled and elderly Mainers is unacceptable,” said LePage.

“I believe that our children, elderly and disabled should receive adequate services, but the reality is, the current system is not providing quality care to our most vulnerable,” he said.

Mayhew said that sustaining the governor’s veto will allow Maine more time to investigate whether the state can afford the long-term cost of expanding Medicaid.

“We must continue our conversations with the Federal government to expand flexibility and care for priority populations. The Legislature seems to have manufactured a false and unnecessary sense of urgency to make a decision on expansion immediately, rather than taking the time to make a sound and sensible policy decision.”

House Republicans were critical of the Majority Democrats procedural maneuvering on the third attempt to expand Medicaid. According to the House Republican Office, the Democrats did not inform Republicans that the veto override would come up for a vote.

Rep. Corey Wilson (R-Augusta), despite voting in favor of L.D. 1066, objected to Speaker Eves’ attempt to force the bill through, alloem.amily coverage must be offered as well.

  • A standardized policy must be offered as required by the state.
  • Providers may review medical records for the six months prior to the beginning of coverage and may impose an exclusion period for up to 12 months.
  • Providers may not attach an elimination rider to a policy.
  • Pregnancy may be classified as a pre-existing condition for up to 10 months.
  • If previous coverage was maintained through employment voluntarily left for over 90 days (or for 180 days if due to unemployment), creditable coverage will apply to any exclusion period on your pre-existing condition.
  • Coverage may not be cancelled because of sickness, but premiums may vary according to the modified community rating system.

Group Health Insurance in Maine

  • Group coverage may not be denied to eligible applicants based on a health problem, nor may they be charged more.
  • Life changes dealing with family or loss of job, creates additional enrollment opportunities.
  • New employers may withhold offering coverage for a short period.
  • HMOs may review six months of an applicant’s medical records for pre-existing conditions and require up to 12 months of an exclusion period if a condition exists.
  • Certain regulations protect applicants from exclusion periods for pre-existing conditions if continuous health coverage was maintained for a certain period before application.

Small Business Health Insurance in Maine

  • Businesses employing up to 50 employees may not be denied small group coverage or be cancelled due to illness in the employee group.
  • Premiums costs for small businesses is rated according to the modified community rating.

Self-Employed Health Insurance in Maine

  • The self-employed may purchase group health insurance, but some providers will limit them to individual policies only.
  • If enrolling in a professional or trade association to get group health insurance, you should contact the Maine Bureau of Insurance for applicable regulations.

CONTACT

    Maine Bureau of Insurance 
    34 State House Station 
    Augusta, ME 04333
    (207) 624-8475
    www.state.me.us/pfr/ins/ins_index.htm

    Location Status of State Exchange Decision Medicaid Expansion Decision Executive Activity
    Maine Default to Federal Exchange3 Opposes

    Data are as of May 10, 2013.

    Coverage through the exchanges will begin in every state on January 1, 2014, with enrollment beginning October 1, 2013. States can elect to build a fully state-based exchange, enter into a state-federal partnership exchange, or default into a federally-facilitated exchange. The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to establish and operate a federally-facilitated exchange in any state that is not able or willing to establish a state-based exchange. In a federally-facilitated exchange, HHS will perform all exchange functions. States entering into a state-federal partnership exchange may administer plan management functions, in-person consumer assistance functions, or both, and HHS will perform the remaining exchange functions.

    The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012). Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion.