Experts point to health care options for Mainers

AUGUSTA (AP) — About 127,000 uninsured Mainers will be required to get health insurance or face penalties starting next year under the federal health care overhaul, but experts say they shouldn't panic because there will be options for coverage, and help getting it.

The requirement, known as the individual mandate, has been one of the most hotly debated pieces of the federal health care overhaul and was at the center of last year's Supreme Court decision upholding the law.

About half of Mainers are covered by employer-provided health insurance, and about 42 percent have individual health insurance policies or are covered by public programs including Medicare and Medicaid, according to the Commonwealth Fund. Ten percent of Maine's population is uninsured and will fall into the individual mandate category, the private health care research nonprofit Kaiser Family Foundation estimates.

One uninsured Mainer who's hoping the new law will make coverage possible is Melisa Belanger, who lives in the rural town of Burnham and, like her husband, works two jobs. The only policy available to her through her employer costs $800 a month and has a $10,000 deductible, Belanger said, leaving her "very sour on what's being offered."

"I'm really hoping something can be done for people that are stuck in the middle without any help," said Belanger, who is 27.

The federal law provides for two ways of covering people who fall under the requirement set by the individual mandate: through expanded Medicaid coverage or subsidies for private insurance.

Expanding Medicaid coverage is an open question in Maine as the Legislature sorts out its spending priorities for the next two years. Republican Gov. Paul LePage remains opposed to the idea, while Democratic leaders say expansion is a priority.

If Medicaid isn't expanded, people who earn up to 133 percent of the federal poverty level but don't get insurance won't be penalized by the government. But many of them wouldn't be eligible for subsidies either and would likely go without health insurance, said Mitchell Stein of Consumers for Affordable Health Care, an Augusta-based group that advocates for quality insurance for everybody.

"So they're left out in the cold, which is why we think it's so important that Maine participate in Medicaid expansion," said Stein.

The federal law also says that those whose incomes are 100 to 400 percent of the federal poverty level can qualify for subsidies, which will be based on incomes. People will be required to spend 2 to 9 1/2 percent of their incomes for health coverage, said Stein.

Those consumers will be able to go to an online marketplace, known as an exchange, and shop for insurance.

For those who simply don't comply with the individual mandate, the government will deduct the penalty from their tax returns or, if there is no refund, send them a bill. But Stein doesn't think that will be the case with many.

"Most people want health insurance," he said. "They just couldn't afford it."

The Commonwealth Fund, which supports independent research on health care issues, acknowledges the controversial nature of the mandate but says there's evidence "an overwhelming majority of households do have room in their budgets for the necessities, health insurance premiums, and moderate levels of out-of-pocket costs established by the Affordable Care Act."

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FRANK EARLEY's picture

Makes perfect sense to me.............Not!!!!!!!

As a direct result of LePage's refusal to expand "MaineCare", thousands of people who, for what ever reason, fall through the cracks and wind up with no health care, will graciously be excused from paying the penalty. That's the answer in Maine? I'm assuming that the good Governor, is expecting these poor individuals to be so ecstatic at their lack of possible prosecution, they will run out and deposit this enormous, unexpected windfall into one of their bulging bank accounts. After which, a lovely and festive dinner will be prepared, and the families will all sit down, and celebrate a special "ThanksGiving". I suppose I need to put "and they lived happily ever after". Sorry, but "Tiny Tim's" leg still doesn't work, and the rest of the family got food poisoning, now what?


gimme Health insurance

Give me Health insurance no less than our state and elected officials that’s all I want and I think a referendum should be set in motion to do so. Better yet make the referendum that all state and elected officials shall have the same benefits of the average worker in the state. WOW we will balance the budget after all, without beating down our elderly or our children. Don’t worry workers of the state you can pay off (err convince) a judge that it is unconstitutional.


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