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."