AUGUSTA — As the U.S. Supreme Court probes the constitutionality of the Affordable Care Act, Maine lawmakers might delay implementation of a critical component of the law.
Republicans on the Legislature's Insurance and Financial Affairs Committee voted recently along party lines to delay setting up the state's health insurance exchange, even though the federal law mandates that states create marketplaces where businesses and individuals can shop for health insurance.
The Legislature last year began studying implementation of the exchange. Lawmakers in both parties reasoned it was better for the state to tailor its own marketplace, rather than to allow the federal government to do it.
The health care law mandates that states have the exchanges in place by 2014.
The federal government has awarded grants to states as incentives. Maine has already spent about $1 million. In November, the federal government awarded the state $6 million to set up an exchange.
However, the GOP has slowed that process since the court announced in November that it would hear the multi-state challenge to the federal health law. The decision is grounded in the hope that the conservative majority of the court will strike down the law's individual mandate, a controversial provision that requires most Americans to buy health insurance.
The mandate is seen by health care experts as the linchpin of the Affordable Care Act. Some believe the law will unravel without it.
Maine Attorney General William Schneider, who last year entered Maine in the multi-state suit challenging the constitutionality of the mandate, told The Associated Press Monday that Congress may have to "go back to the drawing board and address health care in a big way" if the mandate is overturned.
The uncertain fate of the law has persuaded Maine Republicans that now isn't the best time to move forward with the exchange. During work sessions held over the past several months, Republicans on the Insurance Committee argued that creating one could be costly, complex and hypocritical, given the GOP's political position on the law.
Some business advocates say banking on the repeal of the mandate and stalling implementation of the exchange could be risky.
In its most recent newsletter, the Maine State Chamber of Commerce wrote that some of its membership was surprised that Republicans on the Insurance Committee didn't support even the "minimal framework" for an exchange.
"Instead, business organizations are left with nowhere to go when it comes to legislation on exchanges," the newsletter reads.
Business groups weren't thrilled with the Democratic alternatives either. The state chamber opposed the Democrats' proposal, saying it was overly restrictive.
But businesses support installing some kind of an exchange rather than taking the risk of having the federal government do it.
Maine is one 26 states challenging the constitutionality of the health care law. The states opposing the law have taken varying approaches to the exchange mandate.
Some, including Arizona, Florida and Louisiana, want no part of the law and have refused to proceed with any of its provisions.
Other states opposing the law have embraced the exchanges, which proponents say are structured on the free-market principle that competition reduces prices and increases convenience for consumers.
Officials in Mississippi share that belief and are proceeding with an exchange even though it's one of the states challenging the law. The animosity toward the health law nearly scuttled the process in the Mississippi Legislature. However, the state's insurance commissioner, Mike Chaney, eventually deployed an obscure rule to ensure that the exchange setup continued.
"It is important that we have an exchange that is designed by Mississippians, operated by Mississippians, for Mississippians," Chaney told National Public Radio. "We don't want an exchange from the federal government that is one size fits all. What may work in New York state may not work in the state of Mississippi."
Chaney said the exchange would likely endure regardless of whether the federal health care law is overturned. The reason, he said, is that the marketplaces are a good idea.
Last year, when Maine Republicans passed an overhaul of the state's health insurance regulations, the law was crafted to dovetail with an exchange. The reason, proponents argued, was that the exchanges created a solid framework for the interstate sale of insurance plans, which the GOP has long championed.
Democrats say the GOP is playing election-year politics by delaying the exchanges. They say the risk isn't simply an exchange set up by the federal government, but the lost opportunity for consumers to receive subsidies and lower health care costs.
The debate could hit the floor of the House of Representatives this week when lawmakers address the second of two bills dealing with the exchange.
The first, LD 1497, ensures that so-called navigators in the exchange have appropriate licensing to sell or solicit insurance plans. On Wednesday the measure received initial approval in the House by a 71-69 vote.
The debate foreshadowed what promises to be a longer one on the exchange setup, LD 1498.