The national health care bill, known as the Affordable Care Act, will have an enormous impact on the way health care is delivered in this country. To comply with this new federal law, and to get the most benefit from it, Maine will need to change its laws.

To this end, the Legislature established the Joint Select Committee on Health Care Reform to study and analyze the provisions of the Affordable Care Act, and to determine how best to comply with it. The committee will determine which state laws, rules and policies need to be changed, the dates by which they need to be changed, and options in the Affordable Care Act that the state may wish to adopt. The bi-partisan committee consists of 12 members of the House of Representatives and five senators, and I have the good fortune to be one of them.

So far the committee has met twice, and we have covered a number of items, including the impact of the new federal law on the state’s Medicaid program, grants available for public health efforts, the implementation of a high risk pool to help cover people with pre-existing conditions and the tax credits that will be available to Maine’s small businesses that provide health insurance coverage.

While it is hard to say definitively what the total impact of the Affordable Care Act will be, Maine will see a gain in resources under the act. Brenda Harvey, commissioner of the Department of Health and Human Services, and Trish Riley of the Governor’s Office of Health Policy, provided an analysis of the estimated impacts of the new law on the state’s Medicaid program. They explained that during the next 10 years, the state will save nearly $200 million under the new law.

Riley also outlined the state’s efforts to set up a high-risk insurance pool. To be eligible for the high-risk pool a person must have not had coverage for the previous six months and have a pre-existing health condition. The federal law provides resources to states to subsidize coverage for these people, and it can be provided through Maine’s Dirigo program. She also noted that the administration is moving forward with several applications for grants to fund health reform efforts.

The provisions of the Affordable Care Act will be phased in, mostly between now and 2014. One item that has already been voluntarily implemented by Maine’s health insurers is the option of coverage for dependents of policy holders up to the age of 26. Since nationally, as many as one-third of people in this age group lack insurance, this will have a major impact on the number of uninsured.

The committee heard from several presenters on the impact of tax credits for Maine’s small businesses to make coverage more affordable. The vast majority of Maine’s businesses have fewer than 50 employees yet, in 2008, only 45 percent of those small businesses offered their employees health insurance. The Affordable Care Act has a number of provisions aimed at solving that problem. Beginning this year, there are tax credits of up to 35 percent of the premiums a small business pays for its workers, and that will gradually increase to 50 percent in 2014.

We were also told about changes to Medicare that will close the prescription drug “doughnut hole” and eliminate co-pays for preventive care.

The “doughnut hole” is a serious problem for seniors with high prescription drug costs. When someone on Medicare has spent $2,830 on prescription drugs in a year, they are on their own until the total spent reaches $4,550, when Medicare again picks up coverage.

This year, if a Medicare recipient falls into the doughnut hole, they will automatically receive a $250 payment to offset their costs. During the next 10 years, the hole will be phased out, disappearing entirely by 2020.

Additionally, starting in 2011, Medicare will cover preventive care. Services such as annual physicals, colorectal cancer screening and mammograms will be covered. This will help seniors maintain their health and allow their health care providers to catch serious illnesses earlier, when they can be treated more effectively.

Federal health care reform has presented many opportunities for the people of Maine to get access to affordable, quality health care. Maine is already well positioned to take advantage of some benefits under the law and there are other areas where we will need to make changes.

This committee will allow us to take a thorough review and ensure that we haven’t missed any opportunities, and help us be prepared to move forward when the Legislature reconvenes in January.

The Affordable Care Act has the potential to make great improvements, both in the way health care is delivered and in the health of individual Mainers.

State Sen. Margaret Craven, D-Lewiston, serves on the Appropriations and Financial Affairs Committee.


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