AUGUSTA — Rachel Sukeforth of Litchfield would be sorry to see the Affordable Care Act go away.

She was 25 when the law took effect in 2010 and a provision in the new law allowed her to enroll in her mother’s health insurance plan. It was good timing. A medical exam found pre-cancerous cells on the lining of her cervix and she had surgery to remove them.

“The insurance covered the procedure,” Sukeforth said. “I wouldn’t have been able to afford that.”

After three days of legal arguments and probing questions, the U.S. Supreme Court is now expected to decide in June whether to strike down part, or all, of the Affordable Care Act.

Maine is one of 26 states that sued to overturn the law. The states want the entire law struck down, they argued, because of a core, unconstitutional requirement that most individuals buy insurance starting in 2014 or pay a penalty.

Maine Attorney General William Schneider said in a recent interview that there are popular parts of the law — including coverage for children up to age 26 — that Congress could reinstitute later.

It’s anyone’s guess what the court will decide — uphold the law, strike it down or remove pieces such as the individual mandate.

Striking down the law entirely would not affect Maine as much as many other states. That’s because Maine has a number state laws that are similar. Maine law, for example, says parents can add children to their insurance coverage until they reach 25 under certain conditions.

However, there would be some big changes here, both immediately and in the future, if the law is struck down.

Maine seniors would once again have to pay co-pays for preventive care and spend more on prescription drugs, for examples. Free preventive care and drug discounts are two of the provisions that have already taken effect.

The biggest pieces of the Affordable Care Act will take effect in 2014, if the law survives.

Thousands of Mainers who don’t have insurance would be required to buy it or pay penalties. However, they would be able to shop for coverage through a government-run exchange that provides more bargaining power and subsidies for those who qualify.

Less than 10 percent of Mainers are uninsured and would be directly affected by the individual mandate.

But, a decision to strike down that piece of the law would have ramifications for everyone in the state.

Once nearly everyone has coverage, insurance companies will no longer be able to turn down people who have pre-existing conditions or cut someone off if they have a serious, long-term illness that costs too much to treat. Those pieces of the law might not survive without the individual mandate requiring younger, healthier people to buy insurance.

Supporters of the law say achieving nearly universal health coverage will ultimately save everyone money.

Without it, the numbers of uninsured Mainers will grow as the state cuts MaineCare coverage and others drop out of the increasingly expensive private insurance market, said Joe Ditre, executive director of Consumers for Affordable Health Care.

“People losing coverage will now turn to their hospital emergency rooms for care, which insured people and businesses will have to pay,” Ditre said. “Or they will forgo care altogether until their conditions worsen and care gets more expensive.”

Critics, however, maintain that the individual mandate and other parts of the Affordable Care Act will ultimately increase the cost of care and insurance coverage. A decision to strike it down will allow Maine and others states to return to a market-based approach, said Joel Allumbaugh, a health insurance agent and policy analyst for the Maine Heritage Policy Center.

“There are a number of provisions in the Affordable Care Act that would increase the underlying cost of coverage,” Allumbaugh said. “It hasn’t addressed the underlying (health care) cost issues. If anything it exacerbates them.”

Allumbaugh said he works with employers, for example, who are worried about how they will be able to afford insurance for employees, including seasonal workers, when the mandates take effect in 2014.

Deregulation — such as a law passed in Maine last year — holds more promise of reducing costs in the long term, according to Allumbaugh.

But, he said, there are portions of the law — including coverage for adult children — that are not controversial and will likely be revived if the law is struck down. In some cases, insurers might simply keep those features even if the requirement goes away, he said.

Sukeforth is now 26 and, once again, uninsured. She will be one of the Mainers required to buy health insurance in 2014 if the law survives.

She still wants to keep the law, however. Sukeforth said she’s confident the new health insurance exchange will make buying insurance simpler, and that she’ll be able to join with other consumers to get a more affordable, group rate.

“I’m actually looking forward to it,” she said.

John Richardson — 620-7016

[email protected]

What happens in Maine if the entire Affordable Care Act is struck down?

MANDATES: Thousands of uninsured Mainers would no longer be required to buy health insurance or pay penalties starting in 2014. They also wouldn’t have access to new subsidies to help pay for insurance coverage they can’t afford. Employers with at least 50 workers would no longer be required to provide employee coverage starting in 2014. And small businesses wouldn’t be able to get tax credits for expanding worker coverage.

MaineCare eligibility: Gov. Paul LePage would no longer need federal waivers to follow through on a proposal to cut thousands of people from MaineCare, the state’s Medicaid program as he has proposed. That’s because some Medicaid rules are frozen in place until the Affordable Care Act expands Medicaid eligibility nationwide in 2014. The law allows for waivers, but no state has yet been given one.

Exchange — The state would no longer be required to have a health care exchange, a government-run marketplace to shop for private insurance and apply for subsidies. States can set up their own exchanges by 2014, or let the federal government do it, according to the law. Efforts to create a state-run exchange stalled in the Maine Legislature this month.

Children coverage — Insurance companies would no longer be required to cover policyholders’ children until they are 26 years old. As of last June, 7,329 young adults in Maine were able to get insurance coverage because of the rule, according to the U.S. Department of Health and Human Services. Maine law requires coverage up until age 25 under certain conditions.

Prescriptions — Seniors would no longer get rebates or discounts to help pay for prescription drugs when they enter a Medicare coverage gap called the doughnut hole. In 2011, 11,892 Mainers saved an average of $530 in discounts – $6.3 million in all, according to the federal DHHS.

Preventive care — Seniors on Medicare would no longer get free preventive care – such as an annual wellness visit, mammograms and colonoscopies. About 226,000 Mainers have received preventive care without copays or deductibles.

Lifetime caps — In much of the country, insurance companies would once again be allowed to cut off seriously ill policyholders who exceed a lifetime cap on claims. In Maine, however, state law prohibits lifetime caps.

Pre-existing conditions — In much of the country, people with pre-existing health conditions could again be locked out of getting coverage. In Maine, state law already require insurers to cover such patients, although there are waiting periods before the coverage take effect. As of December, 30 Mainers qualified for coverage through a pre-existing insurance plan created by the law.


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