Maine was one of 26 states to take the Obama Administation’s health care reform law all the way to the Supreme Court.

However, Mainers are just as passionately divided about the Affordable Care Act as other Americans.

As news of the historic decision swept through the state Thursday, it brought joy and relief to some and frustration and disgust to others.

“This is a massive overreach by the federal government and is infringing upon the individual choices that we, as Americans, have in pursuing our own American Dream,” said Gov. Paul Lepage, who had promised to try to overturn the law since before he was elected.

“This decision erodes the freedoms which made the United States the greatest country on Earth. It is a sad day, and it is now up to the American people to demand full repeal of Obamacare. The Washington, D.C., elites cannot and should not run our lives.”

U.S. Rep. Chellie Pingree, D-1st District, voted for the law in 2010 and praised the ruling.

“The Court made the right decision in preserving the basic consumer protections in the health care reform law — like letting young people stay on their parents’ policies or preventing insurance companies from cancelling your coverage when you get sick. The court did the right thing by ruling in favor of consumers instead of siding with the big insurance companies.”

Virtually every Maine employer, worker, hospital, doctor, patient, parent and child will be affected in some way by Thursday’s ruling.

Parents learned that their children could stay on their health insurance plans until they turn 26.

Employers learned they will have to provide health insurance to their workers or pay penalties.

Those without insurance learned they will soon get coverage so they can go to the doctor, even if it means they will have to buy the insurance for themselves at costs that are not yet clear. The elderly and women will get 100 percent coverage for expanded preventive care.

The political fallout for Maine’s Legislature surfaced almost immediately, as Democrats and Republicans traded arguments about what the ruling means and whether the state can move forward with plans to end MaineCare coverage for 27,000 citizens.

For the candidates in the middle of campaigns for Congress, meanwhile, the ruling became rallying point for supporters who want the law repealed, and for those who want to make sure it survives that test, too.

Technically, Maine lost the case when the court issued its ruling Thursday. In reality, however, that depends on who you ask.

Uninsured

Rachel Sukeforth, of Litchfield, is one of about 125,000 Mainers — 10 percent of the state’s population — without health insurance.

In 2014, under the Affordable Care Act, the number will drop almost to zero.

Some uninsured Mainers could be added to MaineCare because of expanded eligibility rules. Some could be added to employers’ coverage plans because more businesses will be required to provide them. Many will be required to buy their own private insurance through a new government-run exchange that will provide subsidies for people who qualify.

Sukeforth, for one, is looking forward to being insured again.

Sukeforth works as a laboratory assistant for a small business that does not offer insurance coverage. She can’t afford hundreds of dollars a month for private insurance now, but is hopeful that universal coverage will bring costs down.

“I was a little worried that they were going to strike it down,” she said. “I’m 27. My generation is struggling to find jobs and starting families and the fact that we’re going to have access to affordable insurance, hopefully this will make things easier for us.”

Ethan Francine, of Topsham, on the other hand, was disappointed Thursday.

The 25-year-old college student is on his parents’ plan, but he may be uninsured soon. He had hoped the law would be struck down, because he doesn’t want to be forced to buy health insurance.

“It seems like it’s taking away from freedom and the American way of life,” he said.

Bringing coverage to the uninsured is the basic goal of the law and perhaps the most important way it could ultimately reduce the cost of insurance, advocates say.

That’s because the uninsured tend to avoid doctors and preventive care, waiting until they are so sick they have to go to the emergency room for expensive acute care.

Much of the cost of emergency room care is paid for by everyone else through higher medical fees and higher insurance premiums. Maine’s medical community estimates the cost of caring for the uninsured adds as much as 30 percent to the cost of health care in the state.

Small business

The Supreme Court’s decision to uphold the Affordable Care Act drew mixed reaction from Maine’s business community, but business owners said they were glad to have the law’s legal status resolved.

The law requires businesses with 50 or more full-time equivalent employees to provide health insurance for all workers by 2014 or face penalties. Businesses with fewer than 50 employees — which includes more than 97 percent of all businesses in Maine — are exempt. Small businesses can shop for less expensive health insurance on state exchanges .

“Nothing really has changed. What was the law yesterday is the law today,” said Peter Gore, vice president for advocacy and government relations for the Maine Chamber of Commerce. “A lot of employers went into a holding pattern, waiting for what the court would do. Employers will now begin to see how the law will affect them and can make choices.”

In Maine, 47 percent of residents get their health care coverage through their employers, just below the national rate of 49 percent, according to the Kaiser Family Foundation.

“A lot of what you are going to hear is that it’s business as usual. It doesn’t put in perspective the economic challenges on how they’re going to comply — whether they’re a large business or small business,” Gore said. “We’re a state of small businesses. For Maine, this has particular challenges.”

About 29,400 businesses in Maine have 49 or fewer employees, according to the state Department of Labor.

“If a business is threatened by extinction by this, there will be a backlash,” said Dick Grotton, president and chief executive of the Maine Restaurant Association. “There are some people who will say, ‘I have 49 employees and I’m never going to hire again.’ That’s an emotional reaction. We need to wait another year and a half to see how this all pans out.”

Grotton said the average restaurant employs about 40 to 45 employees, but a restauranteur who owns more than one establishment would qualify as a larger business and be required to provide health care coverage for all workers.

“This presents burdens and challenges for all small businesses, especially the mandate for larger small businesses to provide health care,” said David Clough, director of the Maine chapter of the National Federation of Independent Business. “We’ve been trying to recover jobs since the worst recession since the 1930s. The new requirements could slow down job recovery and stunt growth.”

Senate race

Mainers probably haven’t heard the end of the political posturing about the controversial health care law.

Candidates for Maine’s U.S. Senate and two U.S. House seats are likely to continue debating the perceived merits and pitfalls of the controversial law. Also, whoever represents Maine in Congress next year might vote on attempts to repeal the law, depending on which party controls the White House and the two chambers after the November election.

As with Maine’s sitting representatives and senators, candidates’ reactions to the court ruling fell along partisan lines.

Secretary of State Charlie Summers, Senate President Kevin Raye and Sen. Jonathan Courtney — all Republicans — said they were disappointed with the ruling. Summers is running for retiring Olympia Snowe’s U.S. Senate seat, Raye is challenging U.S. Rep. Mike Michaud in Maine’s 2nd District, and Courtney, a state senator from Springvale, is running against Chellie Pingree in the 1st District.

“Today’s Supreme Court decision makes this Senate race more critical than ever,” Summers said in a statement. “The Court’s ruling makes it clear that the president’s plan amounts to a massive tax increase. Maine people need a senator who will provide a voice for businesses and families as we address this critical issue.”

Raye called on Congress to work on bipartisan reforms that would allow individuals to purchase health insurance across state lines and enable small businesses to pool together to buy insurance at lower rates, among others.

Courtney said he was confident it would be a campaign issue and said he planned to ask “people on Main Street” for their ideas on ways to move forward with health care reform.

“I think you have to repeal it and start over … and do it in a bipartisan way,” Courtney said.

Sen. Cynthia Dill, the Cape Elizabeth Democrat seeking Snowe’s seat, said the Affordable Care Act already is lowering prescription and health care costs for seniors and prohibiting insurance companies from denying coverage due pre-existing conditions. However, Dill said other reforms are needed and repeated her calls for a so-called “single-payer” health care system.

“I also believe we should go further in ensuring that Americans don’t have to choose between health care and bankruptcy, though better cost controls, increased reliance on preventive care, decreased reliance on fee-for-service models, and, ultimately, a universal single-payer system,” Dill said.


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