I have yet to meet anyone who considers a monthly health insurance premium of $967 to be affordable. Never mind that buys you a plan with a $6,000 annual deductible plus another $1,150 in coinsurance until you hit your policy’s $7,150 annual out-of-pocket maximum.

That is the cheapest available Affordable Care Act marketplace plan this year if you have to buy your own insurance and are a 61-year-old living in Aroostook or another of Maine’s rural counties subject to the highest rates under a discriminatory pricing system — unique to the individual market — that can charge you more based on age and residence.

ACA subsidies only go to those earning less than 400 percent of the federal poverty level. This year, the subsidy cap for households of one (nearly 30 percent of Maine households) is $47,550 in pre-tax income, which is less than what the average Maine public school teacher earns.

Without a subsidy, if the 61-year-old in my example required health care this year, her $18,754 combined premium and out-of-pocket costs would consume 39 percent of her pre-tax income.

In short, health insurance is not now and has never been remotely affordable for some middle-class (not rich) people under the ACA, which ACA supporters choose to ignore while decrying Republican plans for, you guessed it, making health insurance unaffordable. The hypocrisy is breathtaking.

This is not new. Health insurance has become increasingly unaffordable for decades, and the same tired arguments and non-solutions offered and implemented by both major parties have not fixed the problem, nor will they so long as we persist in clinging to our insanely structured health care system. Arguing about which version of a fundamentally flawed system will harm more people rather than committing to the starting premise that all must be equitably covered makes a mockery of one nation, indivisible, with liberty and justice for all.


The uninsured and ever-increasing numbers of underinsured people remain unconscionably at risk for premature death and/or medical bankruptcy while we continue to spend more than enough on health care in Maine and nationally to equitably and comprehensively cover everyone. Sadly, like so much of what ails this great nation, our health care system puts profits and political calculus before public welfare.

Demonstrating that he is capable of recognizing facts, President Donald Trump recently noted that the Australian health care system is better than ours. The Aussies figured out what the very Republican state of Utah has to say about its self-funded public sector employee health plan: “Self-funding is the choice of most large employers … The profit margin and risk charge of an insurance carrier are eliminated through self-funding … Self-funded plans have lower overhead and administrative costs than fully insured plans. [Our] administrative costs average about 5 percent of premium, whereas the largest insurance carriers in Utah average about 15 percent. This is a significant savings, especially over time.”

Maine’s largest employers, such as Bath Iron Works, Hannaford and L.L. Bean, have also figured this out and are micro single-payer systems, as is Medicare, our country’s largest and most popular single-payer health plan. We could expand this concept and cover all Maine people under one efficiently administered, statewide health plan using Maine’s self-funded state employee health plan as a platform.

As health care currently consumes more than a fifth of Maine’s economy, we desperately need the savings to be realized by an efficient system. A statewide single-payer plan would save lives and improve public health. It would provide significant property tax relief by freeing municipalities from the expense of teacher and municipal employee health insurance. Workers’ compensation and auto insurance premiums should plunge absent the need for medical expense coverage. A statewide, publicly funded plan would also be the single best thing we could do for Maine business, which has for years been strangled by the ever-increasing cost of health insurance.

I propose that employers be freed from any responsibility for providing health insurance to their employees in return for turning over to their employees as increased wages what they had been contributing to the cost of premiums. While employers would pay more payroll taxes on the front end, the savings realized over time would more than offset that initial expense. Employees would then have higher earnings from which to start contributing their fair share of the cost for coverage under the statewide plan. Those of us long accustomed to paying too much for lousy coverage would welcome the opportunity to pay the same or less for something better. We demand fairness.

Alice Knapp was the first director of the Consumer Healthcare Division at the Maine Bureau of Insurance, a former board member of Consumers For Affordable Healthcare, and a founding member of Maine AllCare. She lives in Richmond.

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