Lawmakers will hear testimony Tuesday on one of the Mills administration’s top legislative priorities – protecting Mainers from a full or partial repeal of the Affordable Care Act by passing a bill to require insurers to continue offering several of the most consumer-friendly parts of the health care law.

The ACA protection bill sponsored by Senate President Troy Jackson, D-Allagash, and House Speaker Sara Gideon, D-Freeport, with support from Gov. Janet Mills, would cement into state law the ACA’s essential health benefits, such as mental health and substance use treatment, maternity, prescription drugs, preventive and pediatric services.

The law would maintain the ACA’s pre-existing condition protections, and also prohibit insurers from establishing lifetime or annual caps on how much they would pay on a patient’s medical bills. Before the ACA, insurance that had such caps on payouts would cause medical bankruptcies for patients with serious, long-term illnesses, such as cancer.

President Trump’s goal is to dismantle the ACA, although congressional efforts to repeal it fell short after a few key Republican senators, including Susan Collins of Maine, took a stand against the president in 2017.

With a new Democratic majority in the U.S. House of Representatives, legislative repeal is off the table for at least the next two years. However, the ACA is still threatened, after a federal judge in Texas ruled in December that the law was unconstitutional. While the decision was stayed pending an appeal – and some legal scholars doubt that the judge’s ruling will stand – a few states are taking steps to protect the ACA.

“In the event the Texas ruling stands, we want to make sure the health care protections that people have access to today continues,” Jackson said Monday.

About 75,000 Mainers have individual coverage through the ACA, and an additional 70,000 will qualify for Medicaid expansion under the law.

Kevin Lewis, president and CEO of Community Health Options, a Maine-based cooperative and ACA insurer, said what’s potentially missing in the bill is an individual mandate, which charges a penalty to people for not having health insurance. The federal individual mandate was originally included in the ACA, but it was removed as part of the 2017 tax cut bill.

Some states, including New Jersey, Massachusetts and Vermont, have an individual mandate, while other states, including Connecticut and Maryland, are considering one.

The mandate helps control costs by providing a financial incentive for younger and healthier people to purchase insurance. When a higher percentage of young, healthy people are in the insurance pool, that helps keep costs down.

“The bill has great intentions, to provide coverage that is rich with meaningful benefits,” Lewis said. “But I’m also mindful of affordability challenges.”

Insurance experts have said that part of the reason ACA enrollment has remained relatively strong despite the individual mandate going away is the emergence of zero-premium bronze plans. The zero-premium plans became more widely available in 2017 as an unintended consequence of Trump’s unsuccessful executive actions that attempted to sabotage the ACA marketplace.

Jackson said the individual mandate was not part of the bill because lawmakers wanted to introduce a bill that mimicked existing ACA law, which does not have the individual mandate. He said a separate bill could introduce an individual mandate if lawmakers wanted to bring it up.

Lewis pointed out that if the courts invalidate the ACA, premium subsidies which help most enrollees afford coverage would likely be eliminated. States would have no control over the subsidies disappearing, and health care costs would increase for enrollees.

Meanwhile, Jackson also is proposing a bill that would regulate short-term health plans. The Trump administration loosened federal regulations on short-term plans by making them available for up to 364 days as a way to undermine the ACA marketplace and encourage younger, healthier people to purchase the short-term plans. The short-term plans are not required to contain the same consumer protections as the ACA’s marketplace plans.

Jackson’s bill would prohibit the short-term plans from lasting more than three months, and would mandate transparency in what they do and don’t cover.

“We don’t want to have any junk health care plans being sold in Maine,” Jackson said. “You might as well not have any insurance if the plans don’t cover anything.”

Joe Lawlor can be contacted at 791-6376 or at:

[email protected]

Twitter: joelawlorph


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