By Ramona du Houx
Since the Affordable Care Act (ACA) of 2010 thousands of Mainers have gained coverage, and hundreds of thousands more have had their coverage substantially improved.
On January 16, 2017 the U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years.
The data show that the uninsured rate in Maine has fallen by 17 percent since the ACA was enacted, translating into 22,000 Mainers gaining coverage, some transfered to the ACA from the established state program, Dirigo Health Care.
Photo: President Barack Obama came to Maine after the ACA was enacted and praised Governor John Baldacci for his work on the creation of the Dirigo Health Care Act. Photo by Ramona du Houx
“As our nation debates changes to the health care system, it’s important to take stock of where we are today compared to where we were before the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Whether Mainers get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.”
Photo: Governor John Baldacci with Robin Mills talking about Dirigo Choice in 2007. Photo by Ramona du Houx
Maine was an unusual case, because the state had enacted the Dirigo Health Care Act during the Baldacci administration, and many of the ACA benefits were already apart of Dirigo. Because of Dirigo it was easier to transfer over to the ACA.
Governor John Baldacci deserves recognition for creating a model for the ACA. Other portions of Dirigo were dismantled by Gov. Paul LePage, who succeeded Baldacci. Never-the-less Baldacci's Dirigo saved thousands of lives by giving people health insurance for the first time, by expanding preventative care, covering more young adults, by eliminating the pre-existing condition and discrimination against women in health coverage.
Dirigo Choice, the insurance branch of Dirigo Health, insured more than 40,000 Mainers and also became a model for President Obama’s ACA. In 2010 Monique Kenyon said, "We were shocked,” when she found out her husband was suffering from cancer. “Being a middle-income family we didn’t qualify for any assistance. We couldn’t afford all the treatment without insurance, but insurance companies wouldn’t accept him because he has this preexisting condition. He’s still with us because of Dirigo Choice.”
Signed into law in the 2003 Dirigo Health Care Reform Act was a bold step toward universal health coverage during a time when policymakers in Washington D.C. and in state houses struggled to take even small steps. A few years later Governor Romney of Massachusetts used elements of Dirigo in his health care policies.
“In many ways, Dirigo was a pace-setter and blueprint to national reform,” said Trish Riley, former director of Maine Governor John Baldacci’s Office of Health Policy and Finance. Riley said the program saved many lives by helping thousands of uninsured gain access to medical care and enabling more than 1,000 small businesses to provide insurance for their owners and employees.
Baldacci expanded Medicare, covering many more Mainers, but LePage has refused to accept this part of the ACA, so thousands who were on, what the state calls MaineCare were kicked off because of LePage - too many have died.
In 2003, Maine ranked 16th healthiest among the states; in 2010 Maine was in the top ten. In 2003, Maine ranked 19th among the states in covering the uninsured; in 2010 Maine was sixth. With Dirigo Health, Maine created an efficient public health system with eight districts that cover the entire state through Healthy Maine Partnerships. During the Baldacci administration the state reached a milestone in healthcare coverage, won awards for Dirigo and became a model for the nation. (photo below taken in 2010)
The ACA picked up the torch and contained to save the lives and livelihoods of thousands of people in Maine.
Highlights of theACA data include:
Employer Coverage: 702,000 people in Maine are covered through employer-sponsored health plans.
Since the ACA this group has seen:
An end to annual and lifetime limits: Before the ACA, 431,000 Mainers with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all Mainers with employer plans now have coverage that’s there when they need it.
Young adults covered until age 26: An estimated 8,000 young adults in Maine have benefited from the ACA provision that allows kids to stay on their parents’ health insurance up to age 26.
Free preventive care: Under the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers. This provision benefits 588,281 people in Maine, most of whom have employer coverage.
Slower premium growth: Nationally, average family premiums for employer coverage grew 5 percent per year 2010-2016, compared with 8 percent over the previous decade. Family premiums are $3,600 lower today than if growth had matched the pre-ACA decade.
Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. Mainers with employer coverage have received $2,507,067 in insurance refunds since 2012.
Medicaid: 273,160 people in Maine are covered by Medicaid or the Children’s Health Insurance Program, including 115,217 children and 52,077 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.
40,000 Mainers could gain coverage: An estimated 40,000 Mainers could have health insurance today if Maine expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health; expansion would result in an estimated 5,000 more Mainers getting all needed care, 5,700 fewer Mainers struggling to pay medical bills, and 50 avoided deaths each year.
Thousands of Mainers with a mental illness or substance use disorder could get help: Nearly 30 percent of those who could gain coverage if more states expanded Medicaid have a mental illness or substance use disorder.
Maine could be saving millions in uncompensated care costs: Instead of spending $40 million on uncompensated care, which increases costs for everyone, Maine could be getting $430 million in federal support to provide low-income adults with much needed care.
Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable Mainers could more easily access and maintain coverage.
Maine is improving health care for individuals with chronic conditions, including those with severe mental illness: The ACA established a new Medicaid flexibility that allows states to create health homes, a new care delivery model to improve care coordination and lower costs for individuals with chronic conditions, such as severe mental illness, Hepatitis C, diabetes and heart disease
Individual market: 75,240 people in Maine have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:
No discrimination based on pre-existing conditions: Up to 590,266 people in Maine have a pre-existing health condition. Before the ACA, these Mainers could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.
Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 63,896 moderate- and middle-income Mainers receive tax credits averaging $342 per month to help them get covered through HealthCare.gov.
Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of Maine.
Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, Maine has received $5 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 25 plans on average.
Medicare: 315,160 people in Maine are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade.
Medicare enrollees have benefited from:
Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 18,970 Maine seniors are saving $19 million on drugs in 2015, an average of $986 per beneficiary.
Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 165,892 Maine seniors, or 71 percent of all Maine seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for Maine Medicare beneficiaries dropped 4 percent between 2010 and 2015, which translates into 232 times Maine Medicare beneficiaries avoided an unnecessary return to the hospital in 2015.
More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 6 Accountable Care Organizations (ACOs) in Maine now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.
ACA Content created by Assistant Secretary for Public Affairs (ASPA)