By J.W. Oliver
A panel of experts explained the health insurance options available under the new federal health care law at Skidompha Public Library in Damariscotta Oct. 29.
The new law, the Affordable Care Act, requires almost everybody to have health insurance by Jan. 1, 2014.
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The health insurance marketplace at http://www.healthcare.gov “provides a way to compare and review choices in a consumer-friendly format,” Mitchell Stein said. Stein is the policy director for Consumers for Affordable Health Care.
The marketplace compares health insurance plans in “apples to apples fashion” with an easy-to-understand “metals” system that rates plans as platinum, gold, silver and bronze, Stein said.
The new law offers discounts on health insurance for people who earn 100-400 percent of the federal poverty level, a wide range of incomes from $11,490 for an individual at 100 percent to $94,200 for a family of four at 400 percent.
Early problems with the online marketplace website continue to cause delays for many shoppers, but the marketplace is also accessible by mail or phone. There is a separate marketplace for small businesses, the Small Business Health Options Program or SHOP.
Anyone who already has health insurance, whether through an employer or a public program like Medicare or MaineCare, does not need to purchase new health insurance.
Anyone who fails to buy health insurance will pay a fine of $95 or 1 percent of income, whichever is more, in 2014. The penalty increases to $325 or 2 percent and $695 or 2.5 percent in subsequent years.
The law exempts anyone who cannot afford health insurance because it would cost more than 8 percent of his or her income, and anyone whose income is less than 138 percent of the federal poverty level if the individual does not qualify for MaineCare.
The Affordable Care Act would provide money for Maine to expand eligibility for MaineCare to 138 percent of the federal poverty level.
The federal government would pay 100 percent of the cost from 2014-2016, 95 percent in 2017, 94 in 2018, 93 in 2019 and 90 in 2020.
A ruling by the Supreme Court of the United States, however, allows states to decide whether to expand eligibility for the programs.
The Maine Legislature has passed two bills to expand eligibility, but Gov. Paul LePage has vetoed both, said Sara Gagne-Holmes, executive director of Maine Equal Justice Partners.
The change in eligibility would raise the maximum income for MaineCare recipients to $15,856 for an individual or $26,951 for a family of three. A person who works a full-time, minimum-wage job in Maine for a year would earn $15,600.
Thus, expanding MaineCare would help residents who cannot afford health insurance “despite working full-time or multiple jobs,” Gagne-Holmes said.
The change would cover up to 69,500 low-income people, create 3100 jobs and stimulate more than $350 million in economic activity within the state, she said.
Here in Lincoln County, it would cover 2425 people and create or retain 124 jobs.
Expanding MaineCare would also slow down the rise of health insurance costs for employers and people who purchase health insurance, Gagne-Holmes said.
More low-income people with health insurance means less bad debt and charity care at hospitals, a cost hospitals pass on to people with private health insurance.
It would also provide low-income people with more access to their doctor and more preventive care, which can often reduce the need for expensive emergency care.
The forum did not address the vigorous nationwide debate of the merits of the Affordable Care Act.
“There are probably as many opinions about this law as there are people in this room, and probably people in the state of Maine,” Stein said in his introduction. “We’re here tonight to give you the information you need to deal with the situation as it exists.”
Mitchell and Stein, along with a panel including representatives from Lincoln County Healthcare and the Maine Lobstermen’s Association, fielded questions from the small but curious crowd after their presentation.
For more information about the Health Care Marketplace or to shop for health insurance, visit http://www.healthcare.gov. For information by phone, call 800-318-2596 24 hours a day, seven days a week.
For free, local assistance from someone who can answer questions and help navigate the marketplace, call 211 or visit http://www.enroll207.com.
According to Stein, there are already reports of fraud around the new law. An example involves phone calls from scammers who say the target needs to pay $200 to receive an “Obamacare card,” which does not exist.
“No one from the government will ever call you and ask you for personal information,” Stein said. He encourages people to ask possible scammers to identify themselves and provide contact information. “If the person refuses, end the interaction,” he said.
Anyone targeted by an insurance-related scam should contact the Maine Bureau of Insurance. For more information, visit http://www.maine.gov/pfr/insurance.
