The Mills administration unveiled a health care bill Wednesday that would make more primary care and behavioral health visits free to patients covered by Affordable Care Act insurance.
The free visits would be part of a series of changes to health care under The Made for Maine Health Care Act, which would add new regulations for insurers and expand a reinsurance program that has so far helped reduce premium costs in Maine. The bill also would create a state-based exchange for the ACA that the Mills administration had announced last summer.
The bill’s rollout highlighted the first day of the 2020 Maine legislative session, which is expected to delve into a wide array of issues, such as broadband access, education, corrections, funding for county jails, transportation and clean energy.
The bill would affect more than 120,000 Mainers who have individual or small group insurance through the ACA.
The small-group and individual markets both have about 60,000 enrollees, so merging the two would effectively double the insurance pool, and potentially reduce health care costs by spreading them out among more people.
Top Democrats, including Gov. Janet Mills, House Speaker Sara Gideon and Senate President Troy Jackson, were on hand for the bill’s unveiling at the State House.
Mills said that reducing or eliminating charges for some doctor or therapy visits will encourage people to take care of their health issues before they become acute. Some people may avoid a primary care or therapy visit because of the cost, even if they have insurance.
“We want to get people in the door, to get access to health care coverage and not wait to the point they need urgent care,” Mills said.
The bill would not raise premiums or increase health care costs because patients would be accessing less expensive preventive and primary care, she said. Under the proposal, the first primary care and behavioral health visit would be free for individual and small-group policy holders. The second and third visits would have co-pays but would not dip into patients’ annual deductibles, limiting the amount a patient would pay for the first three visits.
Mitchell Stein, a Maine-based independent health policy analyst, said the impact of the bill on health care costs is unclear, but it may result in increased premiums.
“Generally, when you mandate a new benefit, premiums will go up,” Stein said. The bill also would standardize plans to make it easier to compare, requiring plans to have the same deductible, out-of-pocket limit and co-pays for “a set of commonly-used services.” Stein said standardizing plans to make it easier for consumers to compare plans has merit.
Similar reforms have been enacted in California, New York, Massachusetts, Connecticut, Oregon, Vermont, Washington and the District of Columbia.
Mills said she believes the bill would attract bipartisan support, although no Republican lawmakers were present for the rollout.
Tom Desjardin, a spokesman for Maine Senate Republicans, said that office received a copy of the bill on Wednesday and will refrain from commenting on it until senators can examine the bill. Democrats hold majorities in the House and Senate.
House Speaker Gideon said the bill will help prevent the rationing of medicine.
“Not a single Mainer should be rationing their medication or avoiding a trip to the doctor because they aren’t sure what it will end up costing,” Gideon said in a statement.
Mills said another goal of the bill is to reduce costs to patients and small-business owners by improving the small-group marketplace.
The Made for Maine Health Coverage Act would combine the small-group and individual markets, which could help keep health care costs in check by creating a larger pool of patients, spreading cost among more people.
Small-group insurance for small businesses is ACA insurance sold outside the online marketplace and, unlike individual ACA plans, is not subsidized by the federal government. That makes the insurance more costly for enrollees and businesses, and as health care costs have increased, usage of the small-group market has declined from 83,590 in 2013 to 59,980 in 2018.
David Clough, Maine state director of the National Federation of Independent Business, which represents small businesses, said he appreciates the focus on the cost of health insurance for small-business owners, but won’t take a position on the bill until the NFIB can study it more.
“The legislation the governor is advocating represents a pragmatic approach instead of radical reforms contained in some state legislation being considered this year,” Clough said.
A reinsurance program – the Maine guaranteed Access Reinsurance Association – that has been credited with reducing costs in Maine would cover the merged market. Fees for the reinsurance program, which currently generates $22.6 million from Maine health care plans and $62.3 million from the federal government, would remain the same.
Eric Cioppa, Maine insurance superintendent, said the larger patient pool should reduce costs for enrollees even though fees would be the same because a larger pool is better at spreading out the risk.
Stein, the policy analyst, said he questions whether that will turn out to be true, especially without raising fees. Other states have decided it’s not worth doing because even though the size of the insurance pool grows, those with individual insurance on average tend to be older and sicker than those with small-group insurance. So it’s questionable whether that’s a benefit to the small-group market, Stein said.
The reinsurance changes would need a federal waiver to go into effect, even if the bill is signed into law. The mandatory free primary care and therapy visits do not need a waiver and could go into effect immediately.
If the bill is approved, the state would move to a state-run ACA marketplace. Enrollees would still use www.healthcare.gov to sign up, but outreach and marketing would be run by the state instead of the federal government.
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