Augusta, MAINE – Governor Janet Mills, Senate President Troy Jackson, and Speaker of the House Sara Gideon today announced legislation to improve private health insurance for Maine people and small businesses. LD 2007, The Made for Maine Health Coverage Act, would make some of the most common medical visits free or less costly, simplify shopping for a plan, leverage federal funds to help make premiums more affordable for small businesses, and put Maine in the driver’s seat to ensure that all Maine people have clear choices for their coverage.
The bill takes a targeted approach to improving private health insurance without the need for any appropriation of state dollars. The legislation was introduced by House Speaker Sara Gideon and Senate President Troy Jackson on the Governor’s behalf.
“Over the past year, more than 57,000 Maine people have been able to access life-saving health care through Medicaid expansion, and, with the Legislature, my Administration has strengthened critical health protections for Maine people through LD 1. Both are significant steps forward. Now, my Administration, with the help of Senate President Jackson and Speaker Gideon, is taking the next step to improve health insurance for Maine people and small businesses,” said Governor Janet Mills. “The Made for Maine Health Coverage Act sets Maine-specific deductibles and copays, offers a Maine solution for small businesses, and creates a Marketplace designed to best meet the needs of Maine people. I look forward to working with the Legislature to continue to tackle health care, a critical issue for our state and our people.”
“Access to health care is about freedom. It’s something I’ve said over and over again because it’s true, and I know what that means for working people. It means the difference between going to the doctor when you’re sick and putting your health – potentially your life – at risk,” said President Jackson. “Last year, we passed a number of important bills to make health care more affordable and accessible. But our work isn’t over; too many barriers still remain. When we said that we would do everything in our power to make health care more affordable and accessible, we meant it. With this bill, we begin to take the marketplace out of the hands of folks in Washington D.C. and put Maine people in charge. I’m proud to be a co-sponsor and will fight to see it become law.”
“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 – every single one of us deserves access to quality, affordable health care. With ongoing uncertainty at the federal level, it’s critical that we craft lasting state policies that ensure stability and predictability for consumers here in Maine,” said Speaker Sara Gideon. “This legislation will help control out-of-pocket costs, bring stability to the volatile small business marketplace, and make shopping for health insurance simpler and easier. This session we must address these urgent matters, and I look forward to continuing our partnership with Governor Mills to ensure prescription drugs are affordable, healthcare – including reproductive care – is accessible, and opioid recovery services are available throughout the state.”
“Health insurance too often remains unaffordable and confusing, with premiums, out-of-pocket costs and deductibles still out of reach for many. This bill keeps the momentum going to drive down Maine’s uninsured rate and improve coverage for our state,” said Maine Department of Health and Human Services (DHHS) Commissioner Jeanne Lambrew.
“LD 2007 will apply the same successful reinsurance model to the small group market that has been used to stabilize Maine’s individual market since January 2019,” said Maine Insurance Superintendent Eric Cioppa. “Thanks to the existing reinsurance program, individuals are paying less on health insurance premiums than they would have otherwise; we anticipate the same will be true for small businesses, if the Governor’s proposed bill is enacted.”
The bill uses a three-pronged approach to improve private health insurance in two markets: the individual market, which serves people who buy their own insurance instead of getting coverage through work or publicly funded programs, and the small group market, which serves small businesses.
This proposal would help by:
1. Providing consumers in the individual and small group markets with relief from high out-of-pocket costs and making it easier to compare plans:
- This bill requires health plans to cover the first primary care visit and behavioral health visit each year for free – with no deductible and no out-of-pocket costs, making some of the most common health care visits less costly. Additionally, under the bill, the second and third primary care and behavioral health visits could have a co-pay but the deductibles would not apply.
- With high deductibles and confusing and hidden costs too often causing Mainers to forgo health care and coverage, this bill makes it easier for consumers to understand their options by having health plans offer the same deductible, copays, and out-of-pocket limits for a set of commonly-used services. By standardizing upfront costs into “clear choice designs”, the bill makes it easier for Maine people to understand and compare plans and encourages insurance companies to compete on premiums and quality. These simplified, standardized designs would be developed in consultation with patients and providers among others, and insurers could offer a different design if it better helps patients.
2. Pooling insurance plans and premiums for individuals and small businesses and improving stability and affordability:
Maine’s small group market has faced increasing monthly premiums and decreasing enrollment, making it difficult for many small businesses to offer coverage to their employees. Meanwhile, Maine people are spending less on premiums in the individual market than they otherwise would have as a result of Maine’s reinsurance program (Maine Guaranteed Access Reinsurance Association or MGARA). The program pays for part of the cost of the most expensive bills, lowering and stabilizing health insurance premiums.
- The bill merges the small group and individual markets in Maine, creating a combined, larger and, as a result, more stable pool of enrollees to help prevent unpredictable premium increases. Insurers will then be able to determine premiums based on this larger pool and offer the same plans to both individuals and small businesses, thereby helping small businesses to get a handle on health care costs.
- The bill extends reinsurance for the first time to small businesses to lower their premiums, funded by the federal government and current fees in MGARA. To ensure taxpayer dollars are well spent and give insurance companies leverage to negotiate prices with health providers, the proposal would by limit the amount the program pays for reinsurance for certain high-priced services to no more than twice what Medicare pays for certain high-priced services.
These two elements (a merged market and changes to reinsurance) would require approval from the Federal government through a State Innovation Waiver (also known as a 1332 Waiver). Maine would be the first in the nation to apply to the Federal government for a 1332 Waiver of this kind to improve small business insurance coverage. This provision would go into effect only if Maine and the federal government agree that the proposal will stabilize and reduce small businesses’ monthly premiums.
3. Tailoring coverage education and enrollment efforts to Maine:
Following up on her commitment to pursue a State-based Marketplace, this third approach will move Maine towards a State-based Marketplace, allowing Maine to capture funding currently going to Washington, D.C. and use those dollars to promote enrollment and customize outreach to fit Maine’s needs. It also can improve the consumer experience by extending the annual open enrollment period so people have more time to sign up for coverage.
- Starting in the fall of 2020, Maine would run a State-based Marketplace using the federal website, HealthCare.gov, and related services. Maine would conduct its own education, in-person consumer assistance, and outreach on coverage.
- Maine would transition from HealthCare.gov to a fully state-run system – operating our own website and call center – if an evaluation of benefits and feasibility of doing so shows that this is the best path forward for Maine people.
- Funding for the Marketplace would come from existing user fees on insurance companies, no higher than what the insurance companies pay now.
This new legislative action by Governor Mills, Senate President Troy Jackson, and House Speaker Sara Gideon comes after the three teamed up last year to spearhead into law LD 1, which codified into State law critical Affordable Care Act protections in the state’s regulated markets, such as guaranteed coverage for pre-existing conditions, a ban on lifetime and annual caps on coverage and allowing young adults up to age 26 to remain on their parents’ insurance, as well as coverage for essential health services such as ambulance services, prescription drugs, and pediatric care. These protections – and more – are at risk in the courts where the Trump Administration refuses to defend the law in the case of Texas versus U.S.
It also builds on their work last year to enact the peoples’ will and expand Medicaid, which has enabled more than 57,000 Maine people to access life-saving health care.