State lawmakers learn about evolving health reform

Posted May 20, 2010, at 10:25 p.m.

AUGUSTA — Plunging into a complex review of private insurance regulation, Medicaid provisions, tax incentives, Dirigo Health, insurance exchanges, individual mandates, electronic medical records and other existing and emerging elements of the health care landscape, state lawmakers on Thursday started down the long road of implementing national health reform initiatives in Maine.

The process promises to be complicated, time-consuming and, at times, contentious.

“This is going to be quite a ride for you,” said Joy Johnson Wilson of the National Conference of State Legislatures, speaking to the 17-member Joint Select Committee on Health Care Reform Opportunities at the group’s first meeting in the Taxation Committee Room at the State House.

Johnson was the first of several presenters in an inaugural daylong session aimed at helping committee members understand the many interwoven provisions of the new Patient Protection and Affordable Care Act. Johnson stressed that while the legislation is now the law of the land, many of its details, rules and regulations will continue to evolve in the months ahead.

In addition, Johnson said, each state will adapt the law to integrate with existing programs and policies.

“This is generic legislation that cannot affect all states in the same way,” she said.

The committee is expected to hold several meetings over the next six months. It then will recommend to lawmakers legislation to implement changes.

The five state senators and 12 state representatives chosen to serve on the bipartisan panel include lawmakers from the Appropriations and Financial Affairs Committee, the Insurance and Financial Services Committee and the Health and Human Services Committee.

In her introductory remarks, co-chairwoman Rep. Sharon Anglin Treat, D-Hallowell, said the committee members must work together to ensure the efficient and accountable rollout of new programs, preserve elements of Maine’s health care sector that are working well and serve as an unbiased source of accurate information about the confusing federal reform.

Johnson spent much of her hourlong talk discussing impending changes to MaineCare, the state’s Medicaid program. The national reform requires states to expand and revise their Medicaid programs, making coverage available to all residents with incomes at or below 133 percent of the federal poverty limit.

That means opening Medicaid, which traditionally covers only children and the disabled, to a much broader population of low-income adults. It is not yet known how many people in Maine will become eligible when the expansion takes effect in 2014.

The new law requires the federal government to pay for the cost of expanding Medicare rolls for three years before reverting to the existing arrangement of shared state and federal reimbursements for the newly eligible enrollees.

But the federal funding won’t reward states such as Maine that already serve a broader population than most. MaineCare already covers many childless adults and the parents of young children enrolled in the program and also has more generous eligibility guidelines than many states.

In addition to reviewing changes to Medicaid, Johnson also told the committee that employer-based health care will continue to be the primary source of coverage for most Americans, that virtually all Americans will be required to have coverage of some sort, and that a system of health insurance exchanges is the real centerpiece of the reform, giving individuals access to affordable, meaningful coverage.

Committee members also heard state-specific information from state officials including Trish Riley, director of the Governor’s Office of Health Policy and Finance; Mila Kofman, superintendent of insurance; and Brenda Harvey, commissioner of the Department of Health and Human Services.

Many of the provisions of the new federal law are already in effect in Maine to one degree or another, including insurance regulations that prohibit companies from refusing coverage based on pre-existing conditions, limits on how much insurers can increase premiums based on individual health, and prohibitions on annual or lifetime coverage caps.

Maine is well positioned to take advantage of available funding for pilot projects and incentive programs included in the federal law, Riley told the committee. Although implementing the law in Maine will be challenging, she said, the state will fare better than many.

“We have some very significant policy decisions to make … but we’re in better shape than many of our peer states,” she said.

Information and materials relevant to the committee’s work are available online at www.maine.gov/legis/opla/healthcarereform.htm.

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