April 26, 2018
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To LePage: Take advantage of Affordable Care Act

By John E. Nale, Special to the BDN

The governor’s decision to not “lift a finger” to set up Maine’s health insurance exchange and to not otherwise take advantage of the Affordable Care Act is a missed opportunity for the governor and our state. The ACA is here to stay. It was passed by both houses of Congress, upheld in large part by the U.S. Supreme Court and reaffirmed by a majority of the people with the re-election of President Barack Obama. It is now “the law of the land.”

The question now is: Will Gov. Paul LePage lead us in taking full advantage of the law for the benefit of the people, or will he continue to fight it by not acting, by not participating, by not “lifting a finger”? Can he now put the people of Maine above tea party politics? By putting people above politics the governor can lead in the redesign of the health care and health insurance systems in Maine. By “lifting a finger” to help set up Maine’s health insurance exchange, we can design insurance policy benefits that focus on our needs as Mainers, with an emphasis on health, as well as insurance. The ACA allows each state to design and adopt state-specific required minimum benefits that we, as Mainers, need and can afford. If we don’t participate, we get whatever some bureaucrat in Washington and insurance company lobbyist comes up with.

By “lifting a finger” and agreeing to participate in the ACA Expanded Medicaid Coverage Program, we have the opportunity to provide health care coverage to approximately 44,000 Mainers who cannot otherwise afford it. We get to provide this coverage at a fraction (10 percent) of the cost that it would otherwise cost the state. This added coverage means that hospitals and doctors will have to do less charity work that is now passed on to Maine taxpayers and those who purchase private insurance policies. Not to mention that coverage will better manage chronic illness, reduce costs and have better health outcomes in the future.

By “lifting a finger” and proactively participating in the provisions of the ACA that are intended to help Maine’s elders and growing aging population, the governor could take the lead in creating a health care system for Maine’s elderly that calls for better care, placing the emphasis on value and not volume, quality and not quantity. Provisions of the ACA encourage states to develop a system that will keep Maine elders home, rather than in a nursing home; compensates doctors for providing at-home care to Maine’s elders; calls for improved hospital-to-home transition care, thereby reducing hospital stays for Maine’s elders; and sets aside $3 billion to fund stay-at-home services, with the goal of helping elders age at home. The waiting list in Maine today for some of these services is 1,100 names long. These ACA long-term care provisions are exactly what is needed in this state as our population ages and more caregivers are needed.

In short, by “lifting a finger,” we get to take the lead. We get to decide what is best for us and our state. We get to take advantage of the law, rather than letting the law take advantage of us.

John E. Nale is an elder law attorney with offices in Waterville.

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