June 21, 2018
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Welcoming local say in Maine health care reform

By Elizabeth Rogers, Special to the BDN

The Affordable Care Act became law in 2011, and, back then, 2014 seemed a long way off. Suddenly, what was once on the distant horizon — the requirement that all Americans have health insurance — is getting closer. The mandate kicks in less than a year from now, on Jan. 1, 2014.

Beginning on Oct. 1 of this year, individuals and businesses — with up to 50 employees — will be able to shop for health-care coverage in health insurance “exchanges” or marketplaces. And while there are still many unanswered questions, we know more than we did a couple of months ago.

Because Gov. Paul LePage decided not to pursue the creation of a Maine-made marketplace, we will access ours by phone or through a website developed by the federal government. Being part of the federal marketplace means that Mainers will benefit from efficiency of scale along with at least 25 other states that are opting out of a state-run system.

Like travel websites, insurance marketplaces will include apples-to-apples comparisons on coverage and cost for each state. We will access Maine-specific insurance plans by providing information about where we live. While all of the plans will cover a required (by law) minimum level of essential, comprehensive health benefits, they will vary by cost and design.

Both the federal government and consumer advocates here in Maine understand that we may experience a steep learning curve in understanding how to “read the fine print” as new insurance purchasers. There are plans in the works to establish a network of independent navigators and application assistants to help us understand the details. Help will be available, but we will need to know who to call or where to go.

Health reform is intended to increase competition, and, from a market perspective, reduce costs. While insurers know that cost is the first consideration for consumers, the pricing structure of new plans is one of the biggest unknowns that we face right now. Compounding that unknown is the fact that cost will also be based on income. Many individuals will be eligible for financial support.

In truth, while all of us will have the opportunity to shop for new insurance coverage, most of us already have health insurance. How will greater flexibility in individual access to health insurance benefits affect our labor market over time?

In our marketplace we will see familiar insurance companies and some new names. For example, Maine is one of 24 states to launch a non-profit Consumer Operated and Oriented Plan. As envisioned by leaders in health reform, the CO-OP model taps into the cooperative movement’s focus on shared leadership, mutual aid and reciprocity, and CO-OP profits will be redistributed into member benefits. New health insurance CO-OPs across the country are forming partnerships with farmers supply, electric, and phone cooperatives, membership organizations for seniors, and small business advocacy and service organizations.

Our CO-OP, Maine Community Health Options, will encourage consumers to have more control over their own health and health care by engaging them in insurance benefit design and practice. MCHO is reaching out to multiple communities across the state to understand what benefits are most important in value-driven health plans covering a range of health-care needs. CO-OP members will participate in decisions management makes to address cost, quality and other issues, and have a say in how profits are used.

Ultimately, increased opportunities for consumer participation in health insurance and health care decisions can provide greater choice in how we — collectively and individually — want to live. The marketplaces will force us to learn more as we decide what kind of benefits make sense for us, for our families, colleagues and employees. The more we understand about the health services we need to be healthy, the more we are able to reduce our individual and collective costs.

Elizabeth Rogers, of South Portland, is a master’s degree candidate in health policy and management at the University of Southern Maine’s Muskie School of Public Service.

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