Maine hospitals reluctant to play lead role in implementing Obamacare

A man looks over the Affordable Care Act sign-up page on the healthcare.gov website in New York last month.
MIKE SEGAR | REUTERS
A man looks over the Affordable Care Act sign-up page on the healthcare.gov website in New York last month.
By Mario Moretto, BDN Staff
Posted Nov. 18, 2013, at 4:55 p.m.

AUGUSTA, Maine — A lobbyist for the Maine Hospital Association says that at least half of the state’s hospitals have specialists on hand to help uninsured visitors sign up for health insurance on the exchanges launched last month as part of the Affordable Care Act.

Still, the hospitals are wary about taking a lead role in implementing the ACA, also known as Obamacare, because they already feel the program is being paid for out of their pockets.

The hospitals stand to lose between $800 million and $900 million in cuts to Medicare reimbursements over a 10-year period, if Medicaid isn’t expanded.

The lobbyist, Jeff Austin, spoke Monday before the state Health Exchange Advisory Committee, charged by the Legislature with monitoring and evaluating the implementation of the health exchanges, also called marketplaces.

Maine is one of several states that has opted to use the federal exchange website — the glitchy and beleagured healthcare.gov — rather than building its own exchange or partnering with the federal government on a hybrid project. President Barack Obama has endured weeks of criticism since the launch of the website, which has been marred by inaccessibility, glitches and user confusion.

Obama has also come under fire in the wake of many Americans — including thousands of Mainers — getting notice from their insurance companies that their plans had been modified or canceled. Obama had previously promised that if someone liked their current insurance plan, they’d be able to keep it under the Affordable Care Act.

So the panel, composed of lawmakers and other stakeholders, was curious to find out what Maine’s hospitals are doing to assist the uninsured in signing up for health insurance. Hospitals, which cover many poor and uninsured patients through charity care, are one group that stands to benefit significantly if more people sign up for health insurance.

Austin said different providers have taken different approaches to ensuring their patients had access to professionals who could help them make their way through the sign-up process. Some simply make referrals to state “navigators,” outside experts who specialize in getting new people signed up for health insurance on the exchange.

Other hospitals have staff on hand called “certified application counselors” who can help uninsured hospital visitors see their options under Obamacare. Austin said it’s similar to what hospitals were already doing when they screened uninsured patients for Medicaid/Medicare eligibility.

Austin said that within the next few weeks, all Maine hospitals would likely have some plan for diverting patients to the exchanges, whether by referral to navigators or to in-house counselors.

Lawmakers on the committee said they want to see Maine’s hospitals actively engage in community outreach programs to sign up people for insurance.

“I would really like to see the hospitals taking a leading role in signing people up,” said Rep. Sharon Treat, D-Hallowell. “It benefits your bottom line, it benefits the health of Maine people in general and it’s going to help make this whole thing work.”

The reduced reimbursements were meant to be offset by a mandatory expansion in Medicaid as predicted by the Affordable Care Act. But the U.S. Supreme Court said that the federal government could not require Medicaid expansion, paving the way for states to opt out. Maine did just that when Gov. Paul LePage vetoed Medicaid expansion bills last session.

Democrats have rallied around Medicaid expansion, which they will push in the upcoming Legislative session, saying about 70,000 Mainers — including 55,000 who are currently uninsured and 25,000 who will lose MaineCare on Jan. 1 — stand to benefit.

Austin said the Maine Hospital Association also wants to see Medicaid expanded, to cover the Medicare losses as they were intended to be covered. The federal government has promised to pay for 100 percent of the expansion for three years before slowly ratcheting down to 90 percent thereafter.

Republicans have said they won’t support the expansion. LePage said he doesn’t trust the federal government’s promise to pay, and on Monday, House GOP leaders said the failure of healthcare.gov was further evidence that Medicaid expansion was a bad idea.

Portland Mayor Michael Brennan, in a conference call with reporters Monday, lent his voice to the rally cry for expansion.

“We have a moral obligation to provide health care to every person in this state,” Brennan said during the call, joined by a White House press official and Rep. Linda Sanborn, D-Gorham, who also serves on the advisory committee.

LePage and Republican lawmakers supported paying back hospitals $490 million in accumulated MaineCare debt, yet oppose an expansion of the program that would accomplish the same goal of reducing hospitals’ burden of uncompensated care, he said.

“Every argument that the governor made and the Legislature made to set aside hundreds of millions of dollars for the hospitals also apply to the Mainecare expansion,” Brennan said.

The Health Exchange Advisory Committee will hold two more meetings before presenting a report — which may contain legislative proposals, including a plan for the state to institute its own health insurance exchange — to the Joint Standing Committee on Insurance and Finance in December.

BDN Health Editor Jackie Farwell contributed to this report.

Follow Mario Moretto on Twitter at @riocarmine.

CORRECTION:

An earlier version of this story stated that hospitals were hesitant to take on a greater role in outreach. Austin instead was referring specifically to hospitals paying patients’ premiums, which they have no plans to do.

http://bangordailynews.com/2013/11/18/news/state/maine-hospitals-reluctant-to-play-greater-role-in-obamacare-rollout/ printed on September 23, 2014