June 25, 2018
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The challenge of the Affordable Care Act for Mainers

By Geoffrey Gratwick, Special to the BDN

In the United States we spend approximately $8,000 per person per year on health care but rank 15th in the world for overall health. The country that ranks No. 1 spends less than half of what we do per person. Are you and I getting our money’s worth? Will the Affordable Care Act help us?

The Supreme Court’s decision presents Mainers with a remarkable opportunity. The

court endorsed a full set of new benefits — free preventative care, lower-cost Medicare prescriptions, the path to universal coverage and much more. Furthermore, everyone who has a personal physician and a good insurance program will be able to keep them.

Over time we can do this without increasing the cost of medical care.

Starting in 2014, the Affordable Care Act will pay Maine to expand MaineCare, our version of Medicaid, which we created years ago to provide health coverage for people with low incomes. The feds will pay 100 percent of the cost for three years, 95 percent for two more and then permanently 90 percent of the cost of this expanded network. The act opens doors for more Mainers to have dependable and secure medical care with minimal cost to us.

Even though the Supreme Court removed the legal uncertainties surrounding the Affordable Care Act, Maine’s work is just beginning. The act’s opponents lost the legal battle but their concerns are real and need to be addressed. At their heart is a fundamental moral question: Is health care a right or a privilege? We are going to have to publicly discuss and answer this question, as well as many practical questions: Can we afford the Affordable Care Act? Can we not afford the Affordable Care Act? Is health care better delivered by for-profit insurance companies, such as Aetna and Cigna with their 22 percent to 33 percent overhead, or government programs such as Medicare, with its 3 percent overhead? What are the alternatives?

Regardless of whether health care is a right or a privilege, there should be no doubt that everyone should be insured; 85 percent of Americans agree that it should be so. My fellow physicians and I see all too frequently what happens to people without insurance. They are good, hardworking Mainers, just like you and me. We have seen how they fail to get preventative care, fail to get the medicines they need, and postpone — sometimes for years — needed doctor’s visits.

Long ago we as a society decided that nobody should be left to die on the streets.

Therefore, the uninsured have the right to go to the emergency room for care. They do so, frequently late in the course of their illnesses. The emergency room is hugely expensive. Hospitals recover their costs by raising fees for the rest of us, resulting in large insurance deductibles, higher premiums and reduced benefits. Even now we all pay for the uninsured one way or the other.

Mainers have an important choice facing them. In its original form, the Affordable Care Act required all states to participate in Medicaid expansion. The Supreme Court, in its only significant change to the law, said states could not be forced to take the federal money. It allows them to find some other way — at their own expense — to offer insurance to those who lack it.

The Affordable Care Act is enormously complex but is a work in process, aiming to improve on 60 years of both superb and deeply flawed for-profit health care. The better Mainers understand the act the better they will be able to engage in thoughtful dialogue.

The rational step is for Maine to join the states that are choosing to accept the federally funded health care expansion. This will assure Mainers access to low-cost insurance options and efficient, fair use of their health care dollars.

Given the opportunity to be fully informed, Mainers will make the wise choice and

embark, fully alert, on the process of designing a health care system that meets all our needs. The process must be transparent, inclusive and pragmatic. We must draw upon our local knowledge of what works. Decision makers have to be held accountable. Drafts of bills must be openly shared across the state, among groups of health care consumers and providers — this is not a time for secret deals or partisan bickering.

This transition will require our best and most thoughtful minds. The benefits for our own health, that of our children, the economy and our country will be enormous.

Those working on this task — surely one of the greatest challenges for Maine in several generations — will succeed if they seek practical solutions rather than political advantage. I am hopeful that all our political leaders are up to the task. The stakes could not be higher.

Geoffrey Gratwick is a candidate for Maine State Senate District 32.

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