Health care advocates say changes to ACA marketplace plans threaten Maine’s healthcare system – Maine Public

Report on Proposed Changes to the Affordable Care Act Marketplace and Implications for Maine’s Healthcare System

Introduction

More than 64,000 residents of Maine currently obtain health insurance through the Affordable Care Act (ACA) online marketplace. However, proposed amendments in the Congressional budget bill threaten to reduce coverage for many individuals. These changes could destabilize Maine’s overall healthcare system, raising concerns among state officials and healthcare advocates.

Case Study: Impact on Individual Coverage

Stephanie Boardman-Wallace, a self-employed hairstylist in Fairfield, Maine, exemplifies the personal impact of ACA marketplace coverage. After losing employer-based insurance due to her husband’s disability and subsequent job changes, she secured an affordable plan costing $160 per month through the ACA marketplace. This coverage provides essential security for her and her family.

Potential Effects of Proposed Congressional Budget Bill

1. Expiration of Enhanced Premium Tax Credits: These credits, which currently make insurance affordable, are set to expire at the end of the year. Without Congressional extension, marketplace premiums could increase by over 75%, according to the Kaiser Family Foundation (KFF).
2. Coverage Loss: Approximately 20,000 Mainers could lose insurance coverage due to changes in marketplace policies.
3. Administrative Challenges: Proposals include eliminating auto-renewals, increasing paperwork for income verification, and penalizing individuals with fluctuating incomes, which would complicate enrollment and renewal processes.
4. Increased Operational Costs: The state marketplace would need to hire additional staff or vendors, incurring millions of dollars in expenses.

Arguments Supporting the Proposed Changes

• Fraud Prevention: Proponents argue that the changes are necessary to combat fraud in the marketplace.
• Fraud Estimates: A report by the conservative Paragon Health Institute estimates over 6 million fraudulent enrollments nationwide, often facilitated by brokers and weak verification processes.

Counterarguments and Concerns

• Minimal Fraud: Independent Senator Angus King stated that fraud in these programs is “vanishingly small” and cautioned against policies that could disenroll legitimate recipients.
• Impact on Vulnerable Populations: The bill would restrict lawfully-present immigrants, including asylum seekers, from enrolling and would exclude plans covering abortion care from federal cost-sharing reductions, affecting states like Maine where abortion coverage is mandated.
• Healthcare System Strain: Disenrollment could increase uncompensated care in hospitals and emergency rooms, shifting costs rather than reducing them.

Stakeholder Perspectives

• Healthcare Advocates: Kate Ende of Consumers for Affordable Health Care emphasized that the proposed changes would primarily result in disenrollment and increased healthcare costs elsewhere.
• Healthcare Providers: Max Lynds, trustee at Houlton Regional Hospital and insurance broker, highlighted the ACA marketplace’s role in expanding coverage and supporting individuals without employer-based insurance.
• Marketplace Administration: Hilary Schneider, director of Maine’s Health Insurance Marketplace, warned that the bill could cause the marketplace to “come crumbling down,” undermining the ACA’s goal of healthcare stability.

Alignment with Sustainable Development Goals (SDGs)

The issues raised by the proposed changes to the ACA marketplace directly relate to several United Nations Sustainable Development Goals:

• SDG 3: Good Health and Well-being – Ensuring healthy lives and promoting well-being for all ages by maintaining accessible and affordable health insurance coverage.
• SDG 1: No Poverty – Preventing increased healthcare costs that could push vulnerable populations into poverty due to lack of insurance.
• SDG 10: Reduced Inequalities – Protecting marginalized groups, including immigrants and low-income individuals, from losing access to essential health services.
• SDG 16: Peace, Justice, and Strong Institutions – Promoting transparent and fair policies that balance fraud prevention with equitable access to healthcare.

Conclusion

The proposed Congressional budget bill presents significant risks to the stability and accessibility of Maine’s healthcare system. While fraud prevention is a valid concern, the potential disenrollment of thousands of residents and increased administrative burdens could undermine progress toward achieving key Sustainable Development Goals related to health, poverty reduction, and equality. Stakeholders urge careful consideration of these impacts to ensure that healthcare coverage remains inclusive, affordable, and sustainable.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being

   • The article discusses health insurance coverage through the Affordable Care Act (ACA) marketplace, highlighting issues related to access to healthcare and insurance stability.
   • Concerns about losing coverage and increased premiums directly relate to ensuring healthy lives and promoting well-being for all ages.

2. SDG 10: Reduced Inequalities

   • The article touches on the impact of policy changes on vulnerable populations, including self-employed individuals, lawfully-present immigrants, and those with fluctuating incomes.
   • It highlights potential exclusion of certain groups from health coverage, which relates to reducing inequalities within and among countries.

3. SDG 16: Peace, Justice and Strong Institutions

   • The article mentions efforts to combat fraud in the health insurance marketplace, reflecting the goal of promoting just, peaceful, and inclusive societies.
   • It also discusses the balance between fraud prevention and protecting honest recipients, relevant to building effective, accountable institutions.

2. Specific Targets Under Those SDGs Identified

1. SDG 3 Targets

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
   • Target 3.c: Substantially increase health financing and recruitment, development, training, and retention of the health workforce in developing countries.

2. SDG 10 Targets

   • Target 10.2: Empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices.

3. SDG 16 Targets

   • Target 16.6: Develop effective, accountable, and transparent institutions at all levels.
   • Target 16.5: Substantially reduce corruption and bribery in all their forms.

3. Indicators Mentioned or Implied to Measure Progress

1. Indicators Related to SDG 3

   • Proportion of population covered by health insurance (implied through the number of Mainers insured via ACA marketplace and those projected to lose coverage).
   • Out-of-pocket health expenditure as a proportion of total health expenditure (implied by discussion of premium costs and affordability).
   • Number of people with access to essential health services (implied by coverage stability and access issues).

2. Indicators Related to SDG 10

   • Proportion of population living below national poverty line, by sex and age (implied by the focus on affordability and vulnerable groups).
   • Disparities in health coverage among different population groups, including immigrants and self-employed individuals.

3. Indicators Related to SDG 16

   • Number of confirmed cases of fraud in health insurance programs (implied by discussion of fraudulent enrollments).
   • Costs associated with administration and enforcement of health insurance programs (implied by hiring costs and administrative burdens).

4. Table: SDGs, Targets and Indicators

Source: mainepublic.org