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Governor Mills: “Made for Maine Health Coverage Act” will improve health insurance

Campaigning across the state in 2018, I met so many people worried that they’ll never be able to afford health care. 

Small business owners bracing for unpredictable hikes in costs for the health insurance their employees all need to stay healthy and stay working.

Seniors who are rationing prescription drug medications – or worse, going without because of the high costs. 

From Abbot to York to Baileyville and Winslow and every town in between, the most common thing keeping Maine people up at night is the cost of health care.

I remembered these people when, on my first day in office over a year ago, we expanded MaineCare by Executive Order. More than 57,000 people now have accessed life-saving health care coverage. 

I remembered them when last session we enacted LD 1 to protect coverage regardless of pre-existing conditions and ensure that Maine people have necessary mental health, pediatric care, maternal care and substance use disorder treatment. 

I remembered them when we enacted a comprehensive prescription drug package to make prescription drugs more affordable and when we restored the Maine Drugs for the Elderly Program that serves 1,800 more seniors in the biennial budget.

While we have made substantial progress in expanding access to health care, our health insurance system is still confusing, difficult to use, and so expensive. 

Thousands of Maine people who do have health insurance are falling through the cracks every day just trying to navigate the system. Not only that, but then they got to afford the health care they need to live, work and raise their families in Maine. 

Maine’s small businesses and self-employed people are struggling to cope with ever-increasing costs to provide health care coverage. 

For these reasons, I have introduced legislation, sponsored by Senate President Troy Jackson and Speaker Sara Gideon, to improve health insurance for Maine people and small businesses – all without any state tax dollars. 

This bill is called the “Made for Maine Health Coverage Act” because it sets Maine-specific deductibles and copays, it offers a Maine solution for small businesses, and it creates a Marketplace designed to best meet the needs of Maine people.

Among other things, the bill requires health plans to cover the first primary care visit and behavioral health visit each year for free – with no deductible, no co-pay, and no out-of-pocket costs. The second and third primary care or behavioral health visits could have a co-pay, but the deductibles would not apply.

This bill will also allow Maine people to shop for and compare plans by creating “clear choice designs” — health plans with the same deductibles, copays and out-of-pocket limits for the most commonly used services.

Maine’s small group market has seen increasing premiums and decreasing enrollment, making it very difficult for small businesses to offer coverage to their employees.

Our bill will pool insurance plans and premiums for individuals and small businesses, creating a combined, larger and more stable pool of enrollees to stem increasing costs. 

The bill will also extend reinsurance for the first time to small businesses – that’s the program that helps insurers cover the patients who need the most expensive treatments –  to lower their premiums. It’s funded by the federal government and by current fees in Maine’s reinsurance program. 

These two provisions of the Made for Maine Health Coverage Act will take effect only if we determine that they will in fact stabilize and reduce small businesses’ monthly premiums. 

The bill will also move Maine toward a State-Based Marketplace. That means Maine will conduct its own education, in-person consumer assistance, and outreach on coverage – putting us in the driver’s seat when it comes to helping Maine people learn about options and sign up for health care.

This move is more important than ever before, with legal and political challenges every day to the Affordable Care Act and to the health care that thousands of Maine people rely on. 

While MaineCare expansion, LD1 and the prescription drug reform package have helped thousands of Maine people by giving them access to health care and strengthening their health care protections, the Made for Maine Coverage Act is another important step forward in improving Maine’s health care system for our people and for our small businesses — all without any state tax dollars.

We are anticipating bipartisan support for this bill and I look forward to hearing from you and to working with the Legislature to enact it.

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