News Feature

Originally published in Community News, January 9, 2014
Understanding the Affordable Care Act
Maine’s decision not to expand Medicaid: what it means for residents

by Jessica Brophy

When the Affordable Care Act, also known as “Obamacare,” was passed in 2010, it was challenged in the courts, eventually ending up in the U.S. Supreme Court. In June of 2012, the court ruled that the individual mandate that people must purchase insurance was constitutional. This is the part of the ACA involving the website, the new marketplace exchanges and subsidies in the form of tax breaks to lower insurance premiums for Americans with incomes between 100 and 400 percent of the Federal Poverty Level.

A second part of the ACA was ruled unconstitutional by the courts. This part of the ACA would withdraw all federal Medicaid funding unless states expanded Medicaid. The ACA originally required states to cover all individuals with incomes up to 133 percent of the Federal Poverty Level, which for a family of four would be $31,321. After the ruling, states were free to choose whether to expand Medicaid or not. Maine is one of the 23 states that decided not to expand Medicaid (known in Maine as MaineCare).

The first part of the ACA offers subsidies to the uninsured to help offset the cost of purchasing private insurance, but only to those individuals with incomes between 100 and 400 percent of the Federal Poverty Level because the ACA was written on the assumption that those who were below the poverty line, or very near it, would be covered by Medicaid. This means those individuals who make less than 100 percent of the poverty line are not eligible for subsidies to offset the cost of purchasing private insurance through the exchange.

Sarah Gagne Holmes, Executive Director of Maine Equal Justice Partners, said non-disabled adults without children who are between the ages of 21 and 64 are not eligible for MaineCare, however low their income. Those whose incomes are below 100 percent of the poverty lines are not eligible for tax break subsidies to help purchase private insurance either.

What’s worse, said Holmes, is that it’s “only part of the picture.” Maine had sought a waiver from the federal government to cover an additional 10,000 people with state-run MaineCare. That waiver expired on January 1.

In total, there are nearly 70,000 Mainers who would be eligible for MaineCare if the expansion were to take place. This includes 45,000 Mainers currently uninsured, said Holmes.

During the last legislative session, two bills were proposed for MaineCare expansion. Both passed the House and Senate, but were vetoed by Governor Paul LePage; there were not enough votes in the House to override the governor’s veto.

At the time of the second veto, LePage said in a statement, “In the early 2000s, Maine began a massive increase in welfare expansion. The goal was to provide health care for those without insurance through government-sponsored care…The story is one we all know well: Maine ran up massive debts to our hospitals as the system outgrew the taxpayers’ ability to pay.”

LePage said that while the federal government “promises they will shoulder nearly all the cost over the next decade…We have heard that before.”

Representative Walter Kumiega (D-Deer Isle) said the expansion is on the docket for the legislative session beginning this month. Kumiega said he thinks the governor will veto another bill, but he’s hopeful that an override could be reached this time. “We were only one vote short in the House last session,” he said.

This is the third in a series of articles about the Affordable Care Act and the new insurance marketplace.