(Augusta)  On Tuesday morning Consumers for Affordable Health Care (CAHC) submitted both written and oral comments to the Advisory Council on Health Systems Development (ACHSD).  The ACHSD has been meeting since April to develop recommendations on how best to implement the Affordable Care Act (ACA), which President Obama signed into law in March. The Council, which is comprised of 20 health care advocates, professionals, providers, and legislators, will be sharing its recommendations with Governor-elect Paul LePage and the 125^th Maine Legislature.  

In its written testimony, CAHC's policy staff agrees with many of the recommendations made by the ACHSD on how to implement the ACA.  The Council found that Maine is well positioned to implement national reform, as state agencies and the Dirigo Health Agency (DHA) already operate similarly to how a State Exchange will in 2014.  The ACHSD focused on seven issue areas including:

• Impact of the ACA on employers and the insurance market, including the requirement on individuals to purchase health insurance, the requirement on larger businesses to contribute toward health insurance coverage, or pay an assessment, and changes to insurance market rules;
• Health Benefit Exchanges, including key functions of an Exchange and basic design recommendations for a Maine Exchange;
• Impact of the ACA on Medicaid, including eligibility and benefits changes, opportunities to coordinate with the Exchange and long term care initiatives;
• Opportunities for payment reform, including demonstration projects focused on system reform through development of Accountable Care Organizations (ACOs) and innovative payment models;
• The future of the Dirigo Assessment; and 
• Impact of the ACA on quality and public health.

Mitchell Stein, CAHC's Policy Director, gave the oral comments and commended the Committee for their "diligent" work "on what is undoubtedly one of the most complex pieces of legislation ever passed."  Further along in his oral testimony, Mr. Stein drew comparisons between today's economic struggles with the beginning of the Franklin D. Roosevelt Administration in the early 1930's, quoting the 32^nd President, "the test of our progress is not whether we add more to the abundance of those who have much; It is whether we provide enough for those who have too little."

Mr. Stein states that the previous quote is the premise of which the ACA is built on, for instance many of the currently 134,000 uninsured Mainers will receive coverage if the ACA is implemented.  He also added that the list of benefits to implementing the ACA should include saving lives - studies have shown that the uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health.

CAHC also commented on the ruling by Virginia federal district Judge Henry E. Hudson on Monday afternoon that the individual mandate provision in the ACA is unconstitutional.  Judge Hudson, who was appointed to the district bench by President George W. Bush, is the first judge to strike down the provision as being unconstitutional following several previous rulings that upheld the law.  Judge Hudson's ruling does not have any immediate impact on implementing the ACA, as he denied the plaintiff's request to freeze implementation. 

Stein is quick to point out that this is not the final verdict and that the ACA is still the law of the land.  "It seems clear that sometime in the next few years this will reach the Supreme Court for a decision - but even if the individual mandate is ultimately found unconstitutional, a result many constitutional scholars doubt, that will not impact implementation of the rest of the law," said Stein in CAHC's oral testimony.  CAHC submits that the law, including the mandate, passes constitutional muster.   

Please click on the following links for either the written testimony submitted by CAHC or the text of the statement presented orally by Mitchell Stein before the Council.