Advocating the right to quality, affordable health care for every person in Maine.
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1-800-965-7476

Spring 2011 Newsletter

New Resources for Consumers…

Sick and Uninsured?

Thanks to the Affordable Care Act (ACA), people with pre-existing conditions can enroll in the Pre-Existing Condition Insurance Plan (PCIP) for health insurance coverage. If you have one of the 37 different pre-existing conditions that are covered by the program and have been uninsured for at least six months, then you qualify for PCIP. In Maine, PCIP is administered by the Dirigo Health Agency (DHA).

Insurance for Part-time and Seasonal Workers

If you or your employees fall into either category you should look into the Part-Time Worker Coverage Voucher offered by DHA. Funded by a federal grant, part-time and seasonal workers can get help paying for health benefits. The best part for owners? It only costs employers 5% of premium a month to offer these benefits to their employees.

Are you taking the safest, most effective, and most affordable drug for your condition? Find out!

Consumer Reports Health Best Buy Drugs™ offers free, trusted educational resources to help patients access the safest, most effective, and most affordable prescription drugs available. This resource is a grant-funded project providing independent, evidence-based reports on prescription drugs based on research conducted at the Drug Effectiveness Review Projectat the Oregon Health & Science University. Consumer Reports Health “translates” findings into consumer-friendly reports that are available for free. These reports identify drugs that are as effective and safe as others in its class but often available at a lower cost, as well as provide information about the underlying condition. These recommended drugs are often generic drugs, but in the case that a brand-name drug is superior to a lower-cost drug in safety or efficacy, it is recommended regardless of price. The reports are freely accessible at: www.crbestbuydrugs.com, and also available for free in magazine format. AARP’s Drug Savings Toolprovides the Consumer Reports Health Best Buy Drugs™ information in a different format to further help people learn about and pay less for their prescription drugs. Visit the tool at http://drugsavings.aarp.org. For information about other Prescription Drug assistance programs visit Help Paying for Prescriptions.

Under 26 and Uninsured?

You may be able to join your parents’ private health insurance plan and keep that coverage until you turn 26. You don’t have to live with your parents or be financially dependent on them to be eligible to join their health plan. Visit our Online Health Care Guide to find out more about this and other health coverage topics.

Which Maine hospitals and doctors provide the best care?

The Maine Health Management Coalition Foundation launched a new tool recenty that will help consumers compare quality of care at different hospitals and health care providers. The Web site also contains information about several chronic conditions, advice on what to do if you aren’t getting the quality care you need, and information on staying healthy. For more information, see www.getbettermaine.org.

News From the Front…

Consumer Protection Rollbacks

As you probably know by now, LD 1333 was passed by the legislature and signed by the governor (and is now 2011 Public Law Chapter 90). What started as a three page bill that was released for public hearing and review morphed into a 45 page bill that was voted on by the House and Senate. Although this bill rewrites many of Maine’s health insurance laws, there was no time for the Bureau of Insurance to do study of the bill’s impact, especially in the shadow of national reforms that are being implemented.

While we don’t know the full extent of the law’s impact, here are a few things we are watching for:

  • Many Mainers forty and older will face higher premiums – while some young Mainers may see a slight drop in their premium
  • Mainers in rural areas may see higher premiums and reduced access to local providers
  • Rural health care providers and hospitals may lose business thus increasing their costs and putting their existence in jeopardy
  • Businesses with older and/or rural workers may face increased premiums
  • Weakening of Maine’s rate review laws

This summer Consumers for Affordable Health Care will be completing our analysis of the bill and releasing a report on the law and its expected impacts. In the meantime, click this link to view the text of the Public Law 90.

State Budget Update

It could have been a lot worse – You hear people using that phrase a lot when describing the budget that passed and was signed by the Governor. Initial proposals that would have taken health care coverage away from 30,000 Mainers were not part of the final package. Thanks to the herculean efforts of our friends at Maine Equal Justice Partners, other community organizations, religious leaders, and hundreds of caring Maine people, these extreme proposals were defeated. That’s not to say that people were not harmed by the budget – they were, and that the essential safety net was not weakened by the budget – it was, but again, it could have been a lot worse.

Click here to read Maine Equal Justice Partners’ summary:
Final State Budget Impact on MaineCare, TANF, General Assistance and Benefits for Legal Immigrants

Anthem Rate Increase

Earlier this year Anthem requested a rate hike of approximately 9.7% for its individual health insurance products to go into effect July 1, 2011. CAHC intervened as a party to the case to represent consumers’ interests and enhance consumer participation in the rate review process.

In April, Superintendent of Insurance Mila Kofman heard arguments from Anthem asking her to consider a 9.7% average rate increase to go into effect July 1, 2011. The Superintendent issued her decision in May and approved an increase on average of 5.2%. Click here to read the entire 44-page decision.

Maine’s highest court dismissed Anthem’s appeal of the Superintendent’s decision limiting its 2009 increase to 10.9% rates as moot. Although the Court did not directly address the merits of the 2009 case in its ruling, the decision is likely to have an impact on the 2011 case. Anthem has since appealed the Superintendent’s 2011 decision and that appeal is being actively litigated in the Business and Consumer Court, with a decision expected by early fall. CAHC is a party in this case representing consumer interests.

Finally, Maine’s Superintendent of Insurance Mila Kofman announced her resignation. Deputy Superintendent Eric Cioppa has been named the Interim Superintendent by Gov. LePage.

If you have an Anthem individual policy, please click here to complete our brief survey.

Exchange Update

Starting in 2014, Exchanges will allow individuals and small businesses to compare health plans, get answers to questions, access quality information, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.

Here in Maine in the last legislative session two bills were submitted to set up Maine’s Exchange (as part of the Affordable Care Act, each state will either build their own Exchange or the Federal government will come in and operate one). There were differences in how the bills handled the creation, administration and functions of the Exchange (one bill was sponsored by a Democrat and one by a Republican). The Insurance and Financial Services Committee decided to table both bills until the next session. It was thought that by then there would be more clarity as to what the actual Exchange requirements will be.

On July 11 the U.S. Department of Health & Human Services released proposed regulations that help clarify how the Exchanges should be set up. Here at Consumers for Affordable Health Care we will be carefully reviewing these regulations and working to see that the Exchange set up here in Maine works for Consumers. Later in the summer we’ll release a summary of the regulations, but in the meantime:

Healthcare.gov website section on Exchanges:

Actual Regulations:

CAHC Making A Difference…

Consumer Assistance Program Story

A mom called recently to seek help for her adult daughter. The daughter’s rheumatoid arthritis is severe enough that she receives SSDI (Social Security Disability Insurance) and Medicare. She is currently very sick but has lost her supplemental insurance that covered expenses that weren’t covered by Medicare. The daughter’s SSDI income is not enough for her to afford to buy a new supplemental policy or to pay the Medicare co-pays.

The mom called the HelpLine to ask if there were any programs that could help her daughter. HelpLine staff looked at all the information and determined that the daughter appeared to be eligible for MaineCare which would pay those Medicare co-pays and her prescription costs. She also appeared eligible for the Medicare Savings Program which would pay her monthly Medicare Part B and Part D premium of $115.

We gave the mom the address and phone number for their local Department of Health and Human Services office. She was anxious to get the assistance started as the situation was terrible so we suggested she go the office to apply because that is faster than getting and sending the application by mail. HelpLine staff also warned her that she would need a release form in order to apply for her daughter. She said they would go together. Both the mom and HelpLine staff are grateful there are important programs available in Maine that will help her daughter.

CAHC in the News

March 17 – Free Press
Public Invited to Comment at Anthem’s Rate Increase Request for Individual Plans

April 12 – Kennebec Journal, Mario Moretto
Anthem rate boost request meets with scorn

April 30 -Sun Journal, Steve Mistler
GOP pushes surprise insurance overhaul through committee

May 1 – Bangor Daily News, Meg Haskell
Committee endorses far-reaching changes to health insurance regulation

May 3 – Portland Press Herald, Tom Bell
Legislature to vote on health care overhaul

May 3 – Morning Sentinel, Tom Bell
GOP pushes insurance bill to House vote

May 5 – Sun Journal, Steve Mistler
Lawmakers rework insurance bill as rancor ensues, House vote looms

May 16 – Bangor Daily News, Meg Haskell
Insurance chief resigns, citing ‘philosophical differences’ with LePage

May 17 – Bangor Daily News, Meg Haskell
Anthem Individual rates to rise 5.3 percent, reducing profits to $600K

May 20 – Portland Press Herald, John Richardson
Anthem given OK to increase rates 5.2% Under Maine’s new law, this may be the last time the Bureau of Insurance gets to review and limit such a rate increase.

May 20 – Kennebec Journal, John Richardson
Anthem gets 5.2% boost in premiums

June 17 – Maine Public Broadcasting Network
Feds Launch Drive to Insure Mainers

June 29 – Bangor Daily News, Meg Haskell
Maine businesses caught in the middle of health reform

July 1 – Bangor Daily News
Maine Consumer Rep. Decries vote- Committee endorses far-reaching changes to health insurance regulation

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Open Enrollment is the time of year you can sign up for health insurance.

Open Enrollment to get insurance for 2018 will start November 1, 2017. It will end December 15, 2017.

If you don't sign up for a health plan by December 15, 2017, you may not be able to get health insurance in 2018. If you don't have insurance, you might have to pay a fine when you file your taxes.

Visit HealthCare.gov or call our HelpLine at 1-800-965-7476 to learn more and find out how to apply!

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