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Coping with the Nitty Gritty of the Affordable Care Act
08/19/2013   Reported By: Patty B. Wight

The Affordable Care Act is far-reaching, complex - and on its way. In about six months - January 1, 2014 - federal law mandates that everyone have health insurance coverage. So what does that mean, exactly? Those seeking a better understanding of that question turned out for a colloquium this afternoon at the University of Southern Maine. The gathering included insurance, business and healthcare experts, and was organized in anticipation of the new online insurance marketplaces that open Oct. 1. Patty Wight spoke to colloquium facilitator Trish Riley, a senior fellow at the Muskie School of Public Service, to find out more.

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Trish Riley of USM's Muskie School says now is the time to get past the politics of the Affordable Care Act and focus on the nitty gritty of what it will mean at a practical level.

"There will be bumps along the way - how to get information that's accurate and fair," Riley says, "and, really, how to give this very important new plan an opportunity to work."

Riley says the people who need to sit up and pay most attention right now are those who will use the online insurance marketplace - in other words, those who don't have health insurance right now, or whose coverage is too expensive. That's estimated to be nearly 170,000 people in Maine, and Riley says the law uses a carrot-and-stick approach to encourage them to sign up.

"Importantly, the Affordable Care Act not only creates discounts to premiums, but limits how much out-of-pocket exposure people have when they use health care," Riley says.

The cap for out-of-pocket health expenses is about $6,300 for individuals and $12,000 for families. The discounts on premiums come in the form of tax credits for those who make between 100 percent and 400 percent of the poverty level.

"A tax credit can be received up front, and it can go directly to an insurance company to immediately discount your monthly payment," Riley says, "so your out-of-pocket expenses for monthly payments are significantly reduced."

But one bump in the implementation of the Affordable Care Act in Maine is already emerging: Those whose incomes are at, or less than, the poverty level are actually not eligible for tax credits.

"So the poorest of the poor will get nothing, and will remain uninsured," Riley says. "That's because the Afforable Care Act originally assumed Medicaid - here in Maine, the MaineCare program - would cover all poor people. The Supreme Court said, 'No,' that was up to states."

And in Maine, Gov. LePage actively opposed the expansion of Medicaid by issuing a veto of a bill from the Legislature that would have covered those low-income Mainers under the federal program. LePage argued at the time that the state couldn't afford to pay for the expansion.

Trish Riley says despite the new health law's imperfections, it's an important step forward. "Since Teddy Roosevelt ran for president 100 years ago, the nation has tried to create some form of universal access to coverage. The Affordable Care Act does that," she says.

Learn more about the Affordable Care Act through the Muskie School, or visit



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