Theda Skocpol, Harvard University
Originally published in the Bangor Daily News on July 21, 2015.
For the last five years, never-ending Obamacare battles have been accompanied by quiet progress in implementation.
Maine has been front and center in ideological warfare and quiet progress. But the state’s final health reform chapters remain to be written. When disputes in Augusta reach an end, will all the state’s people and businesses be able to reap the full benefits of reform? Let’s review the state of play.
In Washington, D.C., congressional Republicans have voted more than 50 times for repeal — even though most Americans prefer to keep the law and improve it and President Barack Obama would veto any such legislation that reaches his desk. Meanwhile, serious challenges to the health law worked their way through the federal courts to twice reach the Supreme Court.
Through it all, the Affordable Care Act has survived. In its latest ruling on the law last month, the high court preserved subsidies for purchases on Obamacare insurance exchanges and even made it clear it is unlikely to entertain any more challenges. Health reform is here to stay.
For Mainers, this is excellent news, because nearly 75,000 people have purchased health insurance plans on the state’s exchange. A higher percentage of eligible Maine customers signed up — more than 60 percent — than in any other New England state except Vermont. Had the court ruled the other way, the majority of these Maine customers probably would have lost their coverage, because nine out of 10 — including rural people and lobstermen and their families in coastal communities — need the federal subsidies to help pay their insurance premiums.
Across the country, health reform surprisingly is working well. More than 10 million Americans have gained new coverage as a direct result of the law, another 9 million are newly included in employer plans and still others have better insurance for the price they pay. Of course, the health law could be improved — for example, by reducing regulations on small businesses — but that can happen only after Republicans stop pushing for repeal and join with Democrats to enact changes with bipartisan support.
Dozens of new insurance companies started offering plans on the state exchanges in 2015, creating more choices and keeping prices down. New Hampshire went from one to five insurers on its exchange, and Maine went from two to three. Depending on how regulators respond to insurance company requests, premiums may go up more for 2016 than they did this year, but consumers would be able to switch plans if they want to pay less. We need to remember health insurance premiums were rising fast before the Affordable Care Act, even though millions of Americans were losing coverage and had no recourse. Things are better now. Still, health care providers must keep looking for new ways to deliver quality care at reasonable prices. Maine hospitals and community health centers already are participating in experiments encouraged by the health reform law.
But the state of Maine is still not reaping the full benefits of reform because Gov. Paul LePage refuses to expand MaineCare. Tens of thousands of low-income Mainers remain in the “coverage gap,” and according to neutral researchers the state will lose more than $26 million in revenues it could enjoy in 2016 and may lose a whopping $294 million through 2022. The private sector also is losing jobs and revenues it badly needs. As matters stand, Maine taxpayers are sending dollars to Washington to subsidize health care and boost economic growth in other states, not their own.
Already, 30 out of 50 U.S. states have accepted the Medicaid expansion, with Indiana, Montana and Alaska the latest to sign on. Republican governors often have led the way, including LePage’s blustery friend Gov. Chris Christie of New Jersey. Maine is the only holdout in New England, following the lead of southern ultra-conservative and racially divided states that refuse to cover all their poor residents.
As a student of history, I admit to finding LePage’s insistence on imitating the Old Confederacy bitterly ironic. After all, in relation to the state’s population back then, Maine soldiers and families made the greatest sacrifices to save the Union in the Civil War. A century and a half later, why does it make any sense for the Pine Tree State to refuse to take full part as the United States moves to extend affordable health insurance to all its residents?
Theda Skocpol, a summer resident of Maine (and, yes, a taxpayer), is the Victor S. Thomas Professor of Government and Sociology at Harvard University and the director of the Scholars Strategy Network, whose Maine chapter invited her to contribute this OpEd.