Maine’s State Innovation Waiver – a part of Governor Mills’ 2020 health reform law – implements first-in-the-nation innovations to stabilize the market and hold down costs
Governor Janet Mills announced today that the Federal government has approved Maine’s plan to enhance medical insurance for small businesses by implementing first-in-the nation innovations to assist increase coverage and hold down premium increases, which is able to save individuals and employees in small businesses money on health care costs.
The U.S. Centers for Medicare and Medicaid Services notified the Maine Bureau of Insurance today that it has approved Maine’s request for a State Innovation Waiver. The waiver is the results of Governor Mills’ bipartisan health reform law – the Made for Maine Health Coverage Act. Medical health insurance premiums are rising in Maine for 2023, as they’re across the county, but Maine’s federal waiver will keep them from rising as much as they might have, leading to premiums which are on average 8 percent lower in the person market and 6 percent lower within the small group market than they might have been without the waiver. For instance, a 40-year-old with a person plan can have paid $99.31 more on their monthly premium in 2023, but with the waiver the premium increase can be $64.35, a savings of $34.96 or nearly $420 annually, not counting federal financial assistance; while a 40-year-old with a comparable small group plan can have paid $44.02 more every month in 2023, but with the waiver the premium increase can be $15.92 – a savings of $28.10 or over $190 annually.
The person market serves individuals who buy insurance on their very own with Federal financial assistance while the small group market serves employers with 50 or fewer staff.
Under the now-approved waiver amendment, Maine will merge its individual and small group health markets right into a single, pooled market starting in 2023. This merger will stabilize the market and permit Federal funding through the Maine Guaranteed Access Reinsurance Association (MGARA) – which has stabilized Maine’s individual market since 2019 – to be prolonged to the small group marketplace for the primary time. Reinsurance provides a direct profit to consumers by paying a portion of provider claims that will otherwise be paid by consumers through higher premiums. This modification is projected to reverse the trend of high premium increases and declining enrollment within the small group market while continuing to limit price increases in the person market. Maine small businesses have been helping to fund the MGARA program through monthly assessments paid by all medical insurance policies in Maine. Adding the small group market to the MGARA program may also now allow Maine small businesses to learn from this program.
It is going to also help insulate Maine’s small businesses from a nationwide increase in health costs on account of inflation, pandemic-induced health care workforce shortages, the continued need for COVID-19 care, and the top of pandemic-related financial assistance. Proposed premiums for 2023 in Maine may increase on average by 3.4 percent for small businesses, which is way lower than the proposed small business premium increases in states reminiscent of Recent York (16.5 percent), Vermont (14.6 percent (PDF)), and Rhode Island (11.5 percent (PDF)).
Maine is the primary state within the nation under the Inexpensive Care Act’s 1332 waiver program to supply Federally supported reinsurance to each small employers and individuals. MGARA, supported by Federal funding and costs on health insurers, pays for a part of the price of the most costly health bills, lowering and stabilizing medical insurance premiums.
“Small businesses are the backbone of Maine’s economy, providing jobs and crucial advantages like medical insurance to tens of hundreds of Maine people. Ensuring that medical insurance stays reasonably priced is critical, not just for the health of small businesses but for the health of their employees as well,” said Governor Janet Mills. “Our bipartisan health reform law will stabilize the medical insurance market and hold down medical insurance costs for small businesses, constructing on my Administration’s work to make medical insurance more cost-effective for businesses and their hard working employees.”
“I recently helped my adult son shop for coverage through a marketplace in one other Recent England state and couldn’t consider how rather more expensive the premiums were than what he would have paid in Maine,” said Sen. Heather Sanborn, co-chair of the Legislature’s Health Coverage, Insurance and Financial Services Committee. “I’m happy with the work by the Legislature and the Mills Administration to carry rates down and stay up for extending these powerful tools to learn folks who work for Maine’s small businesses.”
“The Health Coverage, Insurance and Financial Services Committee worked with the Mills Administration to pursue this waiver application to assist our small businesses higher afford coverage for his or her employees,” said Rep. Denise Tepler, co-chair of the Legislature’s Health Coverage, Insurance and Financial Services Committee. “I’m so pleased that this plan can move forward to expand the success Maine has had with reinsurance in holding down our marketplace rates.”
“Federal approval of Maine’s modern plan to enhance health coverage is sweet news for Maine consumers and small businesses,” said Ann Woloson, Executive Director of Consumers for Inexpensive Health Care. “It is going to make it easier and more cost-effective for Maine people to get the health coverage they need by holding down costs using tools already shown to work in our state. We stay up for these changes in 2023 made possible by the Mills Administration and the Legislature.”
Maine’s plan also received the support of national patient organizations (PDF) reminiscent of the American Cancer Association’s Cancer Motion Network, the American Heart Association, and the American Lung Association, amongst others.
Governor Mills has prioritized helping small business owners and Maine staff afford health care, recognizing that small businesses are the backbone of Maine’s economy and a big source of medical insurance for Maine people.
Through her Maine Jobs & Recovery Plan, the Governor has launched the Small Business Health Insurance Premium Relief Program that lowers the price of monthly medical insurance premiums for small businesses and their employees. Under this system, health insurers receive financial assistance to scale back premiums for his or her small business customers by $50 per covered employee per thirty days and by as much as $130 per thirty days for family coverage. For the month of May 2022, 5,841 Maine Small Businesses received premium credits through this system. This represents a complete of 46,802 Mainers (employees and their families) receiving premium reductions. $2,066,140 in premium credits went to small businesses in May, and greater than $14 million in premium credits have been provided in the course of the first six months of this system. This system is scheduled to proceed through April 2023.
The Governor is committed to delivering reasonably priced, quality, accessible health take care of all Maine residents. As her first official motion on her first day in office, Governor Mills signed an executive order to expand Medicaid (MaineCare), consistent with the need of Maine people as expressed in a 2017 ballot initiative. Today, greater than 95,000 Maine people have access to health care through the expansion, and the uninsured rate amongst non-elderly Maine people has fallen by about 25 percent, from 9.1 percent in 2018 to six.7 percent in 2020. In her first 12 months in office, she also restored a program to assist low-income older residents afford pharmaceuticals.
During her second 12 months in office, Governor Mills led a pandemic response that ranked best within the continental United States, in accordance with The Commonwealth Fund, and Maine received an “A” in accordance with a 2022 National Business and Economic Review evaluation. Maine earned these strong reviews despite being considered one in every of the states most vulnerable to harm from COVID-19 given its demographics and economy, in accordance with Oxford Economics.
In her third 12 months, Governor Mills received federal approval for and launched CoverME.gov, Maine’s Health Insurance Marketplace, which was also authorized through the Governor’s Made for Maine Health Coverage Act. Under the law, the State of Maine runs its own Health Insurance Marketplace, which higher tailors the medical insurance experience to Maine people and their needs. In its first open enrollment for 2022, CoverME.gov enrolled 66,095 individuals, a ten percent increase over 2021, which reversed declines in Marketplace plan selections since 2017.
The Made for Maine Health Coverage Act has also reduced out-of-pocket costs for primary and behavioral health care and simplified co-pays and deductibles through Clear Alternative standardized plans.