Hundreds of miles from the health care debate that will begin again this week in Congress, lobstermen here are out in force, bees are furiously pollinating the state’s famous blueberries and part-time workers are preparing for another summer tourist season.
As a result of their short-term spike in income, many of Maine’s working class will likely lose some or all of their health insurance subsidy, a feature of the federal health care law, which has been a complicated blessing for the citizens of Maine.
Senator Susan Collins, Republican of Maine, has spent a lot of time thinking about how to deal with these “subsidy cliffs,” even as her party’s leaders press for the wholesale repeal of the Affordable Care Act, President Barack Obama’s signature domestic achievement.
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For years, Republicans savaged Democrats for supporting the Affordable Care Act, branding the law — with some rhetorical license — as a government takeover of health care.
Now, cast out of power in Washington and most state capitals, Democrats and activist leaders seeking political redemption have embraced an unlikely-seeming cause: an actual government takeover of health care.
At rallies and in town hall meetings, and in a collection of blue-state legislatures, liberal Democrats have pressed lawmakers, with growing impatience, to support the creation of a single-payer system, in which the state or federal government would supplant private health insurance with a program of public coverage. And in California on Thursday, the Democrat-controlled State Senate approved a preliminary plan for enacting single-payer system, the first serious attempt to do so there since then-Gov. Arnold Schwarzenegger, a Republican, vetoed legislation in 2006 and 2008.
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If the Senate were simply to remove the House bill’s uniform tax credit and continue the hybrid model past 2019 through 2020 and beyond, the bill would most likely get a better coverage score from the CBO. The Senate would be able to direct more financial assistance to those who need it, whether because of old age, ill health, or low income. Indeed, the Senate could tweak the exact formulas for age and income adjustment to maximize the number of people with health insurance in the most cost-effective way.
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For Linda Dearman, the House vote last week to repeal the Affordable Care Act was a welcome relief.
Ms. Dearman, of Bartlett, Ill., voted for President Trump largely because of his contempt for the federal health law. She and her husband, a partner in an engineering firm, buy their own insurance, but late last year they dropped their $1,100-a-month policy and switched to a bare-bones plan that does not meet the law’s requirements. They are counting that the law will be repealed before they owe a penalty.
“Now it looks like it will be, and we’re thrilled about that,” Ms. Dearman, 54, said. “We are so glad to feel represented for a change.”
The voices of people like the Dearmans helped spawn a political movement after the passage of the health law seven years ago.
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We pride ourselves on being a compassionate society, and insurance companies use this to manipulate us into sharing the costs of other people’s excessive health care. Meanwhile, 5 percent of Americans generate more than 50 percent of health care expenses. Why shouldn’t a patient who continues to see me unnecessarily pay more?
The government’s job is to maintain public health and safety. It should ensure that insurance plans include mandatory benefits like emergency, epidemic, vaccine and addiction coverage. The Republican bill would let states apply for waivers to define these benefits differently; it would be a big mistake to drop such coverage entirely.
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The Trump administration appears to have scrapped one of the key tools the Obama administration used to encourage states to expand Medicaid under the Affordable Care Act.
The shift involves funding that the federal government provides to help hospitals defray the cost of caring for low-income people who are uninsured. Under a deal with Florida, the federal government has tentatively agreed to provide additional money for the state’s “low-income pool,” in a reversal of the previous administration’s policy.
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Even as Anthem, one of the nation’s largest insurers, reported an improved financial picture for the last year, the company warned on Wednesday that it would consider leaving some federal health care marketplaces or raising its rates sharply if the government does not continue subsidies to help low-income people.
Joseph R. Swedish, the company’s chief executive, set a deadline of early June for a decision on the subsidies, saying Anthem would weigh increasing rates by at least 20 percent next year.
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The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them. The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market. The future of the payments has been in doubt because of a lawsuit filed in 2014 by House Republicans, who said the Obama administration was paying the subsidies illegally.
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Senior House Republicans said Thursday that they expected the federal government to continue paying billions of dollars in subsidies to health insurance companies to keep low-income people covered under the Affordable Care Act for the rest of this year — and perhaps for 2018 as well. “While the lawsuit is being litigated, then the administration funds these benefits,” the House speaker, Paul D. Ryan, said Thursday. “That’s how they’ve been doing it, and I don’t see any change in that.”
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Under extreme pressure from conservative activists, House Republican leaders and the White House have restarted negotiations on legislation to repeal the ACA. But efforts to revive the legislation in the House could take weeks, lawmakers conceded, as Congress moves forward with a full plate of other time-consuming issues. And the renewed push did not meet with much enthusiasm from Senate Republicans, who said they had other priorities at the moment. Nonetheless, Speaker Paul Ryan vowed to renew efforts to repeal the law, despite last’s week crushing setback when House Republicans tossed aside a repeal bill because they lacked the votes to pass it.
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