As the U.S. Senate holds hearings this week to work toward a possible bipartisan compromise on health care, Maine consumers have some ideas. Not surprisingly, they don’t want to be without insurance, and they don’t want it to be beyond their price range either.
When Southwest Harbor real estate broker Bonnie Boisvert got an insurance plan on the Affordable Care Act’s marketplace a few years ago, she hoped it would be more affordable than the $700-a-month private plan she and her husband, also self-employed, had been paying for themselves and for their son. Initially, it was less expensive, but she says her premiums have steadily increased. This year, they reached more than $2,000 a month.
“Our mortgage is one-quarter the size of our health insurance bill per month,” she says.
Boisvert’s income fluctuates. More often than not, she earns too much to qualify for a tax credit, but too little to afford her high premiums.
She says she’s trapped. She doesn’t want to go without insurance — she has a cancer history and her husband has high blood pressure. Congress, she says, needs to help middle class Americans like her afford insurance.
“I just wish there was a way for people who are self-employed to average it over a few years, so that you actually can plan a little. You’re still paying your fair share, you’re just not having it fluctuate from $2,200,” she says.
Cost is also an issue for 25-year-old Jeanne Hanson of China. She can’t get insurance coverage from her parents, and was unable to afford her own plan after graduating from college last year. Her income was so low from temp jobs that she fell into the coverage gap: she didn’t qualify for Medicaid, since Maine didn’t expand the program under the ACA, and she also didn’t qualify for tax credits.
“I do think the ACA is a step in the right direction. However, with the falling through the crack stuff with myself, and I know with other Americans, it gets a little frustrating,” she says.
Hanson has since started a different job where she earns just enough to get tax credits. She’s glad she’ll have coverage, but she wants Congress to seal up the crack that she fell through before.
“More access to everybody across the socioeconomic board,” she says.
More access to affordable insurance is something Maine hospitals would like to see. The reason, says Mer Doucette, the chief financial officer at Redington Fairview General Hospital in Skowhegan, is that a growing number of patients have high-deductible plans, either because they think the lower premiums will save them money or because that’s the only option available.
“So what happens is the first $5,000 perhaps has to be borne by the patient. And oftentimes, they can’t afford that. As a matter of fact, as I look at charity care applications, some of these people have insurance, and they still qualify for charity care,” he says.
Jeff Austin of the Maine Hospital Association says the growth in bad debt and charity care is accelerating statewide. Over the past decade, charity care at Maine hospitals more than doubled, from $50 million to $113 million, and bad debt increased even more, from $63 million to $160 million.
Austin says the growth of high-deductible plans is a major reason why.
“It’s a way for the insurance industry to shift their risk back to the patient. Knowing that patients can’t fully absorb it, ultimately back to the hospital and the provider,” he says.
Austin says he wants Congress to maintain cost-sharing reduction payments, or CSRs, which help insurance companies provide coverage at a reduced cost to people with low incomes.
Those payments are the subject of a lawsuit, and President Donald Trump has threatened to end them. If Congress doesn’t ensure those payments continue, Austin says there will be blowback.
“That will hit insurance companies, and even potentially providers, and make the bad debt situation worse,” he says.
Keeping those CSR payments, he says, would help stabilize the insurance market.
Doucette says Congress should also look at long-term solutions that reduce the cost of care.
“There’s gotta be a way to determine what services will be provided to everybody, and what services would someone have to either get insurance for or pay out of pocket if you want that service,” he says.
The current system, he says, is unaffordable. The U.S. Senate health committee will continue hearings into next week, with the goal of creating a bipartisan plan to improve health care. Some Democratic senators also plan to introduce a Medicare-for-all bill.
This story was originally published Sept. 7, 2017 at 5:29 p.m. ET.