Feds approve Maine plan to improve health insurance for small businesses

The state of Maine’s innovation waiver — part of Governor Mills’ health reform act of 2020 — implements innovations never before seen in the country to stabilize the market and contain costs

Governor Janet Mills announced today that the federal government has approved Maine’s plan to improve health insurance for small businesses by implementing first-of-its-kind innovations in the country to help increase coverage and contain increases premiums, which will save individuals and small business employees money on health care costs.

The US Centers for Medicare and Medicaid Services today informed the Maine Bureau of Insurance that they have approved Maine’s request for a state innovation waiver. The waiver is the result of Governor Mills’ bipartisan Health Reform Act – the Made for Maine Health Coverage Act. Health insurance premiums are rising in Maine for 2023, as they are across the county, but Maine’s federal waiver will prevent them from rising as much as they would have, resulting in premiums that are on average 8% lower in the individual market and 6% lower in the small group market than they would have been without the waiver. For example, a 40-year-old man with an individual plan may have paid $99.31 more on his monthly premium in 2023, but with the waiver the premium increase will be $64.35, a savings of $34.96 or nearly $420 per year, not including federal financial aid. ; while a 40-year-old man with a comparable small group plan may have paid $44.02 more each month in 2023, but with the waiver the premium increase will be $15.92 – a saving $28.10 or more than $190 per year.

The individual market serves individuals who purchase insurance on their own with federal financial assistance, while the small group market serves employers with 50 or fewer workers.

Under the now-approved waiver amendment, Maine will merge its individual and small group health markets into a single common market beginning in 2023. This merger will stabilize the market and enable federal funding through the Maine Guaranteed Access Reinsurance Association (MGARA) – which has stabilized the Maine individual market since 2019 – to be expanded into the small group market for the first time. Reinsurance provides a direct benefit to consumers by paying a portion of provider claims that would otherwise be paid by consumers through higher premiums. This change should reverse the trend of large premium increases and declining listings in the small group market while continuing to limit price increases in the individual market. Maine’s small businesses helped fund the MGARA program through monthly assessments paid for by all Maine health insurance policies. The addition of the Small Group Marketplace to the MGARA program will now allow small businesses in Maine to benefit from this program.

It will also help isolate Maine small businesses from a national grid. increase in health expenditure due to inflation, pandemic-induced health worker shortages, the continued need for COVID-19-related care, and the end of pandemic-related financial assistance. Proposed premiums for 2023 in Maine could increase by an average of 3.4% for small businesses, which is well below proposed increases in premiums for small businesses in states like New York (16.5%), Vermont (14.6% (PDF)) and Rhode Island (11.5% (PDF)).

Maine is the first state in the nation under the Affordable Care Act 1332 waiver program to provide federally backed reinsurance to small employers and individuals. The MGARA, supported by federal funding and contributions from health insurers, pays a portion of the cost of the most expensive health bills, lowering and stabilizing health insurance premiums.

“Small businesses are the backbone of Maine’s economy, providing jobs and crucial benefits like health insurance to tens of thousands of Maine residents. It is essential to ensure that health insurance remains affordable, not only for the health of small businesses, but also for that of their employees,” said Governor Janet Mills. “Our bipartisan health reform law will stabilize the health insurance market and reduce health insurance costs for small businesses, building on my administration’s work to make health insurance more affordable. for businesses and their hard-working employees.”

“I recently helped my adult son buy coverage at a market in another New England state and couldn’t believe how much more the premiums were than what he would have paid in Maine” , said Senator Heather Sanborn, co-chair of the Legislative Health Coverage, Insurance and Financial Services Committee. “I’m proud of the work the Legislature and the Mills administration have done to keep rates low, and I look forward to expanding these powerful tools to benefit people who work for Maine’s small businesses.”

“The Health Coverage, Insurance and Financial Services Committee has worked with the Mills administration to pursue this waiver request to help our small businesses better provide coverage to their employees,” said Rep. Denise Tepler, co-chair of the Legislative Assembly’s Health Coverage, Insurance and Financial Services Committee. “I’m so glad this plan can move forward to expand on the success Maine has had with reinsurance by keeping our market rates low.”

“Federal approval of Maine’s innovative plan to improve health coverage is good news for Maine consumers and small businesses,” said Ann Woloson, executive director of Consumers for Affordable Health Care. “It will be easier and more affordable for Maine residents to get the health coverage they need by keeping costs down using tools that are already proven in our state. We look forward to these changes in 2023 made possible by the Mills administration and the legislature.

The Maine plan also received the supporting national patient organizations (PDF) such as the American Cancer Association’s Cancer Action Network, the American Heart Association, and the American Lung Association, among others.

Governor Mills has prioritized helping Maine small business owners and workers pay for health care, recognizing that small businesses are the backbone of Maine’s economy and an important source of health insurance. for the people of Maine.

Through his Maine Jobs & Recovery Plan, the Governor launched the Small Business Health Insurance Premium Relief Program which reduces the cost of monthly health insurance premiums for small businesses and their employees. Under this program, health insurers receive financial assistance to reduce premiums for their small business customers by $50 per covered worker per month and up to $130 per month for family coverage. For the month of May 2022, 5,841 small businesses in Maine have received premium credits under the program. This represents a total of 46,802 Mainers (employees and their families) benefiting from premium reductions. $2,066,140 in bonus credits were issued to small businesses in May, and more than $14 million in bonus credits were issued in the first six months of the program. The program is expected to continue until April 2023.

The Governor is committed to providing affordable, quality, and accessible health care to all residents of Maine. As the first official action on his first day in office, Governor Mills signed an executive order to expand Medicaid (MaineCare), in accordance with the will of the people of Maine as expressed in a 2017 ballot initiative. Today, more than 95,000 Maine residents have access to health care through expansion, and the rate of uninsured among non-elderly Maine fell by about 25%, from 9.1% in 2018 to 6.7% in 2020. In her first year in office, she also reinstated a program to help low-income senior residents afford medications on prescription.

In her second year in office, Governor Mills led the pandemic response that ranked best in the continental United States, according to The Commonwealth Fundand Maine received an “A” according to a 2022 Analysis of the National Review of Business and the Economy. According Economy of Oxford.

In her third year, Governor Mills received federal approval and launched CoverME.govMaine’s Health Insurance Marketplace, which was also authorized by the Governor Health Coverage Act Designed for Maine. By law, the state of Maine operates its own health insurance marketplace, which better tailors the health insurance experience to Maine residents and their needs. In its first open enrollment for 2022, CoverME.gov enrolled 66,095 people, a 10% increase from 2021, reversing the decline in Marketplace plan selections since 2017.

The Health Coverage Act Designed for Maine also reduced out-of-pocket payments for primary and behavioral health care and simplified co-payments and deductibles through Clear Choice Standardized Plans.


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