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Left Behind? What Will Happen to Maine People Who Remain Uninsured After Health Reform?

Left Behind? What Will Happen to Maine People Who Remain Uninsured After Health Reform?

The roll-out of the new Health Insurance Marketplace last fall was not exactly what anyone would call “smooth.” Stories about the malfunctioning HealthCare.gov website dominated headlines both nationally and here in Maine for the first two months of its operation. Now that the website seems to be working much better we’ve begun hearing heartening stories of previously uninsured people finally getting coverage they can afford. As of the end of December, over 13,000 Mainers had successfully enrolled through the Marketplace. Hooray!

Without a doubt, many Mainers seeking coverage through the Marketplace will find a plan that suits their needs and their budgets. Financial help for individuals with annual incomes beginning at $11,490 (for a single person household) will help make premiums and out of pocket expenses more manageable.

But we shouldn’t lose sight of other groups who, for various reasons, will find themselves without the opportunity or the means to purchase affordable coverage. One group that comes immediately to mind are folks who would have received coverage under an expansion of MaineCare, but didn’t because of an inability to override the Governor’s veto last year. 

Many people in this group, and many more uninsured people- (government estimates are that around 130,000 Mainers are currently uninsured)-  will continue to seek care through free clinics, community health centers offering sliding fees based on income, and charity care available through our state’s non-profit hospitals and health systems. But Maine’s health care safety net is already challenged to keep up with what seems to be an ever-increasing demand.  At a time when a complete transformation our of health care system is taking place, we have to work on creating more responsive, sustainable, and equitable solutions for uninsured people. Those who will remain without access to public or private health coverage can’t be left out of the transformation equation.

This is the guiding principle behind MeHAF’s Improving Access to Quality Care (A2QC) initiative. We announced the first awards in A2QC in November. Five communities were awarded one-year grants to work with key participants to identify areas of need, create a plan to address the identified needs, and form a collaborative to implement the plan.  A sixth grantee received a three-year grant to implement a nationally recognized model for organizing and delivering comprehensive health care to uninsured people. All of the projects will bring together key stakeholders - including health care consumers - to get a better understanding of the needs of uninsured people, and develop a comprehensive, community approach to addressing the needs in a sustainable way. MeHAF recognizes that broad engagement of all key stakeholders will be necessary to achieve a sustainable system of care that delivers appropriate and cost effective services.

Later this year, we expect to offer an additional round of competitive planning grants in areas of the state where no grantees were selected in the first round. We also expect to invite communities that have made significant progress in the planning and development of a collaboration to compete for a limited number of three-year implementation awards.

Throughout the project period and beyond, MeHAF will seek out ways to support and assist grantees in achieving their project goals. As in other recent grants programs, the A2QC initiative will emphasize improving consumer involvement and engagement, and promoting collaborative leadership.

The overarching goal of A2QC is to catalyze new partnerships that will strengthen the safety net and improve the care and ultimately, the health of all people, regardless of their coverage status, so that none will be left behind.

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