What to watch for in the State of Maine’s health care debate

A year after the state of Maine passed its health care law, many of the provisions have been hammered out, but there is still a lot to be determined about what the new law will look like and how it will affect Maine residents.

Here are the key questions and answers:What is the state’s health insurance system?

What are the main elements of the new health care system?

Will the law affect the insurance premiums people pay?

Will it be a “silver” system, which covers people who get insurance through work, or will it be the “gold” system that covers people with pre-existing conditions?

Who will pay the premiums?

Will people with a pre-existing condition pay a deductible, or can people who have had a condition for more than two years pay a fixed rate?

Will people be able to switch from a silver system to a gold system?

How much will that cost?

Will Maine residents pay more?

How many people will be covered by the state-run system?

Will those coverage amounts be capped or vary by income?

Will Maine residents be able buy health insurance through their employer?

Will employers be required to offer coverage?

Will there be an option for employers to choose a health insurance plan?

What is “continuous coverage”?

Will Maine have a health exchange, like California, with more flexible premiums?

Will individuals be able get coverage in other states?

Will they be able access coverage on a “waiver basis” or by paying a fee?

Will premiums be set by state regulators?

Will insurers be required by law to offer a minimum amount of coverage, or be able charge a premium for “low” coverage?

Will that be determined by the federal government?

Will it be determined in a state-by-state fashion?

Will insurance companies be able offer discounts to low-income individuals?

Will individuals be allowed to keep more of their premiums?

What will happen to a state health insurance exchange if it goes away?

Will states have to negotiate with insurance companies on a fee-for-service basis?

Will state regulators have to approve those plans?

Will companies be allowed (or forced) to sell policies across state lines?

Will insurance companies have to pay a fee for doing that?

Will consumers be able purchase coverage across state borders?

Will insurers be able sell policies in more than one state?

Will all insurance plans have to be covered?

Will individual insurance policies have to cover a range of medical conditions?

Will coverage be determined on a basis of “age, gender, income, and other factors” rather than age or gender?

Will an individual be able or unable to purchase a policy based on the size of their family?

Will a premium be based on age, gender or income?

Will all policies have the same coverage, whether or not an individual has a pre-“existing” condition?

Will premium subsidies be provided through a tax credit?

Will a subsidy be provided by the government?

Will “affordable care” be defined as coverage that is “fully paid for with government money”?

Will people have to buy their own coverage?

Can insurers charge a fee to the government for their coverage?

What about health insurance for people with disabilities?

Will these plans be offered by the State Health Services Agency?

Will workers be able pick and choose their insurance coverage?

Who will be able choose their health insurance provider?

What happens to the employer-based coverage in the state?

Will everyone be covered, or just a small number of employees?

Will employer-sponsored plans be the only ones offering insurance?

Will the government have to offer the same type of coverage to everyone?

Will employees be able enroll in health plans?

Will health insurance be required for all employees?

Is Maine going to have a “universal health care” system?

Does that mean everyone will have coverage?

Are there plans that will cover everyone?

Will there be a minimum level of coverage for every Maine resident?

Will employers be allowed, or forced, to offer health insurance?

Does the government be allowed or forced to offer “minimum essential coverage”?

Is it required?

Will workers be allowed an exemption from paying a “premium” for health insurance that doesn’t meet minimum requirements?

Will health insurers be subject to the same standards of care as everyone else?

Will plans be subject not to the standards of health care, but to the “community standards” set by the Health Care for All Act?

Will consumers be allowed the option to purchase insurance through an exchange or a tax-credit-funded health care plan?

Will any plans be required?

Are they “grandfathered” plans, in which the individual mandate was repealed, or “non-grandfiled” plans that aren’t subject to federal mandates?

Will states be allowed more flexibility in the insurance markets?

Will coverage be based upon “age or gender”?

Will individuals have the option of being covered by their employer or a plan they select?

Will families be able shop for health care coverage? What

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