An Act To Make Health Care Coverage More Affordable for Working Families and Small Businesses
Maine Legislature, Session 130, LD 1463
Committee: Health Coverage, Insurance and Financial Services
Sponsors: TEPLER, MOORE, ARFORD, BROOKS, DUNPHY, MATHIESON, WHITE, BRENNER, VITELLI

Legislative Document
No. 1463
H.P. 1079
House of Representatives, April 12, 2021
An Act To Make Health Care Coverage More Affordable for 
Working Families and Small Businesses
Received by the Clerk of the House on April 8, 2021.  Referred to the Committee on Health 
Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered printed 
pursuant to Joint Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative TEPLER of Topsham.
Cosponsored by Senator MOORE of Washington and
Representatives: ARFORD of Brunswick, BROOKS of Lewiston, DUNPHY of Old Town, 
MATHIESON of Kittery, WHITE of Waterville, Senators: BRENNER of Cumberland, 
VITELLI of Sagadahoc.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA c. 56-A, sub-c. 2-B is enacted to read:
SUBCHAPTER 2-B
MAINE HEALTH CARE AFFORDABILITY FUND AND ASSESSMENT
§4329.  Definitions
As used in this subchapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  Advisory group.  "Advisory group" means the Affordable Health Care Advisory 
Group established in section 4330-B, subsection 1.
2.  Assessment.  "Assessment" means the health care affordability assessment 
described in section 4330-A, subsection 1.
3.  Commissioner.  "Commissioner" means the Commissioner of Health and Human 
Services.
4. Covered entity.  "Covered entity" means an entity that would be subject to Section 
9010 of the federal Affordable Care Act if that section were in effect and that is subject to 
an assessment, including an insurance company, health service corporation, hospital 
service corporation, medical service corporation, health maintenance organization, dental 
service corporation or dental plan organization authorized to issue health benefit or dental 
benefit plans in the State.
5.  Exchange. "Exchange" has the same meaning as in section 2188, subsection 1, 
paragraph A.
6.  Family glitch. "Family glitch" means the situation in which an individual is 
ineligible for premium assistance tax credits under 26 United States Code, Section 36B 
because a relationship to another individual allows the individual to enroll in an eligible 
employer-sponsored plan, as defined in 26 United States Code, Section 5000A(f)(2), that 
is considered affordable for the related individual under 26 Code of Federal Regulations, 
Section 1.36B-2(c)(3)(v)(A)(2) but for which the portion of the annual premium that the 
related individual must pay for family coverage exceeds the required contribution 
percentage, as defined in 26 Code of Federal Regulations, Section 1.36B-2(c)(3)(v)(C), of 
the individual's household income for the taxable year.
7.  Federal poverty level.  "Federal poverty level" has the same meaning as in Title 
22, section 3762, subsection 1, paragraph C.
8.  Fund.  "Fund" means the Maine Health Care Affordability Fund established in 
section 4330 to provide funding for activities or initiatives to reduce the cost of health 
insurance coverage for residents of the State.
9.  Health insurance.  "Health insurance" means a hospital and medical expense-
incurred policy, nonprofit hospital and medical service plan, health maintenance 
organization subscriber contract or other health care plan or arrangement that pays for or 
furnishes medical or health care service, whether sold as an individual or group policy. For 
the purposes of this section, "health insurance" includes limited-scope dental and vision 
benefits.  "Health insurance" does not include accidental injury, specified disease, hospital 
indemnity, disability income, Medicare supplement, long-term care or other limited-benefit 
health insurance or credit insurance; coverage issued as a supplement to liability insurance; 
insurance arising out of workers' compensation or similar law; automobile medical 
payment insurance; or insurance under which benefits are payable with or without regard 
to fault and that is statutorily required to be contained in any liability insurance policy or 
equivalent self-insurance.
10.  Net written premium.  "Net written premium" means the total premiums of health 
insurance policies issued or delivered in the State by a covered entity, less return premiums 
on those policies and dividends paid or credited to policy or contract holders on the health 
benefit plan business.
§4330.  Maine Health Care Affordability Fund
1.  Fund established.  The Maine Health Care Affordability Fund is established within 
the Department of Health and Human Services as a separate and distinct fund for 
accounting and budgetary reporting purposes.  Funds in the fund may not lapse but must 
be carried forward to carry out the purposes of this subchapter.
2.  Administration.  The commissioner shall administer the fund in accordance with 
this section.
3.  Sources of funding.  The commissioner shall deposit to the fund:
A.  Funds received from the assessment;
B.  Funds from any other source, whether public or private, designated for deposit into 
or credited to the fund; and 
C.  Interest earned or other investment income on balances in the fund.
4.  Deposit and use of funds. The use of funds deposited into the fund is subject to the 
following restrictions.
A.  Funds deposited into the fund must be expended by the commissioner solely for the 
following permissible uses:
(1)  Providing financial assistance to lower premiums or reduce out-of-pocket cost-
sharing for qualified health plans, as defined in 42 United States Code, Section 
18021, offered on the exchange to residents of the State who are subject to the 
family glitch or whose household income, as defined in 26 Code of Federal 
Regulations, Section 1.36B-1(e), is at or below 200% of the federal poverty level; 
and
(2)  Other initiatives that increase affordability of health coverage for individual 
policy holders or small businesses, provide greater access to health insurance to 
the uninsured or reduce disparities in health coverage, including through financial 
assistance, and outreach and enrollment activities.
B.  At least 85% of funds deposited into the fund due to the assessment must be used 
for the purposes described in paragraph A, subparagraph (1), except that:
(1)  If federal financial assistance provided under the federal Affordable Care Act 
is repealed or eliminated, 100% of funds deposited into the fund must be used to 
replace the assistance; and
(2)  If residents of the State who are subject to the family glitch become eligible 
for a premium assistance tax credit under 26 United States Code, Section 36B, 85% 
of funds deposited into the fund must be used to provide premium or cost-sharing 
subsidies to residents of the State who purchase qualified health plans, as defined 
in 42 United States Code, Section 18021, offered on the exchange in the following 
order of priority on the basis of household income, as defined in 26 Code of Federal 
Regulations, Section 1.36B-1(e):
(a)  First, to those residents whose household income is at or below 200% of 
the federal poverty level;
(b)  Second, to those residents whose household income is at or below 250% 
of the federal poverty level;
(c)  Third, to those residents whose household income is at or below 300% of 
the federal poverty level; and
(d)  Fourth, to those residents whose household income is at or below 400% of 
the federal poverty level.
If the amount of the federal premium assistance tax credit available to residents of 
the State is less than the amount that would be provided under Section 9661 of the 
American Rescue Plan Act of 2021, any funds allocated under this subparagraph 
must first be used to increase the amount of the available tax credit to equal the 
amount that would be provided under Section 9661 of the American Rescue Plan 
Act of 2021 in the order of priority specified in divisions (a) to (d).
C.  Funds in the fund may not be used to pay for state contributions toward the medical 
assistance program established pursuant to 42 United States Code, Chapter 7, 
Subchapters 19 and 21.
D.  The commissioner shall monitor expenditures of the fund and, in consultation with 
the superintendent, take measures necessary to ensure solvency of the fund. 
5.  Rulemaking.  The commissioner shall adopt rules for the proper administration of 
the fund.  By December 31, 2021, the commissioner shall adopt rules to implement 
subsection 4, paragraph A.  Rules adopted pursuant to this subsection are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.
§4330-A.  Health care affordability assessment
1.  Assessment.  A covered entity shall file with the superintendent a report of its net 
written premiums for the preceding year by no later than April 1st of each year.  The 
superintendent shall calculate and issue to the covered entity a certified assessment, which 
must be equal to 2.85% of the covered entity's net written premiums but may not exceed 
the amount the covered entity would have paid under Section 9010 of the federal 
Affordable Care Act if that section were in effect during that year, and the covered entity 
shall pay the assessment.
2.  Deposit to the fund.  The superintendent shall deposit all proceeds of the 
assessment to the fund.
3.  Rulemaking.  The superintendent shall adopt rules as necessary for the proper 
administration and enforcement of this section.  Rules adopted pursuant to this subsection 
are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
4.  Technical assistance from other state agencies.  Upon the request of the 
superintendent or commissioner, state agencies, including the bureau, the Department of 
Administrative and Financial Services, Bureau of Revenue Services and the Maine Health 
Data Organization, shall provide technical assistance and expertise for the administration 
of the fund or assessment.
§4330-B.  Affordable Health Care Advisory Group
1.  Established.  The Affordable Health Care Advisory Group is established for 
consultation with the superintendent and the commissioner on the development of rules to 
implement this subchapter and on the activities and initiatives funded through the fund.  
The superintendent and commissioner shall convene the advisory group no later than 
October 1, 2021.
2.  Membership.  The advisory group consists of 13 voting members, including the 
superintendent, the commissioner and 11 members appointed as follows.
A. The President of the Senate and the Speaker of the House of Representatives shall 
each appoint 4 members and the Governor shall appoint 3 members, including:
(1)  A representative of nonprofit insurers;
(2)  A representative of for-profit insurers who provide insurance on the exchange;
(3)  A representative of small businesses and self-employed individuals; 
(4)  A representative of consumers with low incomes; 
(5)  A representative of the Health Insurance Consumer Assistance Program under 
section 4326; 
(6)  A representative of navigators, as defined in section 2188, subsection 1, 
paragraph B; 
(7)  A representative of a certified application counselor designated organization 
that has been designated by the Department of Health and Human Services; 
(8)  A person with experience in analyzing health data and the economic impact of 
health coverage on the economy; 
(9)  A representative of workers in the State or organized labor; 
(10)  An academic research professor with expertise in health care coverage; and
(11)  A representative from a hospital.
3.  Duties.  The advisory group shall: 
A.  Identify barriers to accessing affordable health insurance coverage for residents of 
the State, including those with household incomes at or below 200% of the federal 
poverty level;
B.  Determine the most efficient and effective mechanisms to deliver assistance under 
section 4330, subsection 4, paragraph A;
C.  Determine the level of assistance under section 4330, subsection 4, paragraph A 
needed to make health insurance coverage affordable; and
D.  Establish outcome measures to evaluate the success of the activities and initiatives 
under this subchapter.
4.  Reporting.  The commissioner shall submit a report annually by February 1st to the 
Governor and the joint standing committee of the Legislature having jurisdiction over 
health insurance matters that describes the activities and initiatives funded by the fund to 
increase the affordability of health insurance for residents of the State and summarizes the 
advisory group's findings and recommendations related to barriers to affordable health 
coverage for residents of the State and how to improve the affordability of coverage options 
available on the exchange.  This commissioner shall publish the report on the publicly 
accessible website of the Department of Health and Human Services.
SUMMARY
This bill:
1.  Establishes the Maine Health Care Affordability Fund to fund activities and 
initiatives to reduce the cost of health insurance coverage for Maine residents;
2.  Requires the Commissioner of Health and Human Services to adopt rules for 
the administration of the Maine Health Care Affordability Fund and for the disbursement 
of funds from the fund to assist Maine residents with the cost of health care coverage;
3.  Establishes the health care affordability assessment to provide funding to the 
Maine Health Care Affordability Fund and requires the Superintendent of Insurance within 
the Department of Professional and Financial Regulation to adopt rules for the 
administration and enforcement of the health care affordability assessment;
4.  Requires state agencies to provide technical assistance to the commissioner and 
the superintendent for the administration of the Maine Health Care Affordability Fund or 
the health care affordability assessment upon request;
5.  Establishes the Affordable Health Care Advisory Group, which consists of the 
commissioner, the superintendent and 11 additional members appointed by the President 
of the Senate, the Speaker of the House of Representatives and the Governor, to consult on 
the development of rules to implement and administer the Maine Health Care Affordability 
Fund and the health care affordability assessment; and
6.  Requires the commissioner to submit an annual report to the Governor and the 
joint standing committee of the Legislature having jurisdiction over health insurance 
matters describing activities and initiatives funded by the Maine Health Care Affordability 
Fund to increase the affordability of health insurance for Maine residents and summarizing 
the findings and recommendations of the Affordable Health Care Advisory Group by 
February 1st.  The commissioner is also required to make the report publicly available 
online.