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Maine health insurance

Maine ranked #7 on health scorecard, ACA seems to be helping

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Learn what measures are driving Maine’s “healthiness” rankings and understand how the prevailing political leanings affected the rollout of the Affordable Care Act in the state.

Maine health ratings

Maine ranks 7th in overall health on the 2014 Scorecard on State Health System Performance, improving from 9th in 2009. The scorecard, compiled by The Commonwealth Fund, compares the states and the District of Columbia on health-related measures. See how Maine scored on about 40 measures in the categories of Access, Prevention & Treatment, Avoidable Hospital Use & Cost, Healthy Lives, and Equity.

America’s Health Rankings, most recently published in 2013, also provides state-by-state health rankings based on measures related to Behaviors, Community & Environment, Policy, Clinical Care, and Outcomes. Maine ranked 16th in 2013, down one spot from the previous year.

Highlights for Maine include a low violent crime rate and a low percentage of people without health insurance. Health-related challenges include a high rate of binge drinking, a high rate of cancer deaths, and limited availability of dentists.

Yet another resource for public health information is the 2014 edition of Trust for America’s Health. You will find scores on various health measures for Maine and the other states.

Finally, the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin have created a tool with county-level health rankings for Maine.

Maine and the Affordable Care Act

When Congress voted on the Affordable Care Act in 2010, Maine’s senators voted against the measures, while its two representatives voted for it. Sen. Susan Collins, Rep. Chellie Pingree, and Rep. Michael Michaud remain in office. Sen. Olympia Snowe retired in 2013, and Sen. Angus King now represents Maine. King is generally supportive of the Affordable Care Act.

In both 2011 and 2012, the Maine legislature considered bills to establish a state-run health insurance marketplace. However, the bills were not passed. Gov. Paul LePage, a Republican, announced in late 2012 that Maine would default to the federally facilitated exchange. LePage is firmly opposed to the ACA. In addition to opposing a state-run marketplace, he repeatedly vetoed legislation to expand Medicaid. LePage is facing current U.S. Rep. Michael Michaud in the November 2014 gubernatorial election.

Is the ACA affecting the uninsured rate in Maine?

Following the national trend, the uninsured rate in Maine dropped after the ACA’s individual mandate went into effect.

In 2013, Maine’s uninsured rate was 16.1 percent according to Gallup. The rate dropped to 13.3 percent as of mid-2014. Nationally, the uninsured rate dropped 3.9 percentage points to 13.4 percent as of mid-2014.

Maine enrollment in QHPs

More than 44,000 Maine residents signed up for a qualified health plan (QHP) during the ACA’s initial open enrollment period. That figure translates to about 36 percent of the estimated eligible market in Maine, more than the national average of 28 percent.

During 2015 open enrollment, individuals shopping on the exchange will have additional choices. Harvard Pilgrim Health Care is joining Anthem Blue Cross & Blue Shield and Maine Community Health Options in selling policies through the marketplace. Aetna is also entering the individual market in Maine, but it is only selling polices off the marketplace in 2015.

Preliminary filings from the marketplace insurers suggest rates will increase for 2015, but only modestly.

Medicaid and Medicaid Expansion

According to the Kaiser Family Foundation, 38,000 Mainers are excluded from Medicaid given the state’s decision against expanding the federal-state health insurance program for low-income residents. Kaiser also estimates that 24,000 people are in the coverage gap, meaning they don’t qualify for Medicaid or for premium subsidies to help offset the cost of purchasing a QHP policy through the marketplace.

Without Medicaid expansion in Maine, non-disabled adults without dependent children are not eligible for coverage. Parents of dependent children qualify for Medicaid if their household income is under 105 percent of the federal poverty level – about $20,500 for a family of three.

During the ACA’s 2014 open enrollment period, about 7,100 Maine residents qualified for Medicaid or the Children’s Health Insurance Program (CHIP) based on the state’s existing eligibility criteria.

Visit the MaineCare website for information about Maine’s Medicaid programs.

Other ACA reform provisions

The Consumer Operated and Oriented Plan (CO-OP) Program was included in the Affordable Care Act to increase competition and consumer choice. Twenty-four CO-OPs, including Maine Community Health Options, received loans totaling $2.09 billion as of January 2014. Maine Community Health Options received about $64 million.

While some CO-OPs have struggled to attract new members, Maine Community Health Options fared much better. About 80 percent of individuals shopping on the marketplace selected a plan from Maine Community Health Options.