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Maine health insurance exchange / marketplace

Weighted average proposed rate increase no more than 1.5%; CO-OP thriving; Governor vetoes universal healthcare study

Weighted average proposed rate increase no more than 1.5 percent

Things are looking pretty good in Maine as far as health insurance premiums go.  The three carriers in the exchange have requested the following rate changes for 2016:

  • Community Health Options = 0.5 percent increase (about 80 percent of the market share in the exchange)
  • Anthem BCBS = 5.7 percent increase (“most” of the remaining market share)
  • Harvard Pilgrim Health Care = 4.8 percent decrease

At ACAsignups, Charles Gaba crunched the numbers and came up with a weighted average proposed rate increase of just 0.7 percent, assuming that Anthem has 12 percent of the enrollees, and Harvard Pilgrim has the other 8 percent.  Even if Anthem has 19 percent of the enrollees and Harvard Pilgrim has just one percent, the weighted average proposed rate hike is still only 1.45 percent.’s rate review tool only displays proposed rate increases of ten percent or more, and only one plan – an Anthem small group, off-exchange plan – shows up on the list for Maine.

CO-OP thriving

Maine is one of 23 states where a CO-OP health plan was established under the ACA.  Two have not survived: CoOpportunity (Iowa and Nebraska) closed in early 2015, and Louisiana’s CO-OP announced in July that it would wind down its operations by the end of 2015.

An HHS report published in July analyzed the financial and enrollment status of the CO-OPs, and Maine’s (Community Health Options) stood out as the only one with a positive net income in 2014.  Community Health Options also exceed enrollment expectations in 2014, enrolling 257 percent of their projected 2014 target.

In 2014, one one other carrier – Anthem – competed with the CO-OP for individual enrollments on the Maine exchange, and the CO-OP garnered about 83 percent of the enrollments.  In 2015, Harvard Pilgrim joined the exchange, but even with two competitors, Community Health Options still got about 80 percent of the 2015 enrollments.

Universal health care study vetoed

In Mid-June, Maine lawmakers passed LD384, a bill to study options for universal health care in Maine that would be compliant with the ACA.  The bill calls for consultants to develop at least three ACA-compliant universal health care designs and submit them to the legislature by December 2016.   It also makes available $100,000 in federal grant money for the study, to be dispersed by the end of June 2016.  The final proposal must include at least one of each of the following models:

1.  A government-funded single payer system that only allows private health insurance to cover supplemental benefits, with no private coverage available for benefits covered by the single-payer system.

2.  A government administered that incorporates integrated health care delivery and payment.

3.  A “public health benefit option” run by the state, but with the option for people to select either the public option or private health insurance.

But Governor Paul LePage was unimpressed with the legislation, and vetoed it on June 26.  In his veto, LePage called the bill “one of the least Republican measures I have seen during my tenure as Governor,” and a “charade.”  He also expressed the opinion that government-run healthcare is a “fiscal folly” and reminded lawmakers of Vermont’s failed efforts to enact a single-payer system.
LePage has been at odds with Democratic lawmakers recently, announcing in May that he would veto every bill sponsored by a Democrat unless the Democrats agree to LePage’s proposal to amend the state constitution to eliminate Maine’s income tax.  So while a bill to generate proposals for universal healthcare is admittedly pretty far to the political left, it appears that any legislation sponsored by Democrats in Maine is currently needing a two-thirds majority (to override a veto) in order to pass.
Lawmakers did not have the votes to override LePage’s veto of LD384 (the final vote to override the veto was 18 in favor, 17 against).

2015 enrollment

A much larger percentage of eligible Maine residents opted to enroll in medical insurance through in 2015 compared to 2014. This year saw nearly 60 percent of eligible Maine residents (about 75,000 of 124,000) purchase coverage versus just 36 percent in 2014.  About 80 percent of them selected Community Health Options, an ACA-created CO-OP.

By the end of March, effectuated (in force, with premiums paid) enrollment through the Maine exchange stood at 68,037.  Nearly 90 percent are receiving premium subsidies, and 58 percent are receiving cost-sharing subsidies (available to reduce out-of-pocket exposure on silver plans for enrollees with incomes up to 250 percent of the poverty level).

Open enrollment for 2015 has ended, but individuals who get married, change jobs, or have another qualifying life event can also enroll in coverage outside the standard open enrollment period.  In addition, enrollment is year-round for those who qualify for Medicaid/CHIP, and for Native Americans.

Subsidies safe in Maine

The Supreme Court issued a ruling in King v. Burwell on June 25, and subsidies are now safe for 57,000 people in Maine, despite the fact that the state uses  Plaintiffs had argued that subsidies could only be provided by state-run exchanges, but their claim was rejected by the Court in a 6-3 ruling.  Had subsidies been eliminated, not only would premiums have skyrocketed for people losing subsidies (by an average of 383 percent), they would also have risen sharply for everyone in the individual market, including those who weren’t receiving subsidies in the first place.

Prior to the King v. Burwell ruling, the Maine Bureau of Insurance had confirmed that if the Supreme Court had eliminated subsidies in FFM states, Maine’s carriers would have had until July 24 to file new (presumably much higher) rates for 2016.  But since subsidies were upheld, state regulators are analyzing the rates that were filed in May, making sure they’re actuarially sound.  Final rates will be announced after the rate review process is completed, and open enrollment starts November first.

Higher tax penalty if you skip coverage

The penalty for not having insurance goes up this year. If you don’t qualify for an exemption, you’ll have to pay the higher of:

  • 2% of annual household income.
  • $325 per adult or $162.50 per child under 18.

This penalty calculator can help you figure out how much you may have to pay if you aren’t covered during 2015.

2015 rates and insurers

According to the Maine Bureau of Insurance, Maine Community Health Options (MCHO), Anthem Health Plan of Maine, and Harvard Pilgrim Health Care are offering about 40 individual polices through the exchange. These three insurers are also selling policies to small businesses through the SHOP exchange. Harvard Pilgrim is new to the Maine marketplace in 2015.

Aetna also sells health insurance in Maine, but is selling policies off the marketplace only. Mega, a Texas-based insurer, withdrew from the Maine market at the end of 2014.

Average premiums for 2015 are the same or slightly lower than 2014 rates. MCHO, which won a large percentage of 2014 enrollees, kept its rates flat for 2015. Anthem’s rates dropped an average of 1.1 percent.

Uninsured rate dropped after 2014 open enrollment

According to a Gallup-HealthWays survey, Maine’s uninsured rate dropped 4.5 percentage points between 2013 and 2014.

More than 44,250 Maine residents enrolled in qualified health plans (QHPs) during the 2014 open enrollment period. In addition to QHP enrollment, 7,103 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP). Ninety percent of those selecting a QHP qualified for subsidies to help pay the cost of their premiums, compared to 85 percent nationally.

History of the Maine marketplace

Maine’s health insurance marketplace is operated by the federal government. Gov. Paul LePage announced the state’s decision against a state-run model in November 2012. In a letter to then HHS Secretary Kathleen Sebelius, LePage said the Affordable Care Act has “severe legal problems” and state-run exchanges will be “actually controlled” by the federal government.

LePage’s administration did explore creating a state-run exchange. The governor appointed an advisory committee, and in September 2011 that committee recommended that Maine implement a state-run exchange. The committee also issued recommendations as to how the exchange should be structured and governed. However, Maine ultimately joined the Supreme Court case that attempted to overturn the Affordable Care Act, and the state legislature failed to pass exchange legislation in both 2011 and 2012.

No Medicaid expansion

Maine is the only state in the north-eastern US that has not expanded Medicaid.

Democrats in the Maine Legislature pushed for Medicaid expansion during the 2014 session, but could not overcome Gov. LePage’s ongoing opposition on the issue. LePage has vetoed five Medicaid expansion bills. The November election offered hope for a turnaround on Medicaid expansion, with two challengers supporting expansion and LePage was considered vulnerable. However, LePage was returned to office.

Maine has provided Medicaid coverage to low-income young adults age 18 – 20 since 1991, but LePage had proposed eliminating coverage for 19 and 20 year old non-disabled adults as a way to save the state $3.7 million in Medicaid costs.  A federal appeals court prevented that change in late 2014, and in June 2015, the Supreme Court declined to hear Maine’s case.  As a result, 6,500 young adults in Maine will be able to keep their Medicaid coverage.

Maine health insurance exchange links


State Exchange Profile: Maine
The Henry J. Kaiser Family Foundation overview of Maine’s progress toward creating a state health insurance exchange.

Maine Quality Forum

 Maine Bureau of Insurance – Federal Health Care Reform