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Maine health insurance

ME holds on to ACA co-op, holds out on Medicaid expansion

2018 enrollment update

Maine overview

The only state in the northeast to say no to Medicaid expansion under the ACA, Maine has fared relatively well in implementing Obamacare. U.S. Census Bureau statistics show that the uninsurance rate in the state has dropped from 11.2 percent in 2013 to 8.6 percent in 2016.

Of the original 23 ACA-created co-ops, Maine’s was one of only a handful that continued into 2017. It is one of four selling plans for 2018.

The lion’s share of Maine’s federally facilitated exchange enrollees selected plans through Community Health Options in recent years, and CHO was the only cooperative in the country to turn a profit in 2014, when the ACA took effect. Seeking to recover money it claims it is owed by the U.S. Department of Health and Human Services, CHO filed a lawsuit against the federal government and a federal judge in December ruled the co-op can proceed with it.

Special enrollment period for Maine residents due to windstorms; Anthem enrollees also have a SEP

Open enrollment for 2018 coverage ended on December 15, 2017. But residents of Maine have until December 31 to enroll, due to the windstorms that swept the state in October 2017. Senator Angus King confirmed that Maine residents can request the special enrollment period (SEP) without having to provide any additional documentation to the exchange. The special enrollment period continues until December 31, and enrollees will have coverage effective January 1, 2018.

In addition, Maine residents who have coverage in the exchange from Anthem in 2017 are eligible for a special enrollment period during which they can select a replacement plan from Community Health Options or Harvard Pilgrim. Anthem is leaving the exchange at the end of 2017. Current exchange enrollees were mapped to replacement plans by the exchange if they didn’t pick a new plan by December 15. But they are also eligible for a special enrollment period. The SEP continues until March 1, 2018. And for Anthem enrollees who pick their new plan by December 31, the new coverage will take effect January 1. Those who pick a new plan after December 31 will have coverage under the plan that the exchange picked for them as of January 1, and the new plan will replace it on February 1 at the earliest.

2018 health insurance plans and rates

Maine’s individual health insurance market included three insurers offering coverage in 2017 – all statewide, but on Anthem announced in September that the carrier was leaving the exchange. The on-exchange carriers for 2018 include the following; their approved average rate changes are also listed:

  • Community Health Options: 17.5 percent
  • Harvard Pilgrim HMOs: 27.1 percent

Read more about rate increases and carriers in Maine.

Maine health ratings

Maine ranked 22nd in the 2016 edition of America’s Health Rankings, a seven-spot slide from 15th in 2015. The state performed well (5th) in the Community & Environment measure, but it performed at 20th for Policy as well as Clinical Care.

In 2015, the state placed 11th in overall on the Scorecard on State Health System Performance. The scorecard, compiled by The Commonwealth Fund, compares the states and the District of Columbia on health-related measures. Categories include Access, Prevention & Treatment, Avoidable Hospital Use & Cost, Healthy Lives, and Equity.

Maine ranked 16th in Access, performing better than the national average in number of uninsured adults, adults who went without care due to cost in the past year, at-risk adults without a routine doctor visit in the past two years, and adults without a dental visit in the past year. The state ranked 1st for Prevention & Treatment, with higher than average percentages of adults and children with a usual source of care and a medical home, adults and children with preventive care visits, and children who received key vaccines.

See Maine’s scorecard for additional details on its ranking.

Yet another resource for public health information is the 2015 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.

Is Obamacare 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 4.5 percentage points to 11.6 percent by the end of 2014. Nationally, the uninsured rate dropped 3.5 percentage points from 17.3 percent to 13.8 percent.

By mid-2015, Maine’s uninsured rate dropped another 6.7 percentage points to 9.4 percent, still better than the national uninsured rate of 11.7 percent and better than the 13.4 percent uninsured rate among other states that have not embraced the ACA (i.e., those that have not implemented a state-run marketplace or expanded Medicaid, or have only implemented one of those measures).

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. Olympia Snowe retired in 2013, and Sen. Angus King now represents Maine. King is generally supportive of the Affordable Care Act. Sen. Susan and Rep. Chellie Pingree remain in office. Rep. Michael Michaud, a Democrat, left office and was succeeded by Rep. Bruce Poliquin, a Republican, in 2015.

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 faced current U.S. Rep. Michael Michaud, a Democrat, and independent Eliot Culter in the November 2014 gubernatorial election. Both Michaud and Cutler supported Medicaid expansion. LePage was re-elected, ending hopes that the state might move ahead with expansion under a new governor. However, residents of Maine approved a 2017 ballot measure to expand Medicaid. Finding funding for it will be a priority for state lawmakers when the legislative session commences in January.

Maine Medicaid Expansion

According to the Kaiser Family Foundation, 38,000 people from Maine were excluded from Medicaid given the state’s decision against expanding the federal-state health insurance program for low-income residents. However, on November 7, 2017,  voters in Maine approved a ballot measure to allow 80,000 additional Maine residents to be able to qualify for Medicaid. Lawmakers still have to determine how to fund the state’s portion of the cost of expansion, and that’s likely to be a priority for lawmakes during the 2018 session.

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 less than 105 percent of the federal poverty level – about $20,500 for a family of three.

During the ACA’s 2016 open enrollment period, about 5,414 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.

As of September 15, 2016, all but six Obamacare CO-OPs had announced their closure. Maine’s CO-OP, which has been renamed Maine and New Hampshire Community Health Options, was not among them. However, enrollment in CHO’s individual plans is currently frozen. The plan has requested an average rate increase of 22.8 percent for 2017.

In an HHS report published in July 2015, Community Health Options was the only CO-OP with a positive net income in 2014. That was not the case in 2015.

The carrier ended 2015 with $74 million in losses, and Maine’s Insurance Superintendent proposed putting the CO-OP in receivership and cancelling a portion of its plans. CMS did not allow this action to be taken.

CHO has fared better in 2016. Claims were lower than expected, administrative costs were reduced, and the CO-OP did not have to draw down as much from reserves as anticipated.

Medicare in the state of Maine

Maine Medicare enrollment reached 306,420 in 2015, about 23 percent of the state’s total population. Nationwide, 17 percent of the population is enrolled in Medicare.

Maine’s Medicare enrollees have traditionally been about 80 percent individuals who qualify based on age alone and 20 percent who qualify as the result of disability. Maine spends about $7,678 annually per enrollee and ranks 38th in total spending on Medicare with $2.3 billion per year.

Maine’s Medicare recipients can choose a Medicare Advantage plan instead of Original Medicare. These plans offer some additional benefits beyond traditional Medicare, and about 22 percent of Maine Medicare beneficiaries choose Medicare Advantage compared with 32 percent nationwide. Fifty percent of Medicare beneficiaries in Maine have a Medicare Part D plan for stand-alone prescription drug coverage. Nationwide, 45 percent of Medicare enrollees have Part D.

State-based health reform legislation

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Your state’s Medicaid expansion, eligibility, contacts


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