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Maine health insurance

While others close, Maine's CO-OP stands alone in the black

Learn what measures are driving Maine’s “healthiness” rankings and understand how the prevailing political leanings continue to affect the state’s implementation of the Affordable Care Act.

Maine health ratings

Maine ranked 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.

The 2014 edition of America’s Health Rankings also provides state-by-state health rankings based on measures related to Behaviors, Community & Environment, Policy, Clinical Care, and Outcomes. In this latest edition, Maine ranked 20th, down four spots from16th in 2013. The state faces several health challenges including limited availability of dentists, high percentage of children in poverty, and low immunization coverage among children.

Maine’s health-related strengths include low rates of violent crime and low birthweight as well as a high rate of high school graduation. The state has seen a 16 percent decrease in drug deaths in the past two years.

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.

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.

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 enrollment in qualified health plans

More than 44,000 Maine residents signed up for qualified health plans (QHPs) 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 the 2015 open enrollment period, 74,805 people selected QHPs through Maine’s federally facilitated exchange—47 percent of them were new enrollees. As happens nationwide, some of these individuals dropped their coverage or failed to make initial premium payments. By June 30, effectuated enrollment was 66,628. Of those remaining enrollees, 88.6 percent were in plans with advanced premium tax credits and 57.5 percent were receiving cost-sharing subsidies.

When 2016 open enrollment began November 1, three carriers offered exchange plans to Maine residents:

  • Community Health Options, a CO-OP
  • Anthem BCBS
  • Harvard Pilgrim Health Care.

The average benchmark plan premium in Maine is 1.2 percent less expensive than 2015.

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

During the ACA’s 2015 open enrollment period, about 5,327 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.

By the time 2016 open enrollment began, 11 CO-OPs had announced their closure. In an HHS report published in July 2015, Community Health Options was the only CO-OP with a positive net income in 2014.

State-based health reform legislation

Here’s a summary of recent Maine legislation related to healthcare reform:

In mid-June 2015, Maine lawmakers passed LD384, a bill to study ACA-compliant options for universal healthcare in Maine. However, Gov. LePage vetoed the bill on June 26. Lawmakers tried but failed to override his veto.

Medicare in the state of Maine

Maine Medicare enrollment reached 304,263 in 2015, about 22.8 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 77 percent individuals who qualify based on age alone and 23 percent who qualify as the result of a disability.

Maine spends about $8,821 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 22.8 percent of Maine Medicare beneficiaries choose Medicare Advantage compared with 32 percent nationwide. Forty-nine percent of Medicare beneficiaries in Maine have a Medicare Part D plan for stand-alone prescription drug coverage. This number is slightly higher than the national average of 43 percent.