Obamacare enrollment in Maine drops slightly, but more people get health coverage

January 25—The number of Mainers enrolled in health insurance coverage through the Affordable Care Act has dropped slightly this year. But overall, the state tends to have more people covered by health insurance in one way or another, either through the ACA, Medicaid, Medicare, or a employer-based plan.

Maine’s uninsured rate fell from 8% in 2019 to 5.7% in 2021, according to the most recent data released last fall by the US Census, with experts attributing much of the decline to the expansion of Medicaid.

Enrollment in the ACA Individual Plan in Maine grew from 66,095 in 2022 to 63,388 in 2023, according to state and federal data. Nationally, a record 16.3 million people signed up for an ACA plan in 2023, after the Biden administration eliminated many of the program’s disincentives that deterred some people from enrolling.

Aaron Child, 41, of Damariscotta, who is self-employed and owns a tree service business, said he first took out ACA insurance three years ago. It has helped him gain peace of mind knowing he can go to the doctor without worrying about exorbitant medical bills.

“Before (the ACA), I was paying top dollar for rudimentary plans without any preventative or routine care,” Child said. “I was afraid to go to the doctor. But now these grants allow me to get great coverage at an affordable price.”

He said last year he used his insurance to attend to what he originally thought was a broken wrist and for tests linked to a cancer scare. After a sudden and unexplained weight loss, he ended up testing negative.

He said he didn’t hesitate to go to the doctor, when he could have done it before.

Child said 10 years ago, before the ACA was enacted, he was paying $400 a month in premiums for a health insurance plan that didn’t cover much, while he currently pays $110 per month for a plan that provides full services.

Mitchell Stein, a Maine-based independent health policy analyst, said Maine residents are benefiting from improvements to the ACA, including more generous grants.

But he said a combination of factors — such as the expansion of Medicaid — has caused enrollment in Maine’s ACA market to flatten in recent years.

Maine’s aging population also impacts ACA enrollment because when people reach age 65, they become eligible for Medicare and no longer have ACA insurance. Changes in the unemployment rate can also affect the ACA. While many ACA enrollees are self-employed, those who start working full-time with employer benefits become ineligible for ACA.

The ACA is designed to fill in the gaps for people who aren’t covered by an employer, such as the self-employed, small-business workers without insurance, or people who work part-time. Prior to the ACA, many people in these categories would have been left without any coverage.

“Registration changes are complicated,” Stein said. “Furthermore, all of these factors play out differently in each of the 50 states. We know that much of the national increase in enrollment has occurred in states that have not yet expanded Medicaid. Here in Maine, individual market listings have plateaued, given our current population and economic conditions.”

STABLE PROGNOSIS

Since 2020, ACA registrations have fluctuated between about 60,000 and 66,000 registrants, signifying stability in the market, Stein said.

Taking into account that stability, Stein said, is Maine’s participation in expanded federal Medicaid benefits, a program that was implemented in 2019 by Governor Janet Mills. This helped increase the number of people insured in Maine, but reduced ACA enrollment.

Maine people newly eligible for Medicaid under the expansion — those earning between 100% and 138% of the federal poverty level — have risen from zero enrollees in 2018 to 106,000 currently. The total number of Medicaid enrollments in Maine is approximately 408,000.

In 2019, the last year that people enrolling in an ACA plan the previous fall would not have been eligible for Medicaid under the expansion, ACA enrollment was 70,987. The year Next, with more people enrolled in Medicaid, ACA enrollment in Maine fell to 62,031.

Stein said if it weren’t for the Cut Inflation Now Act, more generous ACA subsidies that began in 2021, especially for high-income people who previously paid expensive ACA premiums but who now pay more reasonable monthly premiums, ACA enrollment in Maine may have actually declined significantly over the past two years. The new rules ensure enrollees pay no more than 8.5% of their income on health insurance premiums and also provided more generous subsidies to most ACA enrollees.

Child, owner of Apex Tree & Earthworx, said it’s helpful to know that if his business takes off, he won’t suddenly be forced to pay expensive bonuses.

“I know I’m not going to go broke paying for my health care,” Child said.

According to the Maine Department of Health and Human Services, 83% of enrollees received subsidies to make premiums more affordable, and 10,000 Mainers chose a plan where the monthly premium was less than $10.

Of those who signed up for individual plans, 21,157 chose a community health options plan, 20,618 chose an Anthem plan, and 20,157 chose a Harvard Pilgrim plan. Taro Health entered the market for the first time, selling only in Cumberland County, with 456 people choosing an individual plan. Taro Health plans to expand to other counties in 2024, company officials said. Taro Health primarily works with a network of direct primary care physicians.

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