As Congress battles over Obamacare, Mainers rush to sign up

Nov. 22--Despite ongoing political uncertainties, Mainers appear to be signing up at a good clip for health insurance plans offered through the Affordable Care Act, as well as for subsidies that make those plans affordable.

The open enrollment period for the ACA, also called Obamacare, began on Nov. 1, as in years past. But this year, among other limits imposed on the ACA under the Trump administration, it closes two weeks sooner, on Dec. 15. After that, consumers must wait another year or meet special requirements to apply, such as a job loss, divorce or death.

Mainers who procrastinate could find themselves without any coverage or stuck in health plans they can't afford or that don't meet their needs. Free help is available for the asking, but the experts who provide it are booking up.

Consumers may also sign up directly, at H ealthcare.gov or through the websites of the organizations that offer ACA plans. In Maine this year, those organizations are Community Health Options and Harvard Pilgrim Health Care.

The ACA provides private insurance options for Americans who don't have health coverage through their employers and who don't qualify for Medicaid or other government programs. Insurance plans are grouped in three tiers: basic-coverage bronze plans, more comprehensive silver plans, and benefit-rich gold plans.

The program is under intense political fire by most congressional Republicans, who claim it oversteps federal boundaries.

"A lot of people want to know if Obamacare even still exists," Kaylie Hess, who oversees the work of about 40 trained "assisters" at community health centers across the state, said. "Obviously it does."

Assisters also are available at hospitals, community action agencies and other organizations.

"We weren't sure what would happen with all the political stuff that's been going on, but we've been surprisingly busy," Hess said.

While some elements have changed this year, including steep increases in the monthly premiums of some plans, others remain the same, such as the subsidies for income-eligible enrollees that can help keep those plans affordable. In bronze plans, subsidies can bring some consumers' monthly bill to zero, though out-of-pocket spending may be high.

Those subsidies are available to households that earn up to 400 percent of the federal poverty limit -- that's about $48,000 for an individual and $98,000 for a family of four. Lower-income Mainers may also qualify for an additional subsidy that lowers out-of-pocket spending.

"We're chock-a-block full," Patrice McCarron, executive director of the Kennebunk-based Maine Lobstermen's Association, said. Specially trained staff there are helping members enroll in the office, on the phone and at special enrollment clinics up and down the coast, she said. Though many members go on to complete and submit their own applications, McCarron said staff have submitted at least 25 member enrollments each week this month. She said interest in the program continues to grow, despite ongoing efforts in Congress to dismantle it.

"We're not here to support or promote the ACA," she said. "It's just a tool to support our constituents," many of whom have lived for years without health insurance or with only catastrophic coverage to protect their assets.

"Once we work with a family, they get word to other families," she said. "We get a lot of referrals by word of mouth."

Nationally, ACA open enrollment is so far being hailed as a success, with higher than expected numbers of new enrollments and re-enrollments despite widespread concerns over the program's stability and its future.

As of Nov. 18, open enrollment had brought in nearly 2.3 million applications nationally, covering some 4.1 million consumers and their families. About 566,000 were new applicants while 1.7 million were renewing or re-enrolling, according to data from the Centers for Medicare and Medicaid Services. More than 8.1 million people had accessed the Healthcare.gov website for ACA information and assistance, or to file their applications.

In Maine, CMS reports 19,900 "plan selections" so far during 2018 open enrollment, a figure that does not include automatic re-enrollments or plans whose first-month premium has already been paid. Last year, about 79,500 Mainers were covered by an ACA plan, according to the Henry J. Kaiser Family Foundation, and most of those qualified for a subsidy.

But approximately 10 percent of Mainers in an ACA plan do not qualify for a subsidy, and for them, the decision to maintain coverage is more difficult.

Elizabeth Garber of Belfast said her silver plan is slated to rise from about $1,000 per month in 2017 to $1,450 per month for the coming year, a 45 percent increase that Garber, who is 64 and suffers from a chronic heart condition, calls "impossible." So for next year she has downgraded to a bronze plan, which will cost her about the same in 2018 as her silver plan cost in 2017.

"It's a $4,000 deductible plan that covers very little," she said. "My plan for the next year is to stay healthy, not see any doctors and pay $1,000 a month for the privilege."

About 29,000 Mainers were covered in 2017 by individual plans sold by Anthem, which is leaving the Maine ACA market in 2018. People enrolled in an Anthem plan will automatically be assigned to a similar plan with either Harvard Pilgrim Health Care or Community Health Options.

But Hess cautioned that all consumers should review their options carefully every year and not simply accept an automatic re-enrollment or re-assignment. In addition to premium costs, she said, consumers should check carefully on copays and other out-of-pocket spending requirements, participating provider networks and other factors.

Mike Gendreau, a spokesman at Community Health Options, said it's too early to report changing enrollment figures, but activity is generally on target for this stage in the process. In 2017, Community Health Options covered about 38,000 Mainers. For 2018, it will pick up a greater share as Anthem enrollees transfer their plans.

At Harvard Pilgrim Health Care, Ed Kane, vice president for operations in Maine, said open enrollment is proceeding smoothly, despite the political battle raging around Obamacare and the provisions of the ACA.

"The general uncertainty ... may have left a lot of people with the impression that the program is in tatters," he said. "It is not. The law is in place."

Harvard Pilgrim covers about 16,500 Mainers through marketplace plans and will build its business in 2018 as a result of Anthem's departure.

But Kane worries that the clock will run out on those who wait too long to start the re-enrollment process, which can be confusing and time-consuming.

"People who shopped on the exchanges a year ago or two years ago had twice as long," he said. "This year, it's all over on Dec. 15. It will be too late after the holidays."

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