Janet Mills Wants Maine To Step Toward Running Its Own ACA Exchange

Gov. Janet Mills announced on Thursday that she will lead a 2020 push for Maine to begin managing parts of its own health insurance marketplace under the Affordable Care Act in what could be a step toward a fully state-run exchange.

It would make Maine the sixth state to partner with the federal government in this way to run its exchange, where individuals, families and small businesses can shop for health insurance plans. The exchanges were a major part of the 2010 law, and the people who use them often qualify for income-based subsidies.

Mills, a Democrat, has increased Maine's participation in the Affordable Care Act after succeeding Republican Paul LePage in January. She expanded Medicaid under the law before the end of her first day in office to adults with incomes up to 138 percent of the federal poverty level, and nearly 36,000 people were covered under it as of last week.

The state has oversight of plans offered on the exchanges, but people in Maine and 27 other states rely on the federal government and their Healthcare.gov portal to buy them, according to the Kaiser Family Foundation. Nearly 71,000 Mainers enrolled in exchange plans in 2019.

Under Mills' proposed move, which would require legislative approval in 2020 and begin in 2021, Mainers would still rely on that portal, but the Maine Department of Health and Human Services said the state would have greater control over public education, marketing and consumer assistance under the law that would be paid for by increased federal funding.

The department said the state will explore running its own exchange -- as 12 states do -- in the future. Mills said in a letter to the federal government released by her office on Thursday that the transition to the state-run exchange could happen as soon as 2022.

"Enrolling more people, especially younger and healthier individuals, will improve the market and can lead to lower premiums for all enrollees" Mills said at a health care forum in South Portland on Thursday. "That's the major goal."

Maine's exchange suffered a blow in 2017, when the insurance giant Anthem left the market, citing the increasing costs of covering state residents and a dwindling population. But it re-entered the market in 2019 after the federal government approved a state reinsurance plan that helps defray the costs to insurers of covering patients with extensive medical needs.

Several factors -- including higher premiums and uncertainty about the Affordable Care Act -- led the number of Mainers in the exchanges to decline from a high of 84,000 in 2016, according to HealthInsurance.org. Medicaid expansion is expected to lead to further decreases.

The National Academy for State Health Policy found states that run their own exchanges grew enrollment slightly on average in 2019, while those that rely on the federal government dropped by 3.7 percent over the past year. They also saw lower premium increases attributed to outreach work, reaching younger customers and specific policies such as reinsurance.

Sen. Robert Foley, R-Wells, who serves on the Legislature's health insurance committee, was noncommittal on the move in a statement, saying he hoped "we will receive more detailed information from the governor about her plans" and "if we are asked to take part in future discussions and forums, we will be able to offer a more complete opinion of the administration's plans."

"Affordable, available health care with affordable insurance coverage is a top priority for me and I hope to be a part of any solution that benefits Maine's small businesses and families," he said.

This story will be updated.

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