Enrollment under the Affordable Care Act in Maine has increased by about 20 percent over last year and could climb even higher before the Jan. 31 deadline as consumers look to avoid the largest tax penalty since the law passed.

The U.S. Department of Health and Human Services reported Wednesday that 79,789 people in Maine had enrolled in health insurance plans under the Affordable Care Act from Nov. 1 through Jan. 16. Last year, 66,118 enrolled in Maine. The year before that, it was roughly 45,000. Of the total so far for 2016, more than 15,000 people have signed up for the first time.

“Yet again, Maine is seeing really high enrollment in the marketplace,” said Emily Brostek, executive director of Consumers for Affordable Health Care. “We’ve exceeded expectations each year.”

Nationally, 11.3 million individuals had enrolled through Dec. 26, including roughly 3 million new consumers, about 27 percent of the total.

Neighboring New Hampshire, which has roughly the same population as Maine, enrolled 50,737 through Dec. 26, including 22 percent who were first-timers.

Brostek said that if the past two years are an indication, Maine’s enrollment numbers for 2016 will spike from a late rush before the Jan. 31 deadline.

“There is usually a big crunch in the last week or two, whether from people who may not know the deadline or people who wait until the last minute,” Brostek said. “The (increased) penalty is certainly one of the things that’s bringing people through the door.”

The individual mandate and the penalty for non-compliance have long been among the more controversial components of the Affordable Care Act, but the government has been slow to ramp up the penalty.

In the first two years, fees were waived as consumers navigated the new law. Beginning in 2014, the penalty was $95 for an individual. Last year, that increased to $325 or 2 percent of household income, whichever was higher.

This year, the penalty will reach its plateau – $695 per adult and $347.50 per child, or 2.5 percent of household income, whichever is higher. After this year, the penalty will be adjusted only for inflation.

Alisha Keezer, a health navigator for the Maine Lobstermen’s Association, agreed that the penalty is driving new enrollees, some of whom might have bitten the bullet in previous years.

“For sure, I think that’s probably what’s driving people to call or enroll,” she said. “That’s a lot of money.”

Janice Daku, who oversees the state’s health care navigators and works for Western Maine Community Action, said she’s been “pleasantly surprised” by the number of enrollees.

“I think the penalty is one of the drivers,” she said. “Certainly, people last year who got that unpleasant surprise when they filed their taxes, they paid attention.

“But the other thing that may be coming into play is the message that it’s not just about avoiding a tax penalty, but about having coverage that meets your needs.”

The current number of enrollees in Maine represents about 64 percent of the 125,000 or so Mainers who are eligible. The marketplace is open to those who earn more than 100 percent of the federal poverty level, are under age 65 and cannot obtain insurance from their employer.

Maine has consistently ranked among the top states for enrollment percentage.

Females account for 54 percent of all enrollees in Maine, which mirrors the national percentage.

Broken down by age, 33 percent of Maine enrollees were under the age of 35, compared with 35 percent nationally, and 31 percent were between the ages of 55 and 64, compared with 27 percent nationally.

In Maine, 85 percent of ACA enrollees receive some sort of financial subsidy, slightly higher than the national rate of 82 percent.

While Maine’s enrollment numbers had been strong leading into 2016, a bit of news last month could have an impact.

Maine Community Health Options, the Lewiston-based cooperative, announced that it would not accept applications after Dec. 26. The move was driven by a $17 million loss in the first nine months of 2015 that was attributed to higher-than-anticipated medical costs among enrollees. The previous year, the company netted roughly $11 million.

Michael Gendreau, communications director for Maine Community Health Options, said in an interview Wednesday that his company was simply “pressing the pause button on enrollment,” to ensure that it can adequately serve existing customers.

“We’re confident that as we continue to diligently manage administrative costs and work with our members, we’ll be back selling individuals plans,” he said.

Many cooperatives – small nonprofits created to bring competition into the market – have struggled. An Associated Press analysis last month found that 12 of 23 created because of the ACA already have folded, and the rest are struggling financially.

With Community Health Options out of the picture, the only Maine options left on the ACA marketplace are through Anthem and Harvard Pilgrim.

“I thought that might be more of an issue,” Keezer, of the lobstermen’s association, said of Community Health Options’ decision. “They did have lower premiums. But affordable plans are still out there. There are still plenty of options.”

Daku, of Western Maine Community Action, said Anthem and Harvard Pilgrim both offer good choices for consumers, but she worried more about those who don’t qualify for subsidies and also don’t qualify for MaineCare.

“There is a growing coverage gap since Maine has not expanded Medicaid,” she said.

The issue of Medicaid expansion is expected to be revisited during the current legislative session. Some moderate Republicans have submitted a compromise bill, but Gov. Paul LePage is almost certain to veto it.

 


Only subscribers are eligible to post comments. Please subscribe or to participate in the conversation. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.