Maine’s Obamacare Paradox

The recent 3rd annual Health Care for Maine conference (or “HC4ME” for those of you who love acronyms) assembled health care providers, social service agencies, advocacy organizations and other partners who have been on the front lines of the implementation of the Affordable Care Act (ACA) in Maine.    

I participated in this conference in its first two years in my role as the coordinator of the statewide ACA enrollment navigator project, but this time I was there as the newest member of the MeHAF staff.

This year’s event was a chance for those who educate Mainers about the law and assist people with enrollment in ACA health coverage to reflect on their progress over the last two years and to plan for the next health insurance Marketplace open enrollment season that kicks off November 1st.

A look back on the first two years of the health insurance Marketplace gave the group a lot to celebrate.  Thanks in large part to the HC4ME attendees, Maine has consistently been one of the top states in the nation in per-capita Marketplace enrollments.  

Since 2010, MeHAF has supported the efforts of many of the HC4ME participants who were instrumental in that outreach and enrollment push.  Their commitment to working and learning together, in combination with tireless efforts on the ground, has put Maine ahead of the curve in many respects when it comes to the ACA.

At the same time, a look forward gave HC4ME attendees a sense of some big challenges still to come.  In fact, on the same day as the conference, the Maine Center for Economic Policy released an analysis of U.S. census data suggesting that despite Maine’s stellar Marketplace enrollment numbers, we are the only state in the country that hasn’t seen a drop in its rate of people who are uninsured since the passage of the ACA in 2010.

No, that’s not a misprint.  It’s Maine’s Obamacare paradox.  We are a national leader in ACA signups and the only state without an overall increase in coverage rates since the law passed.

How can that be?  

This perplexing trend reflects Maine’s decisions about our Medicaid program.  While thirty states have accepted federal funding made available in the ACA to provide health coverage through Medicaid, Maine has actually reduced eligibility for Medicaid, dropping roughly 35,000 Mainers from the program. The remarkable gains achieved in Marketplace enrollment have yet to outweigh the coverage losses inherent in this Medicaid retraction.  

Yet a recent state budget analysis by Manatt Health Solutions demonstrated that reversing this decision and expanding Medicaid could save the state nearly $27 million and expand coverage at the same time.

When I worked as an outreach and enrollment navigator, I helped hundreds of Mainers in-person as they attempted to access Marketplace coverage.  In that time, I saw both sides of our paradox.  On any given day, I might have seen a client awash in the relief that comes with finally being able to afford health coverage.  Or, I might have seen the despair and bewilderment of a client who is left with no reasonable coverage options because their income is too low for Marketplace subsidies and they don’t qualify for Medicaid, leaving them in Maine’s dreaded Medicaid coverage gap.  Most of the HC4ME attendees have similar stories from their work with clients over the last two years.

Has your work brought you in contact with one or both sides of our Obamacare paradox?  Use the comment section to share your experience.


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