Early indicators show that Affordable Care Act enrollment for 2019 is down significantly in Maine compared with 2018, when sign-ups in the state led the nation in terms of a percent increase from the previous year.

The change is a sign that the move by congressional Republicans in late 2017 to eliminate the federal income tax penalty for those without health insurance could be contributing to the decline in new sign-ups. Other factors also may be at play, including the Trump administration’s unwillingness to promote ACA insurance, and reduced media coverage because of elections, scandals and other big national stories.

According to the U.S. Centers for Medicare and Medicaid Services, net enrollment in ACA-compliant individual health insurance plans in Maine totaled 13,669 sign-ups from Nov. 1 through Nov. 17, a decrease of over 31 percent from the 19,880 sign-ups that occurred during Nov. 1-18 in 2017. The decrease is mitigated slightly by the fact that there was one additional day of sign-ups included in the 2017 data.

Still, it indicates a sharp decline following a year in which Maine saw a 72 percent spike in ACA sign-ups over 2016 in the early weeks of open enrollment. The ACA open enrollment period stretches from Nov. 1 to Dec. 15 in most states, including Maine.

“What we are seeing with early data is very concerning,” said Lori Lodes, founder of pro-ACA advocacy group Get America Covered and a Centers for Medicare and Medicaid Services official during the Obama administration.

Nationally, ACA net enrollment totaled about 1.9 million sign-ups from Nov. 1-17, down about 17 percent from the same period in 2017. Net enrollment includes both new sign-ups and active plan renewals, but does not include automatic renewals.

WHY SO LOW?

Before 2018, all U.S. taxpayers faced a penalty under the ACA’s “individual mandate” if they did not submit proof of health insurance coverage when filing their federal income tax returns. Health policy experts said the mandate brought more healthier and younger people into the insurance pool, keeping premiums in check.

But the tax reform bill approved by the Republican-led Congress in December 2017 included a measure that effectively eliminated the mandate.

Lodes said, however, that the elimination of the individual mandate may not be that big of a contributor to the enrollment decrease. She said the more likely factors are the Trump administration’s refusal to promote the ACA and a relative lack of media coverage for open enrollment this year.

“I think you have a lot of different factors coming together to bring enrollment down,” Lodes said, adding that lack of awareness is probably foremost among them.

Lodes said post-Thanksgiving enrollment data, particularly the numbers released in the first week of December, will provide a more accurate picture of how this year’s ACA enrollment stacks up to previous years.

Kevin Lewis, president and CEO of Lewiston-based ACA health insurer Community Health Options, said the decrease in enrollment is not a cause for concern at this point.

“It still feels early in the process, and we expect much greater activity in the remaining three weeks of open enrollment,” he said. “This is similar to prior years when engagement in open enrollment ramped up just after Thanksgiving. In any event, we are seeing a steady stream of new enrollment.”

Lewis said the most popular plans for 2019 continue to be the lower-cost “bronze” plans, which generally cover about 60 percent of a patient’s medical costs. Plans that provide extra coverage for chronic illnesses and prescription drugs also are proving popular with consumers in Maine this year, he said.

In 2017, ACA insurers responded to the Trump administration’s elimination of so-called cost-sharing reduction subsidies by dramatically increasing the price of their “silver” plans, which generally cover about 70 percent of a patient’s costs. Before that tactic, which has become known as “silver-loading,” silver plans had been the most popular among consumers because they were the most highly subsidized.

Through silver-loading, insurers were able to keep prices relatively stable for plans in the other tiers: bronze, gold and platinum. When prices for silver plans spiked in 2017, many consumers shifted to the lower-cost bronze plans.

“Right now there are bronze level plans in Maine that cost zero dollars,” Lodes said. “I just don’t think people know about it.”

NO BIG PRICE HIKES

Nationally, the roughly 9 million Americans covered under the Affordable Care Act are expected to see only modest premium increases in 2019, and some will even get price cuts.

In Maine, the federal government approved a request by the Maine Bureau of Insurance in July to relaunch its $93 million reinsurance program, known as the Maine Guaranteed Access Reinsurance Association, which will help reduce premiums for individual insurance on the ACA marketplace.

The Centers for Medicare and Medicaid Services granted a waiver that permits the state to diverge from the normal rules set up by the ACA for insurance. The waiver will be effective from 2019 through 2023. Maine previously had operated a reinsurance program, but it was shelved in 2013 after the ACA went into effect.

The average rate increase for Harvard Pilgrim Health Care’s ACA-compliant individual insurance coverage in Maine will be 4.6 percent with reinsurance in 2019, but it would have been 9.5 percent had reinsurance not been approved. Community Health Options requested a 6.9 percent increase with reinsurance compared with a 9.2 percent hike without the reinsurance program. In the end, the company only increased its rates by an average of 0.9 percent.

Anthem Blue Cross Blue Shield said in its June filings that it would resume offering coverage on the Maine ACA marketplace in 2019 if the reinsurance program was approved. Anthem had exited the Maine marketplace and did not offer individual plans for 2018.

J. Craig Anderson can be contacted at 791-6390 or at:

canderson@pressherald.com

Twitter: jcraiganderson

This story was updated at 11 a.m. on Nov. 28, 2018 to clarify the Community Health Options rate increase.