Affordable Care Act enrollment is down so far in Maine and across the country, compared to last year’s sign-up period. But in Maine, at least part of the downturn can be attributed to Medicaid expansion, because thousands with ACA insurance are being transitioned to Medicaid.

Through Nov. 30, 16,613 Mainers signed up for ACA insurance, according to federal data released on Wednesday, down from 23,809 during the same time period in 2018.

“Medicaid expansion is a new dynamic,” said Eric Cioppa, superintendent of the Maine Bureau of Insurance. “Hopefully, (ACA enrollment) will pick up.”

Through Nov. 22, more than 42,000 Mainers have insurance through Medicaid expansion, although that number includes people who were eligible for ACA insurance as well as those who were not. When the ACA was implemented in 2013, for states like Maine that didn’t expand Medicaid, those earning between 100 percent and 138 percent of the federal poverty level – or $20,780 to $28,676 for a family of three – would be eligible for ACA insurance but not Medicaid.

Once Maine expanded Medicaid in January, those in that 100-138 percent category were no longer eligible for ACA insurance, but would be referred to the Maine Department of Health and Human Services for potential enrollment in Medicaid.

Although there aren’t any official numbers yet of people moving from ACA insurance to Medicaid, the Kaiser Family Foundation estimates that in Maine it could be between 5,000 and 9,000 people.

“We have affordable insurance in Maine,” said Jeanne Lambrew, Maine’s health and human services commissioner. “Premiums this year (for 2020 coverage) are less than last year. Sixty percent can find a plan that has a premium of $10 or less per month.”

Lambrew said one indicator is that there’s been a surge in Medicaid applications since Nov. 1 – corresponding to when ACA enrollment began – but it’s unknown right now how many of the new applicants are those who are being switched to Medicaid from an ACA plan.

Even if ACA enrollment for 2020 continues to be lower than for this year, about 60,000 or more people are likely to sign up for ACA insurance, based on past enrollments. Currently, about 71,000 have ACA insurance in Maine.

People started signing up for ACA insurance on Nov. 1, and the enrollment period continues to Dec. 15 on www.healthcare.gov. Also, Maine has created its own websites to help inform people about coverage options, including www.coverme.gov and www.enroll207.com.

Kate Ende, policy director for Augusta-based Consumers for Affordable Health Care, said a number of factors may be suppressing enrollment so far, in addition to Medicaid expansion. In the first few days of open enrollment this year, healthcare.gov did not work very well, while the website worked much better at the start of open enrollment in 2018. Also, it’s possible that a higher percentage will wait until the last two weeks to sign up, or more people will be automatically renewed for 2020. Those who had a plan in 2019 are automatically renewed with the same plan for 2020 if they don’t make a new selection.

“These last two weeks, the final push, are really important. Half of people selected a plan during the last two weeks of open enrollment last year,” Ende said.

Bill Whitmore, vice president and market lead in Maine for Harvard Pilgrim Health Care insurance, said he’s optimistic about enrollment this year, and he believes the bulk of the decrease in Maine is caused by Medicaid expansion. Harvard Pilgrim customers will see a 7 percent premium decrease in 2020.

“Because premiums have decreased, it shouldn’t be a financial decision for people to exit the marketplace,” Whitmore said. But he said it’s difficult to tell because so much of the enrollment happens during the final 10 days before the deadline.

Meanwhile, the Trump administration has slashed outreach and marketing efforts by 90 percent. President Trump opposes the ACA, which he inherited from former President Barack Obama, but Trump failed to garner enough votes to repeal the ACA. Since Trump took office in 2017, ACA enrollment has declined from 12.7 million to 11.4 million nationwide.

In Maine, the Trump administration’s marketing cutback has been partially alleviated by a $750,000 grant from the Robert Wood Johnson Foundation to boost enrollment.

Maine currently is considering switching from a federally run ACA marketplace to a state-run marketplace in 2021, which among other changes would unlock about $2 million in federal money for outreach and marketing in the state.

“That will really ensure people will hear clear communications about the value of coverage,” said Lambrew, a former Obama administration health official who assisted in federal ACA implementation.

Ende said the ACA has survived and thrived despite persistent efforts to repeal it.

“Ever since it passed there’s been countless efforts to overturn or weaken the ACA, but now it’s become foundational to our health care coverage system,” Ende said.