Chris Welch, a Kennebunk lobsterman, had never purchased health insurance before the Affordable Care Act started offering individual marketplace insurance in 2013. He’s maintained the benefits ever since, even though as a healthy 28-year-old he doesn’t need to use his insurance that often.
Welch is among the thousands of people who work in Maine’s iconic lobster and fishing industries who could have their ACA insurance taken away if the law is repealed without a comprehensive replacement. Congress has set the wheels in motion to repeal the ACA, and lawmakers are debating whether to immediately replace it, and if so, with what plan. Lawmakers have yet to coalesce around a replacement plan, and the incoming Trump administration has not yet revealed a proposal.
There’s no exact count of how many fishermen or lobstermen have purchased ACA insurance, but U.S. Census data indicate robust enrollment in the industry.
Coastal communities with large numbers of self-employed workers have some of the highest percentages of residents signed up for ACA insurance, according to a ZIP code analysis of 2016 enrollment data from the federal government and workforce data from the U.S. Census.
For instance, on North Haven and Vinalhaven islands, both on the midcoast and known for the lobster industry, 22 percent and 21 percent of the people on each island, respectively, have ACA insurance, among the highest rates in the state. Forty-seven percent of Vinalhaven households include a person who is self-employed, while on North Haven it’s 38 percent, among the highest levels of self-employment in Maine.
Other coastal fishing communities with high ACA enrollment levels include Pemaquid, Round Pond, Beals and Brooklin.
The ACA’s individual marketplace was designed to be a place where those who can’t obtain insurance through an employer – such as a self-employed fisherman or a part-time worker – can purchase subsidized insurance. About 80,000 Mainers have health benefits through the ACA.
“If a repeal happens, it’s going to be a big hurt for these communities,” said Emily Brostek, executive director of Consumers for Affordable Health Care, an Augusta-based health advocacy nonprofit. “These are industries that we care about in Maine, but that don’t traditionally offer medical benefits.”
Congressional Republicans and President-elect Donald Trump have vowed to repeal President Obama’s signature health care legislation, which could leave more than 20 million Americans without insurance, depending on what a replacement bill looks like.
Welch, who has operated his own lobster boat since he was 16, has had health insurance since 2014, seeing it as a way to protect his health and finances.
“I didn’t have insurance prior to the ACA, and I wouldn’t have got it if it weren’t for the ACA,” said Welch, who estimates he pays about $220 a month for the benefits.
Welch saw the value in health benefits when his aunt – who did not have health insurance at the time – was in a car accident and struggled financially with “huge” medical bills from the care she received to recover from her injuries.
VITAL BENEFITS, BUT FIXES NEEDED
Congresswoman Chellie Pingree, a Democrat who represents Maine’s 1st District, lives on North Haven and knows many in the lobster and fishing industries who have acquired ACA insurance.
“They are a group that’s really benefited from the ACA,” Pingree said. “I’m really frightened for them.”
Pingree said that before the ACA existed, insurance companies could bar people from purchasing insurance who had pre-existing conditions, or raise their premiums to sky-high levels because they worked in an industry – such as fishing – where there are many on-the-job injuries.
“If you’ve worked in the fishing industry for any length of time, it’s hard not to have a pre-existing condition,” she said. “They could have a bad back, rotator cuff, knee problems or any number of chronic conditions.”
Pingree said she’s “nervous” that Republicans will repeal the ACA and only agree to a replacement plan that offers far fewer services compared with what’s required under the current law. Under the ACA, preventive services such as screenings and annual checkups must be free, and the plans must include benefits such as mental health and substance abuse services.
Pingree, however, said she’s encouraged that Maine Sen. Susan Collins, a moderate Republican, is proposing a plan with Sen. Bill Cassidy, R-Louisiana, that is being touted as a bipartisan compromise. One of the tenets of the proposal is that states can choose to maintain the Affordable Care Act if officials believe the law is working well in their state. Details of the bill are expected to become available next week.
“It’s great that Susan Collins is one of the members actively looking for a solution,” Pingree said.
Alisha Keezer, a health insurance navigator for the Maine Lobstermen’s Association, said “having health insurance has meant so much” for many lobstermen, many of whom are in their 50s and need insurance. In addition to the health benefits, it protects their finances, she said.
“If you fall down and get hurt and don’t have insurance, you could lose your boat,” Keezer said.
She said the law does need fixing, and that some lobstermen are getting hit with high premium increases.
The law protects those who qualify for subsidies from premium increases, which is about 85 percent of those buying marketplace insurance.
But those just over the income limit for subsidies – 400 percent of the federal poverty level or $97,000 for a family of four – are bearing the full brunt of the increases. Keezer said some lobstermen who had a good year financially are upset to see such high premium increases because they no longer qualify for subsidies.
Keezer said a typical premium for a lobsterman who qualifies for subsidies is about $250 per month. But for those who earn more than the limit and don’t receive subsidies, premiums are usually about $400 to $500 per month.
NO INTEREST IN RETURNING TO PAST
Still, Keezer said it’s better than nothing or the catastrophic insurance that was available before the ACA, when lobstermen had high premiums and paid for most medical services out-of-pocket.
“You can actually use this insurance, and there are so many services that are covered,” Keezer said.
Patrice McCarron, executive director of the Maine Lobstermen’s Association, said the organization is holding back on taking a position until there are more details about what would replace the ACA.
“The MLA does not want to see the ACA repealed, but we would like to see some reforms implemented,” McCarron said. “While the ACA has helped lots of lobstermen and their families, we have found that many could not afford to purchase coverage this year. It’s tough when you are self-employed because there are no other options.”
Joe Lawlor can be contacted at 791-6376 or at: