Maine is leading the nation with a more than 72 percent increase over last year in Affordable Care Act enrollment, according to data released Wednesday.

A health policy analyst says that reflects the ACA’s enduring popularity in Maine despite the Trump administration’s efforts to undermine the law. Sign-ups in Maine through the first 18 days of open enrollment, Nov. 1-18, totaled 19,880, or 72.4 percent higher than the same period last year. The next closest state was Wyoming, with a 60.7 percent increase in enrollment. Most states have experienced enrollment surges of 40 to 50 percent over last year.

In total, 80,000 Mainers signed up for a 2017 ACA insurance plan through the individual marketplace. The ACA marketplace is where those who don’t have access to health insurance through an employer – often part-time workers or the self-employed, can purchase subsidized insurance.

Nationally, 2.3 million people have signed up so far for ACA insurance for 2018, according to numbers released by the U.S. Centers for Medicare and Medicaid Services. When open enrollment ended for 2017, 9.2 million Americans had ACA individual insurance.

Mitchell Stein, a Maine-based independent health policy analyst, said Maine Sen. Susan Collins’ key vote to preserve the ACA got a lot of media attention in the state, and may have contributed to a greater awareness of the ACA, boosting enrollment.

Collins was one of three Republican senators – Lisa Murkowski of Alaska and John McCain of Arizona were the others – who voted July 27 against the party’s attempts to repeal the law, keeping it intact by one vote. Collins’ vote and subsequent opposition to a similar attempt in September vaulted her into the national spotlight. The Maine Medicaid expansion referendum also shined a light on the ACA, as Mainers decisively voted in favor of expanding Medicaid, 59 to 41 percent.

Recently, Collins has expressed strong reservations about the Republican leadership’s inserting a clause to repeal the ACA individual mandate in the pending tax reform bill. She also criticized other provisions of the bill, such as sunsetting tax cuts for individuals while making corporate tax cuts permanent. The Senate tax reform bill touted by Republican leadership would result in a tax increase for about 50 percent of Americans by 2027 – according to the Tax Policy Center, a Washington-based think tank – trigger cuts to Medicare and increase marketplace health insurance premiums by $2,300 on average. Tax cuts would largely go to the top 1 percent of wage earners. A vote on the Senate tax bill could happen as early as next week.

The ACA’s individual mandate imposes a tax penalty on people who don’t obtain insurance. The mandate brings more healthy and younger people into the insurance pool, keeping premiums in check, health policy experts say.

Stein said another factor in Maine’s strong enrollments may be the emergence of new zero-premium plans developed after the Trump administration’s decision to withhold certain subsidy payments to insurers. Maine and other states took steps to keep insurance companies from losing money, with the effect that companies are now offering zero-premium basic plans.

About half of the Mainers who are eligible for subsidies – those who earn between 100 and 400 percent of the federal poverty level – would also qualify for a zero-premium bronze plan for 2018. The bronze plans have fewer benefits and higher deductibles than silver and gold plans, but lower premiums.

Kevin Lewis, president and CEO of Community Health Options, one of the insurers on the Maine marketplace, said enrollees are choosing bronze plans in greater numbers, and it’s likely being driven by the zero-premium plans.

“We’ve seen a definite increase in members choosing bronze plans. Almost half of the bronze plans being chosen (at CHO) have zero premiums. It’s a significant factor,” Lewis said.

He said business has been brisk over the past few weeks, with many people choosing plans.

Other factors in Maine’s increased enrollment rate may be the state’s relatively high levels of self- and part-time employment, the people the marketplace was intended for because they were more likely to lack affordable options for health insurance.

Maine also ramped up outreach efforts in the face of Trump administration cuts to advertising and outreach, which may have also helped, Stein said. Maine’s health insurance navigators did not experience the steep cutbacks applied to other states, and the Maine Health Access Foundation contributed $200,000 in outreach funding. Nationally, the Trump administration cut advertising funding by 90 percent.

Even with a surge in sign-ups, the enrollment period was slashed in half this year, from 12 weeks to six weeks. So total enrollment will likely be lower in 2018, even in Maine, which is largely a reflection of the compressed enrollment period.

“So there’s good news and bad news. The law is still working,” Stein said. “The sabotage by the Trump administration has been effective, but not as effective as (Trump) hoped.”

Joe Lawlor can be contacted at 791-6376 or at:

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