Maine plans to create a state-based health insurance marketplace under the Affordable Care Act, taking over marketing, outreach, advertising and in-person assistance from the federal government, Gov. Janet Mills said Thursday.

Maine would still use the federal website www.healthcare.gov for sign-ups, and the move would not change the providers who presently offer plans in the marketplace: Community Health Options, Harvard Pilgrim Health Care, and Anthem Blue Cross and Blue Shield of Maine. About 71,000 Mainers have insurance through the ACA.

But all outreach efforts for the marketplace would be carried out by the state rather than the federal government.

“This change means the state can control its own destiny,” said Andy Slavitt, a former federal health official in the Obama administration who was in Maine for the announcement. “This is a dramatic sea change for the state of Maine.”

The takeover will require action by the Legislature and approval from federal regulators – so no change would occur before 2020. There will be no effect on sign-ups for those purchasing ACA insurance this fall.

Maine would stand to gain about $2 million in federal dollars to pay for the outreach efforts, said Eric Cioppa, superintendent of the Maine Bureau of Insurance.

The move means Maine would join 17 states, including Massachusetts, California and New York, that run their own marketplaces. Some states create their own websites for enrollment, but Maine would join five states – including Nevada and New Mexico – that conduct their own outreach but still use healthcare.gov.

New Jersey also recently announced that it would launch its own state-based marketplace, starting in 2021.

The marketplace is where consumers – often self-employed or part-time workers – can purchase subsidized Affordable Care Act insurance.

“By pursuing a state-based marketplace, we will be putting ourselves – not the federal government – in the driver’s seat when it comes to helping consumers and small employers understand their options for affordable coverage, and we will better insulate ourselves from the attacks on health care that are coming out of Washington,” Mills said.

Mills said Maine would no longer be at the mercy of the federal government, and potentially could lower health care premiums if more people enroll. Maine’s ACA enrollment declined from about 76,000 in 2018 to 71,000 this year.

“We will be very aggressively marketing, reaching out to people and small businesses, and finding what needs are and matching them with the health insurance plan that best suits them,” Mills said.

States that run their own marketplaces have tended to perform better in maintaining enrollment, according to federal statistics. Enrollment fell 2.6 percent in 2019 among the 39 states that use federally run marketplaces, but among the 12 states that entirely run their own, enrollment increased nearly 1 percent.

The Trump administration – which has advocated for repealing the ACA – has slashed advertising spending from $63 million in 2016, before President Trump took office, to $10 million in 2018.

Maine’s federally funded statewide advertising budget declined from $550,000 in 2017 to $100,000 last year.

Mitchell Stein, a Maine-based, independent health policy consultant, said taking over the marketplace makes a lot of sense for Maine because of how hostile the Trump administration has been to the law. Trump is supporting a lawsuit that could repeal the ACA.

“The ACA didn’t account for the Trump administration, an administration that has not been interested in implementing the law to its fullest extent,” Stein said. “It’s too bad that it has come to this, but this is a necessary step.”

Jeanne Lambrew, Maine’s health and human services commissioner, said in a statement that states running their own marketplaces “have performed better on both enrollment and the cost of monthly premiums.”

“This move will allow us to customize our outreach to the communities and small businesses we know need access to health care, but who are hard to reach,” Lambrew said.

If Maine were to operate its own enrollment website – which Mills said could be on the table in the future – Maine also could extend the enrollment period, which some states have done. The Trump administration has cut the sign-up period to six weeks in recent years.

Meanwhile, a reinsurance program operated by the Maine Bureau of Insurance that uses $62 million in federal funds has helped keep ACA premiums in check. Next year’s premiums will range from a decrease of 7 percent to an increase of 0.8 increase, depending on the insurance carrier.

And Maine, under Mills, expanded Medicaid under the ACA, which so far has covered 36,000 Mainers.

Other states have taken more ambitious approaches, such as California, which extended subsidies to reach more people in the middle class, making a family of four with income of up to $154,500 eligible for ACA subsidies. The previous subsidy cutoff was $105,000. And Washington state has created a “public option” where people can buy into Medicaid coverage.

Ann Woloson, executive director of Consumers for Affordable Health Care, a Maine-based advocacy group, believes the state-based marketplace is a “step in the right direction.”

“People will have better information and be more likely to enroll in a plan,” Woloson said. “With more people in the insurance pool, premiums should decrease.”

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