Medicaid expansion is reshaping Maine’s health insurance landscape, with the state’s uninsured rate likely to decline even though fewer people signed up for Affordable Care Act insurance this year, according to data released by Friday.

With all but the final day of an extended open enrollment period included, 62,213 Mainers had signed up for ACA insurance for 2020, the federal government said. The enrollment period ended Sunday, but glitches at caused the federal government to extend enrollment to Wednesday.

The 62,213 signups include the period from the start of the enrollment on Nov. 1 through Tuesday.

Meanwhile, 44,441 low-income Mainers now have insurance through Medicaid expansion, and many of them were previously uninsured. The uninsured rate, which was hovering around 8 percent in Maine, should decline in 2020, health care advocates said. How much the uninsured rate will decline is uncertain, but Gallup polls and the U.S. Census have been closely tracking state uninsured rates.

“We want more people to have insurance, so with expansion if that means fewer people are enrolled in (ACA) marketplace plans, at the end of the day more people have coverage,” said Kate Ende, policy director for Consumers for Affordable Health Care, an Augusta nonprofit.

During the first four weeks of enrollment for 2020, Maine signups were lagging 30 percent behind a similar signup period last year. But signups have since recovered so that 2020 enrollment is now only 13 percent behind 2019, when 71,577 had in ACA insurance.


Ende said that’s not surprising, as it’s common to see a big surge toward the end of the enrollment period.

The Trump administration has attempted to repeal the ACA through the courts and Congress. While those efforts have so far failed, the administration cut outreach and advertising spending by 90 percent.

Since Trump took office in 2017, ACA enrollment has declined from 12.7 million to 11.4 million nationwide.

But Mitchell Stein, a Maine-based independent health policy analyst, said that at least in Maine, more people are getting coverage.

“The sabotage by the Trump administration has failed to counteract the benefits of Medicaid expansion,” Stein said.

As Maine implements Medicaid expansion – the expansion began in January when Democratic Gov. Janet Mills too office – there is some overlap between expansion populations and ACA enrollees. Some ACA enrollees who earn up to 138 percent of the federal poverty level, or about $28,000 for a family of three – are being shifted to Medicaid insurance for 2020.


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

A Maine Department of Health and Human Services spokeswoman said the Mills administration remains committed to ensuring as many Mainers as possible have health insurance.

“While marketplace enrollment has declined in Maine and elsewhere due to a lack of federal support, more than 44,000 Maine people now have health care coverage through the expansion of MaineCare under Governor Mills’ administration,” Jackie Farwell said in an email Friday night. “We will continue our work to sign people up for affordable, high-quality coverage as we strive to ensure that all Maine people are insured.”



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