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Number of Uninsured in Maine Fails to Fall, Despite ACA

AUGUSTA, Maine — The number of Mainers who don't have health insurance has remained stagnant over the past few years, despite new insurance options under the Affordable Care Act's online marketplace.

Two surveys released Monday by the Maine Health access Foundation show that while the number of uninsured hasn't changed much, the distribution of insurance has. The surveys also find that the number of both insured and uninsured Mainers who struggle to pay health bills has increased.

Maine has the second-highest enrollment rate in the nation for the online insurance marketplace. In 2014 — the first year the marketplace opened — 44,000 people enrolled, triple the goal of 15,000. In 2015, the number enrolled grew to nearly 75,000.

So far for 2016, the number is about 78,000. Yet with all of those sign-ups, the number of uninsured in the state has remained fairly steady at 10-15 percent.

"The various cuts with our MaineCare program have resulted in fewer people being served by that insurance," says Barbara Leonard, vice president for programs at the Maine Health Access Foundation.

Leonard says at the same time enrollment in the online marketplace has gone up, eligibility for MaineCare, the state version of Medicaid, has gone down.

That's the finding of two reports released by the Maine Health Access Foundation on Monday. One is a federal and state survey called the Behavioral Risk Factor Surveillance System. The other is a survey developed by the Urban Institute called the Health Reform Monitoring Survey.

Not surprisingly, says Leonard, those who are uninsured are more likely to be low income, and that number is growing.

"Forty-nine percent of the uninsured fell into the group that made less than $25,000 in 2013," she says. "And then, that increased to 57 percent in 2014."

Emily Brostek of Consumers for Affordable Health Care says the issue is that Maine hasn't embraced the Affordable Care Act in its entirety — specifically, Maine has opted not to expand Medicaid.

"That's one reason we're seeing uninsured rates stay pretty steady, because a lot of people still can't afford it if their incomes are low," she says.

Under expansion, the federal government would pick up 100 percent of the tab through 2016, then ratchet down to 90 percent by 2020. But the LePage administration opposes expansion, because it's concerned about rising taxpayer costs in years to come.

Department of Health and Human Services spokesperson Samantha Edwards says in an email that when Maine expanded Medicaid in 2001, the uninsured rate dropped only slightly, but thousands of Mainers switched from private insurance to Medicaid. Edwards says history would likely repeat itself — at taxpayers' expense — if Maine expanded Medicaid again.

The issue will come before lawmakers this session with a Republican-led bill that would expand Medicaid. In the meantime, Leonard says there's another health care issue that also deserves attention.

"The total cost of care continues to be an enormous burden on individuals, on businesses, and on our communities," she says.

Leonard says the Health Reform Monitoring Survey found that the number of both uninsured and insured Mainers who struggle to pay their medical bills increased.

In 2014, 45 percent of the uninsured had difficulty with bills, compared to under thirty percent of those who had insurance. And each of those numbers are higher than the national averages.