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Health

What Mainers need to know as the state opens up its own health insurance marketplace

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The Mills administration has announced Maine will become the 16th state to run a state marketplace under the Affordable Care Act.

Consumers can enroll in coverage through the CoverME.gov website starting Nov. 1, through Jan. 15.

For more about what that means, Maine Public's Irwin Gratz spoke with Health and Human Services Commissioner Jeanne Lambrew and Ann Woloson, executive director of Maine Consumers for Affordable Health Care.

This interview has been edited for clarity.

Gratz: Commissioner, let me start with you. The state marketplace will open next month. What actually changes?

Lambrew: We can, for example, extend the amount of time that people can take to sign up for insurance. This year, there's an extra month, until Jan. 15, for people to sign up for a plan for 2022. It allows us to tailor our marketing efforts and our outreach to our communities. And it also allows us to better integrate our marketplace with Maine's private insurance system as well as with Medicaid or MaineCare.

So does this change anything at all about the extent of coverage people might get under Obamacare policies, or the costs of those policies?

Lambrew: It's going to give Maine people clearer information on their options that allows them to better choose a plan that fits their needs. It will allow them more tailored support, so if they have questions or are trying to figure out what is out there, we'll be able to do that work better. And we expect it will also, in a competitive marketplace, help keep those premiums affordable. We are excited that thanks to the American Rescue Plan, there is more financial assistance available to Maine people who need it. So this year alone, 80% of people who are signing up for coverage through the health insurance marketplace will get some financial assistance. And for 25% of those people, they can find a health plan for less than $10 a month.

Some people probably remember the very, very early difficulty the federal government had with the website. Is the state ready to pick up all of this additional work?

Lambrew: Trust me, we learned the lessons of 2014 and healthcare.gov, and spent considerable amounts of time doing testing, user testing, insurance carrier testing. We had our federal partners who tested and retested our systems to make sure that they work. So we are feeling prepared for Nov. 1, when the new system opens up, and people can go online to coverme.gov and apply for coverage. There may be challenges, we'll work our way through those challenges. But the team has done a fabulous job of working night and day, even during the pandemic, to implement coverme.gov.

Ann Woloson, let me ask you, from your standpoint, is this an improvement to the system for Maine?

Woloson: Oh, definitely. And congratulations to Commissioner Lambrew and to Gov. Janet Mills for getting the federal approval of the state-based exchange. It really is great news for individual consumers, who will benefit in many ways. Being able to extend open enrollment for individuals who need coverage, being able to create our own special enrollment periods to accommodate people who may experience loss of coverage for whatever particular reason.

I'm just curious as to how much of an untapped population you still think may be out there.

Woloson: When you look at what has happened, especially over the last couple of years with the pandemic, people losing their jobs, losing their employer-based coverage, people who have never ever had to look into or explore what their health insurance options are, it can be very difficult and overwhelming.

Lambrew: I think in addition to the fact the pandemic has just shone a bright light on the need for health insurance, we also know that people who are just starting out their careers, maybe building their own company, maybe older and deciding to phase out of full-time work. A lot of these people will need coverage on their own. They won't have the access to employer-based coverage. And they may not qualify for MaineCare or Medicaid.

Ann, let me start with you on this. During the political campaigns last year, there was some talk about improving the Affordable Care Act. So I guess I'm curious as to whether you've noticed changes that have improved the way the act is working for people this year so far. And if there are still other things either the federal or state governments could be doing that would improve the operation of the ACA.

Woloson: Moving to the state-based exchange is good example of things that we can do to improve access to affordable health coverage for Mainers. I also think that there are some things that could be done at the federal level to improve access to coverage. There are still people who will fall into a gap that aren't eligible for MaineCare or ACA coverage.