While the Affordable Care Act is under attack in the courts, Maine’s three providers of individual insurance in the ACA marketplace have requested relatively small average rate increases for 2020, ranging from 1 percent to just under 8 percent.

Insurers in Maine said lower rate increase requests stem from lower-than-expected claims in 2018 and the revival of a state program to reimburse insurers for high-cost claims.

For 2020, Lewiston-based Community Health Options requested the largest rate increase of the three providers at 7.7 percent, while Massachusetts-based Harvard Pilgrim Health Care requested a 1.9 percent increase and Indiana-based Anthem Blue Cross and Blue Shield requested a 1 percent increase. In prior years, the insurers have requested much larger annual increases of up to 40 percent.

Community Health, Anthem, Harvard Pilgrim, Aetna and UnitedHealthcare also offer a variety of ACA small group insurance plans in the state. Average requested rate increases for those plans in 2020 are somewhat larger, ranging from 8.3 percent to 19 percent, according to the Maine Bureau of Insurance.

A public meeting on the rate requests is set for 9 a.m. Thursday, July 25, at the bureau’s offices in Gardiner.

The bureau’s recent revival of a $93 million reinsurance program to help reduce premiums for individual insurance in the ACA marketplace has helped to stabilize the market in Maine and reduce annual rate increases, the insurers said.


“It’s reducing the impact of high-cost claimants on the overall risk pool,” said Community Health President and CEO Kevin Lewis.

In July 2018, the U.S. Centers for Medicare and Medicaid Services granted a waiver that permits the state to diverge from the normal rules set up by the ACA for insurance. The waiver will be effective through 2023. Maine previously had operated a reinsurance program, but it was shelved in 2013 after the ACA went into effect.

Reinsurance is a complex program that involves many shifting costs, but the bottom line is that it’s a way for the state to pump money into the system, reducing risk for insurance companies in exchange for lower premiums for policyholders. Each Maine insurer submitted two sets of rate requests last year for 2019 ACA premiums – a lower one that assumed a revived reinsurance program and a higher one that did not.

In its latest financial statement filed with the bureau, Community Health – Maine’s largest ACA insurer – said it is performing better than expected for the year, with net income of $3.8 million for the period from January through May, compared with an expected net income of $800,000 for the same period.

The insurer noted that its membership has decreased significantly, from about 54,500 in May 2018 to 40,600 a year later. Community Health attributed the decrease to the re-entry of Anthem into Maine’s ACA individual insurance market in 2019, as well as the repeal of the ACA’s individual mandate and its associated income tax penalty.

Nearly 71,000 Mainers enrolled in ACA insurance programs for 2019, down from a high of more than 84,000 for 2016. Total enrollment has declined steadily over the past few years.


Lewis said Gov. Janet Mills’ approval of Medicaid expansion in January also contributed to the reduced participation in ACA individual insurance. The expansion, approved by voters in 2017 but blocked by former Gov. Paul LePage, added more than 70,000 to the pool of Mainers eligible for the state’s Medicaid insurance program, known as MaineCare.


The ACA’s legality is currently being challenged in federal court. On Tuesday, a panel of three federal judges in New Orleans sharply questioned attorneys defending the ACA, increasing the chances that the 5th U.S. Circuit Court of Appeals may throw out at least part of the 2010 law, according to Tribune News Service.

Two of the three judges on the appeals court panel – both appointed by Republican presidents – repeatedly pressed California’s deputy solicitor general, who is defending the law, to explain why it should remain on the books after Congress in 2017 scrapped a tax penalty against people who didn’t have health insurance. That provision was once deemed essential to the program.

Texas and 17 other mostly Republican states are suing to scrap the entire health care law, including its protections for people with pre-existing health conditions. Also at risk are billions of dollars in federal assistance that have helped millions of Americans get health insurance through Medicaid and state insurance markets.

Lewis said it’s too early in the process to anticipate what might happen to Maine’s ACA marketplace if the appeals court strikes down the law. He said he expects the case ultimately will end up before the U.S. Supreme Court.

“I would hesitate at this point to try and reflect on all the changes that would have to occur,” Lewis said. “In the meantime, though, I think it’s really important for people to understand that there is fantastic coverage available, and that the reason we have such a strong individual market in Maine is because of the tremendous value that is present with the availability of subsidies.”

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