Maine: Gov. Mills announces state to establish their own ACA exchange

Some Guy, June 25, 2015 (right after the Supreme Court ruling in King vs. Burwell):

It's even conceivable--unlikely, but conceivable--that a few years from now, after 1) The ACA has become even more firmly entrenched nationally; 2) the software/technology for running a state exchange has become even more streamlined, simplified, faster, easier to use, cheaper, etc etc; and 3) (hopefully) some changed attitudes/changed administration officials (ahem), a few states on now may even decide to go ahead and move onto their own "full" exchange/website after all...completely of their own volition.

February 2018:

Nevada wants out of federal health exchange

Nevada's Silver State Health Insurance Exchange took the first step on Thursday to getting out of the federal system and build its own exchange.

The Legislative Interim Finance Committee granted SSHIX $1 million from its own reserves to put together an RFP and find a private provider.

October 2018:

NM will operate its own exchange platform starting with the 2021 plan year

New Mexico has a unique exchange; the state runs the small business portion, and while the individual exchange is also technically state-run, is used to enroll people in individual insurance (ie, a federally-supported state-based marketplace). But the exchange is planning to establish its own enrollment platform that will be in use by the fall of 2020.

March 2019:

Governor Murphy Announces New Jersey to Transition to State-Based Exchange

Acting to improve health care access for New Jersey residents, Governor Murphy today announced that the State of New Jersey will move to a State-Based Health Exchange for the year 2021. The action will allow New Jersey greater control over its health insurance market and the ability to establish stronger protections against the Trump Administration’s sabotage of the ACA. The Governor has also proposed codifying in state law the protections provided by the Affordable Care Act.

April 2019:

The Oregon marketplace issued a technology RFI to help assess the feasibility of transitioning to a full state-based marketplace

— Rachel Schwab (@RachelE_Schwab) April 23, 2019

(Note: this one is still up in the air...Oregon toyed with the idea of splitting off in 2016 and again in 2017, so I'm not getting ahead of myself this time.)

June 2019:

Pennsylvania moves to take over health insurance exchange

Pennsylvania is moving to take over the online health insurance exchange that’s been operated by the federal government since 2014, saying it can cut health insurance costsfor the hundreds of thousands who buy the individual Affordable Care Act policies.

New legislation unveiled Tuesday has high-level support in Pennsylvania's House of Representatives, with the chamber's Republican and Democratic floor leaders as the bill's lead co-sponsors.

August 2019:

Governor Mills Announces Maine Will Pursue a State-Based Health Insurance Marketplace Under the Affordable Care Act

During a health care forum today, Governor Janet Mills announced that Maine will pursue a State-based Health Insurance Marketplace that improves the state’s ability to fund education and outreach while using the federal website to enroll consumers in private health insurance under the Affordable Care Act.

There are basically 3 types of ACA exchanges: Full state-based exchanges which operate their own technology platform; state-based exchanges which still utilize for actual enrollment; and states which fully rely on the federal exchange to handle pretty much everything. Maine is shifting from the 3rd status to the 2nd for now.

Governor Mills submitted a letter of intent (PDF) today to the U.S. Centers for Medicare and Medicaid Services (CMS) indicating that Maine will pursue this option for the 2021 health insurance plan year. She expects to introduce legislation to establish the details of the new state-based marketplace when the Legislature reconvenes in January and will be assessing additional options to make health insurance for small businesses more affordable.

“Over the past eight months, my Administration has expanded health care to more than 36,000 people across the state. These are folks who can now see doctors, receive preventive care, treat illnesses, and afford their medications. While I am pleased with the progress we have made, there is more we can – and must do – to make affordable health care available to more people,” said Governor Mills. “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.”

“Other states that have pursued this model have performed better on both enrollment and the cost of monthly premiums,” said Health and Human Services Commissioner Jeanne Lambrew. “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.”

“A State Based Marketplace would give Maine the ability to better coordinate with health insurance carriers, Marketplace Navigators, and Assisters,” stated Maine Insurance Superintendent Eric Cioppa.  “It would also provide the State with direct access to important data about how the system is working, which will in turn enable the State to make data-driven modifications that specifically benefit Maine consumers.” 

Under the Affordable Care Act, states can choose one of three options for their Health Insurance Marketplaces, which consumers and small businesses use to shop for plans and apply for financial assistance for coverage. Maine currently relies on the federal government to fully run its Health Insurance Marketplace. Under the model announced today, Maine will have greater control over outreach, marketing, and consumer assistance initiatives, while the federal government will continue to provide its call center and where consumers can apply for and enroll in coverage. The Mills Administration is also exploring the possibility of transitioning from this model to the third option, a fully State-run Marketplace in the future. 

Nevada, New Mexico and Oregon currently fall into the 2nd category, but all three (assuming Oregon follows through) are shifting to fully state-based exchanges. New Jersey and Pennsylvania are shifting to the 2nd category for 2020, but plan on completely splitting off starting in 2021. Maine would be making half the move in 2021 while also apparently considering completing the split in 2022 or later....assuming the ACA survives the #TexasFoldEm lawsuit, of course.

Under this approach, the Maine Bureau of Insurance would still oversee the individual and fully-insured group markets. It would also continue “plan management,” or engagement with insurance carriers on the plan offerings. 

If legislation passes to create a State-based Marketplace using the Federal Platform, then Maine will submit a plan to CMS for approval. DHHS can manage the cost of this activity with some of the additional federal funding that will result from Maine assuming control over its Marketplace’s outreach and education.

The decision announced today will not affect the upcoming open enrollment period in November 2019, which will proceed in the same way as previous open enrollment periods. Still, DHHS will work with community partners to increase awareness and promote shopping for plans that meet the needs of Maine families and businesses.

The Governor announced the decision today at All In: A Forum on Health Care Coverage and Affordability in Maine, an event held at the Maine Department of Health and Human Services (DHHS) regional office in South Portland in collaboration with the Maine Bureau of Insurance. The forum invited national and local experts to discuss strategies that have worked in other states, mobilize public and private organizations to develop solutions to rising costs, and build upon the progress the Mills Administration has made to ensure every person in Maine can access health care.

The Maine legislature will still have to pass legislation approving the partial exchange establishment, of course, but I can't imagine that will present too much of a problem; stay tuned....

This move is among the significant steps the Mills Administration has taken over the last eight months to expand access to health care. In the last legislative session, the Mills Administration worked with the Legislature to pass language to enable Maine to examine new ways to make private health insurance more affordable through a State Innovation (1332) Waiver from the federal government. Under this waiver, states may change the application of federal laws governing private health insurance -- including the design of federal tax credits – as long as the resulting coverage is affordable, comprehensive, covers as many people, and does not raise federal costs compared to current law.

Since the launch of State Innovation Waivers in 2017, 13 states, including Maine, have successfully applied for and received approval for these waivers. Maine’s current waiver enables the State’s reinsurance program, the Maine Guaranteed Access Reinsurance Association, to receive roughly $62 million in Federal funding in 2019 to lower premiums for consumers in the individual health insurance market. The language included in the budget does not change this existing waiver, but provides more flexibility to further improve affordability. Before submitting a waiver request to the federal government, the Mills Administration will gather public input. 

Additionally, Governor Mills expanded MaineCare on her first day in office and, as of August 26, more than 36,016 people have gained health care under MaineCare expansion. Governor Mills also signed into law L.D. 1 which adds State guaranteed protections for health care coverage for people with pre-existing conditions as established under the Affordable Care Act in the State’s regulated markets. She expanded reproductive health care coverage under MaineCare, and signed a comprehensive prescription drug reform package into law to reduce the cost of prescription drugs. She also restored the Maine Low-Cost Drugs for the Elderly and Disabled program to cover an additional 1,800 Maine seniors, supported treatment and prevention programs to help combat the opioid epidemic, and bolstered public health, which can improve affordability of coverage by reducing health problems due to tobacco use and low immunization levels, among other initiatives.