Maine Gov. Janet Mills notified the CMS Thursday that her state wants to take more control over its Affordable Care Act exchange to counter Trump administration moves against the Affordable Care Act.
Mills, a Democrat, submitted a letter of intent indicating Maine wants to take over the marketplace's outreach, marketing and consumer assistance functions starting in 2021, while continuing to use the federal government's ACA enrollment platform. It will explore shifting to a fully state-run exchange in the future, she said.
She plans to introduce legislation in January to authorize the new state-based exchange.
"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 healthcare that are coming out of Washington," she said.
ACA supporters blame Trump administration moves, such as cutting funding for enrollment outreach and expanding access to plans that don't comply with ACA consumer protections, for an increase in the number of uninsured Americans.
Exchange enrollment in Maine has fallen from 84,000 in 2016 to 71,000 in 2019. But Mills boosted coverage this year by pushing through Medicaid expansion to low-income adults, enrolling 36,000 people so far. Her Republican predecessor, Paul LePage, had vetoed Medicaid expansion multiple times.
Mills administration officials said shifting to a state-based exchange will let the state customize its outreach to individuals and small businesses and better coordinate with insurers and enrollment workers.
Maine is the fifth state that has taken recent steps to shift to a state-based exchange. Nevada, New Jersey, New Mexico and Pennsylvania are the others, while Oregon is considering it. Twelve other states have fully state-run exchanges, with a few such as Illinois operating some functions of their exchange.
States with their own exchanges, such as California and Massachusetts, have used the added flexibility to design standardized health plans with reduced cost-sharing for high-value services.
Maine also has taken other recent actions to make coverage more affordable. Lawmakers there passed a bill this year easing the path for the state to seek a Section 1332 innovation waiver to revamp its coverage system, potentially using federal ACA funding in ways to expand coverage and improve benefits.