Who’s really covered by MaineCare — and who isn’t

AUGUSTA, MAINE — 01/08/14 — A woman holds a sign at a rally and lobby day organized by the Maine Peoples Alliance at the State House in Augusta around the issue of Medicaid expansion. Troy R. Bennett | BDN

Maine voters will head to the polls in November to decide whether to expand Medicaid under the Affordable Care Act. The ball is now in the public’s court after Gov. Paul LePage and his Republican allies in the Legislature thwarted six previous attempts to expand Medicaid under the health reform law.

LePage has said that expanding Medicaid, known here as MaineCare, would prove financially disastrous. Proponents argue that by not expanding, Maine is foregoing $1 million a day that could support health coverage and jobs.

With debate over ACA repeal ramping up yet again in the Senate, and health advocates raising alarms about proposals to drastically cut Medicaid, it’s a good time to take another look at who’s covered by MaineCare — and who isn’t.

Here’s what a new Census report shows us about Maine’s health insurance landscape in 2016:

Most Mainers continue to get health insurance through work. Just shy of 55 percent of residents, or 720,000 people, have a plan through their employer. So while most of the current debate centers on ACA plans and Medicaid, the majority of Mainers don’t get coverage that way.

Employer plans are just one form of private insurance, or coverage purchased from a commercial insurance company. Another sizable slice of Maine’s population, about 16 percent, buys their insurance directly from those insurers. That group includes the roughly 70,000 Mainers who buy such plans through the ACA exchange, Healthcare.gov. A few more Mainers have coverage through TRICARE, a health insurance program for military members.

Medicare covers the next biggest chunk. The federal insurance program for elderly individuals and people with disabilities covers about 22 percent of Maine’s population, most of them over age 65. That’s roughly 290,000 people. Not surprising, given that Maine’s population is the oldest in the country.

MaineCare covers a lot of people too, but not who you might think. Last year, the program covered 19.2 percent of Maine’s population, or 253,000 people. The Census report breaks down the recipients by age, which reveals a couple of interesting points.

The first is that a lot of Maine’s elderly people rely on the program, compared to other states. Seventeen percent of residents over age 65, or 42,000 seniors, are enrolled in Medicaid, the 6th-highest rate in the nation. Nearly all of them are also insured under Medicare (people who are low-income and over age 65 can qualify for both programs).

But another group has an even higher share of Mainers insured by Medicaid — children.

According to the Census data, Medicaid insures 33.5 percent of Maine residents aged 18 and under. That’s 92,000 children. (The margin of error on that data point is a little high at 1.9 percent, but the trend still holds.)

Expanding Medicaid under the ACA would extend health coverage to another 70,000 Maine people. Many of them are among the 8 percent of Maine residents, or 106,000 people, who lacked health insurance last year.

Jackie Farwell

About Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.