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V O L . X X V N O. I JA N UA R Y 7 , 2 0 1 9 18 H E A LT H CA R E For Maine's health care, a positive prognosis B y W i l l i a m H a l l D espite a decline of over 5% from 2018 to 2019 in the number of Mainers obtaining health insurance through the Affordable Care Act, Community Health Options President and CEO Kevin Lewis says he is "cautiously optimistic" about the year ahead. A total of 71,577 residents enrolled in 2019 ACA coverage by the deadline, compared to 75,089 who enrolled in 2018 plans under the federal program. Lewis believes CHO, a nonprofit insurer offering a dozen ACA plans in Maine, will see a slight decline in members when enrollment data is finalized. at's partly due to the decline statewide, and partly because of the return of Anthem Blue Cross and Blue Shield to the ACA marketplace, bringing the number of insurers to three. (In 2018, only CHO and Harvard Pilgrim Health Care offered ACA plans.) e falloff in Maine's ACA enrollment mirrors the nationwide decline of 4%, which some experts blame on a lack of promotion of the program. A ruling in December by a federal judge in Texas that the ACA is unconstitutional has also created uncertainty about the program's future and a "chill- ing effect" on its public perception, Lewis says. Insurance costs are an ongoing worry for consum- ers, he adds, noting that CHO's premiums for 2019 will increase from 2018 by an average of 0.9% across all individual ACA plans. "ere's great concern about cost. Health insurance premiums continue to be on people's minds," he says. Still, he says, "our open enrollment results looks really solid. I'm confident we'll have a good 2019." "We continue to see a shift toward Bronze (a category of low-cost ACA plans), but people are choosing one of our most benefit-rich Bronze plans," Lewis says. "at tells us people are at least looking beyond premiums." With Gov. Janet Mills' pledge that Maine will participate in the federal government's expansion of Medicaid benefits under the ACA, Lewis sees another upside for 2019. "I'm optimistic about Medicaid expansion," he says. "We think it's important for Maine, so that there are no gaps in the health care spectrum and people can get coverage when they need it. And it's better for the overall risk pool." C O N S T R U C T I O N With construction, no 'stopping anytime soon' B y l a u r i e s C H r e i B e r P eter Horch founded Horch Roofing, in Warren, in 2003. In recent years, it has been among Maine's fastest-growing companies. Roofing's fortunes are linked to those of the con- struction industry, particularly new construction, which has been on a slow and steady rise since the recession. Reroofing and roof maintenance on older buildings, the bulk of his projects, remain a strong sector, he says. "I think building construction and the trades in general will continue to grow," Horch says. "People need maintenance on their buildings. And I don't see the Portland market, with all the growth there, stopping any- time soon." Issues include workforce and trucker shortages, and increases in material costs. Steel prices have shot up 25% in the past three years, he says. ese circumstances translate to increased pricing to consumers, he says. Lack of skilled workers remains a major issue. More and more entry-level workers have no experi- ence with basic tools of the trade like a hammer or tape measure, he says. "In the past, entry-level workers had a base- line understanding of how to use these tools," he says. "Increas ingly, we've found it's a skill that needs to be taught." He continues to offer on-the-job training. Horch is also involved with technical schools, locally and state- wide, to try to get more young people interested in the trades and to demonstrate that the trades both pay well and are more manageable than days gone by. "A trade school can offer much quicker turn- around at a much more reasonable cost, and provide a good career that pays well," he says. "And the work has become easier with the tools we have now. For example, we have power ladders to bring materials to the roof, so we're not carrying them up anymore. So young people shouldn't be afraid of the trades, as in, 'I'll be exhausted every day' or 'I'll hurt myself.'" He points out that construction prices continue to rise, a result of the labor shortage and cost of materials. "I don't see the need for skilled labor and lower material costs changing anytime soon either," he says. "So the future looks like prices to consumers will continue to increase until we can take care of some of these things long-term." In the past, entry-level workers had a baseline understanding of how to use these tools. Increasingly, we've found it's a skill that needs to be taught. — Peter Horch Horch Roofing There's great concern about cost. Health insurance premiums continue to be on people's minds. — Kevin Lewis Community Health Options Peter Horch Kevin Lewis F O C U S P H O T O / DAV E C L O U G H P H O T O / T I M G R E E N WAY

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