Executive Summary Maine’s potential transition to a state-based marketplace (SBM) presents an opportunity to expand coverage and increase affordability for health care consumers in Maine. This report explores these opportunities and provides policy recommendations to advance these goals. Under the Affordable Care Act (ACA), states can implement their own health insurance marketplaces for the individual and small-group markets, which provide states greater flexibility and independence than using the federally-facilitated marketplace (FFM) on Healthcare.gov. Prior to November 2020, Maine’s participation in the FFM exposed the state to the Trump administration’s shortening of open enrollment periods (OEPs), funding cuts to outreach and enrollment efforts, and the refusal to create a special enrollment period (SEP) for the coronavirus pandemic. In March 2020, Governor Janet Mills signed the Made for Maine Health Coverage Act (H.P. 1425) authorizing the development of an SBM in Maine.1 This report explores the opportunities associated with a potential marketplace transition, informed by over 30 interviews with stakeholder groups across Maine in the fall of 2020. Through this work we learned that the transition to an SBM has the potential to close cover-
age gaps, enhance outreach to groups that have been historically marginalized in the health care system, and improve population health. This report also applies a framework of targeted universalism throughout its analysis. This goal-oriented mode of equity analysis informs many recommendations focused on making health care accessible and affordable to all Mainers, particularly those historically marginalized by the health care system.
Broad Recommendations In addition to our below recommendations on specific topics, our interviews and research led us to make the following overarching proposals, which should guide the overall transition to an SBM and ensure that consumer engagement and support is at the core of the transition. 1. Increase consumer assistance capacity. 2. Integrate consumer engagement into the process of designing and implementing Maine’s SBM. 3. As a longer-term initiative, re-establish the Maine Office of Health Equity and empower its staff to coordinate equity efforts across the SBM, the MaineCare program, and all Department of Health and Human Services (DHHS) Offices. EXECUTIVE SUMMARY | 5
