Introduction

In recent years, the State of Maine has taken several steps to embrace the ACA and expand health care access for its residents. Since taking office in January 2019, Governor Janet Mills has implemented Medicaid expansion2 and enshrined into state law the consumer protections outlined in the ACA.3 The OEP beginning November 2020 marked Maine’s shift to a state-based marketplace on the federal platform (SBM-FP) for private health insurance. This move away from the FFM aims to improve the State’s ability to develop a marketplace more responsive to the needs of Mainers.

DHHS requested our assistance in identifying important considerations for Maine’s potential transition to a full SBM, where the State would be responsible for operationalizing both outreach to Mainers and the enrollment platform, including a website, for marketplace insurance.

In this report, the Background section outlines Maine’s health care landscape and addresses challenges and opportunities associated with an SBM transition. Next, the Methodology section outlines our approach for identifying and evaluating policy options, examining each along dimensions of consumer impact and state feasibility. This is followed by a section on our Health Equity Approach describing the equity framework central to our analysis. Our Broad Recommendations section follows, drawing on themes that arose consistently in interviews and presenting cross-cutting proposals that center and support consumers while complementing many of the topic-specific recommendations we make. After the broad recommendations, we delve into recommendations on specific topics that DHHS identified as areas of consideration for designing a potential SBM. The policy areas that we developed and evaluated are briefly described below. • Enrollment Periods: Would flexibility to expand the OEP and SEPS help achieve state enrollment and affordability goals? • Displaying Clear Choice Plans: How can Clear

Choice plans be best displayed to maximize their impact? • Auto-Renewal: Would changes to automatic re-enrollment (“auto-renewal”) policies help achieve state enrollment and affordability goals? • MaineCare Integration: How could an SBM transition improve the integration between the marketplace and MaineCare? • Planning for the Future: How can a potential

SBM transition best be designed to take advantage of future federal policy making? The authors of this report are 12 graduate students at Princeton University’s School of Public and International Affairs, and this report is prepared for the capstone project of the Master in Public Affairs program. This report is informed by secondary research as well as interviews with stakeholders across the state conducted throughout the fall of 2020. The research also benefited from the guidance of the course’s co-instructors: Heather Howard and Daniel Meuse, two national health care policy experts who lead the State Health and Value Strategies program of the Robert Wood Johnson Foundation, located at Princeton University.