Methodology

This section describes the analytical approach used to develop the recommendations in this report. We first outline our approach to researching Maine’s health policy landscape and relevant policy options, followed by a discussion of the criteria we use to evaluate them. Finally, we describe how we prioritize policy options within each area using our Decision Matrix. Research Approach

The analysis in this report is driven by interviews with 38 Maine stakeholders performed throughout October and November 2020.i These stakeholders include representatives from health care providers, advocacy groups, and carriers; state health policy experts; and senior officials from key State of Maine departments. While the majority of interviewees were Maine-based, we also consulted several experts from nationally-focused organizations and other states. In our interviews, we discussed the opportunities and challenges that Maine’s potential transition to an SBM could pose to increasing coverage, reducing complexity, and improving affordability. Based on analysis of these stakeholder interviews and further background research, we then developed potential recommendations. Using the following criteria aimed at evaluating consumer impact and state feasibility, we rank the priority of each recommendation within each policy area.

Consumer Impact

Affordability: What is this recommendation’s impact on premiums, deductibles, and other forms of cost-sharing for consumers? Complexity: How does this recommendation impact the ease with which consumers can navigate accessing health coverage? Coverage: How does this recommendation impact uninsured levels, and do impacts vary across different populations? If applicable, how does it affect wheth-

er people are getting the high-quality, comprehensive coverage they want? Equity: How does this recommendation impact marginalized populations in Maine, such as immigrants or people living in poverty?

State Feasibility

Political: How easily is this recommendation likely to move through the administrative or legislative process? Will relevant stakeholders be supportive of this proposal? Financial: What impact would this have on the state budget? Is this recommendation realistic in the context of severe fiscal challenges and a recession triggered by the coronavirus pandemic? Implementation Capacity: Can this recommendation realistically be implemented in terms of start-up, ongoing implementation, and long-term maintenance? Decision Matrix

We present our decision matrix in Appendix Table 1. Each cell of the matrix is assigned a color on a scale from dark green to dark red. Dark green indicates strong feasibility or significant positive impact on consumers, while light green indicates likely straightforward feasibility or limited impact on consumers. Similarly, dark red indicates lack of feasibility or significant negative impact on consumers, while light red indicates limited feasibility or limited negative impact on consumers. Gray indicates neutral consumer impact. Again, these determinations take into account stakeholder interviews, background research, and analysis of the political and policy landscape both in Maine and nationally. To generate rankings, we assigned numeric scores to each color determination, weighting consumer impact more heavily. This framework was selected because the core of a promising policy is not the ease of implementation but rather its impact on consumers with respect to affordability, complexity, coverage, and equity. For instance, if a policy is feasible but has limited positive impact on consumers, we consider it to hold less value than a policy with a stronger positive consumer impact that may face higher feasibility concerns. See Appendix 1 for more details on color determination and weighting.