Health coverage in Maine has experienced major changes in the past few years as Medicaid enrollment increased and the number of people without coverage shrank. More change is expected in the coming year. In 2019, the state expanded Medicaid eligibility to 138 percent of the federal poverty level (FPL). The following year saw the COVID-19 pandemic, with substantial disruptions in employment and availability of health care. In response, Congress passed the Families First Coronavirus Relief Act, which imposed a continuous coverage requirement on Medicaid and the Children’s Health Insurance Program (CHIP): enrollees could not be disenrolled unless they requested it. This requirement was in effect through March 2023, leading to record-high Medicaid enrollment and record-low uninsurance. Also, during this time, Marketplace premium tax credits (PTCs) were enhanced, leading to record-high Marketplace enrollment. Like all other states, Maine is now resuming normal Medicaid and CHIP eligibility determination, often called the “unwinding.” Enrollment in Medicaid and CHIP is declining, affecting enrollment in the Marketplaces, employer-sponsored health insurance, and the number of uninsured people. Health coverage in Maine after the unwinding will not look like any recent survey data, so we prepared this summary of health care coverage and costs in 2025 when these transitions are expected to have stabilized. We used a detailed simulation model that incorporates real-world data from Maine before and after the COVID-19 pandemic. We show the distribution of all types of health coverage by income and age and provide additional details on the uninsured. We then provide estimates of average household health care spending by income.

WHY THIS MATTERS

Policymakers need to start with good estimates of health coverage and costs under current law to assess policy proposals. In particular, this analysis was intended to assist Maine’s newly formed Office of Affordable Health Care.

WHAT WE FOUND

We estimate that 59,000 Mainers—5.8 percent of the nonelderly population—would be uninsured in 2025 after the Medicaid unwinding has finished. About 70 percent of uninsured Mainers would be eligible for Medicaid, CHIP, or Marketplace PTCs but not enrolled. Thus, additional outreach and improving enrollment processes could increase health coverage significantly. Groups with the highest rates of uninsurance include those with the lowest incomes, those with the lowest educational attainment, and young adults. About 78.5 percent of the uninsured are in working families, and most have a full-time worker.

We estimate that Mainers would spend an average of 10 percent of household income on health care. Those with incomes too high to qualify for adult Medicaid (138 percent of FPL) but below 400 percent of FPL would pay a higher share on average (12 to 13 percent). While Marketplace PTCs and cost-sharing reductions (CSRs) reduce health care costs substantially, costs are still notably higher than Medicaid, so affordability may still be an issue. Also, not all are eligible for PTCs and CSRs.

HOW WE DID IT

We simulated health insurance coverage and costs using the Urban Institute’s Health Insurance Policy Simulation Model.