The ACA Remains Critical for Insurance Coverage and Health Funding, Even Without the Individual Mandate

"Our analysis shows that if the entire law were eliminated, the number of uninsured people would increase by 17.1 million, or 50 percent, in 2019; this estimate reflects coverage losses over and above the losses associated with setting the individual mandate penalties to $0." -- Urban Institute analysis of the Texas v. United States case

New Medicaid Scorecard - Lots of Data, But How to Use It?

The Trump Administration has initiated a "Medicaid Scorecard" to examine how states fare in comparison to each other in their utilization of the Medicaid system. Medicaid has long been a fundamentally shared program between the federal government and states, with the feds providing a large portion of the funds, and the states having a great deal of control over how those funds are administered in terms of eligibility and benefits.

Medicaid currently covers more than 67 million individuals, while CHIP covers nearly 6.5 million, and is the largest insurance program in the country. In Maryland, Medicaid covers 1 in every 5 individuals. To learn more about Maryland's Medicaid program, who it serves, and its impact on the state economy visit our Medicaid Supports Maryland website.

Federal health officials want to give states more flexibility over Medicaid’s rules and benefits. Recently, the administration told states this year that it would encourage them to establish work requirements for enrollees, or require participation in other forms of “community engagement” to remain qualified for benefits.  Several states have already implemented, or are moving to implement work requirements, but there is currently no interest in that in Maryland.

Gathering data is easy, comparing it equitably across states is going to prove far, far more difficult. For instance, some states enroll all their Medicaid recipients in managed care programs, other states do not. Medicaid expansion states have a higher number of people with higher incomes, who may prove to be healthier overall than the states that didn't expand and have much poorer individuals on their rolls.

Some examples:

  • Adults on Medicaid with controlled high blood pressure ranged from 26% in Louisiana to 72% in Rhode Island.
  • Children ages 3 to 6 on Medicaid and CHIP receiving adequate doctors’ care varied from 48% in Alaska and Idaho to 86% in Massachusetts. 

The Medicaid and CHIP Scorecard can be found here

Where does Maryland stand? Find the data here.

Areas where Maryland scored well:

  • Infant and pediatric PCP visits. Well into the 90th percentile.
  • Immunizations - above the 80th percentile.

Areas where Maryland scored poorly (below the 50th percentile):

  • Any measure related to pediatric asthma care.

Perhaps the most striking disparity in all of the Maryland data:

  • Percentage of Women Delivering a Live Birth with a Prenatal Care Visit in the First Trimester or within 42 Days of Medicaid/CHIP Enrollment = 83.9
  • Percentage of Women Delivering a Live Birth who had More Than 80 Percent of Expected Prenatal Visits = 67.9

Like we said - lots of good data. We'll be able to use this to identify services crying out for expanded health literacy and equity campaigns in Maryland

Total Cost of Care and Maryland's Primary Care Program

Last week, we reported on the approval of the new Maryland Model. This builds on our state's current All-Payer Model, which put in place global budgets at hospitals to "provide greater coordinated care, expanded patient-care delivery, and collaboration of chronic disease management, while improving the quality of care at lower costs to the consumer." 

  • A timely article in the most recent Journal of the American Medical Association, co-authored by Joshua M. Sharfstein, MD, provides an assessment of the Maryland's global budgets. 

What has received less attention is the approval of the new Maryland Primary Care Program. This is designed to support "the delivery of advanced primary care throughout the state and allows providers to play an increasingly important role in improving health outcomes, while reducing unnecessary Emergency Department and hospital visits."

Taken together these programs show Maryland's leadership in developing innovative approaches to the delivery of health care. At the same time, there are major implications for consumers. To be successful, therefore, consumers must be informed and engaged in the design and implementation phases. 

Consumer Health First will continue to serve as the lead policy and advocacy organization on these important issues to ensure that the needs and interests of consumers always come first.

1332 Waiver Application Update

Last Friday, Consumer Health First submitted a letter to the Maryland Health Benefit Exchange laying out our support for Maryland's application for a State Innovation 1332 Waiver. The purpose of the waiver is to establish a state-based reinsurance program that will lead to more affordable insurance premiums for those who must purchase their insurance in our individual market. 

In addition to our support, we also made three key points regarding the program's design. It must:

  • Equitably lower costs for both the HMO and PPO products; 
  • Provide opportunities to improve health outcomes by incentivizing meaningful health improvement programs; and 
  • Promote consumer choice.

Monday afternoon, our views and those of other organizations were presented to the MHBE Board. Our thanks go to those organizations and individuals who signed on to our comments. 

  • Find the MHBE staff presentation on the public process here. This includes the timeline for future action with the submission of the waiver application on May 31. 
  • Read the Consumer Health First letter of support here
  • Read the testimony from all four public hearings and ALL of the public comments submitted to MHBE - here.

At the conclusion of the meeting, the MHBE Board approved a resolution to move forward with the waiver application. We wish to thank the MHBE Board and staff for being responsive to our recommendations, and for their leadership on this important issue.

Health Reform: A Look Back at the 2018 General Assembly

Thanks to everyone that was able to join us online for today's webinar! In case you missed it, or want to review the presentation at your leisure, here are links to the PowerPoint Presentation and the audio recording.

Here's a brief summary of the webinar with CHF's President and Vice-President, Beth Sammis and Leni Preston:

  • Reviewed the Session's health legislation and policy highlights. Including the authorization to:
    • Fund a reinsurance program to stabilize rates;
    • Create a pilot project to provide dental care to Medicaid recipients; 
    • Expand women's access to contraception; 
    • Restore funding for community behavioral health services;   
  • Layed out an agenda for areas that Consumer Health First will be working with its partners. These include, but are definitely not limited to: 

Register Now for Our Annual 2018 GA Wrap Up Webinar this Friday!

We'll make it fun - we promise!  "Health Reform: A Look Back at the 2018 General Assembly Session and Next Steps."

CHF's President and Vice-President, Beth Sammis and Leni Preston, will: 

  • Review the Session's health legislation and policy highlights. Including the authorization to:
    • Fund a reinsurance program to stabilize rates;
    • Create a pilot project to provide dental care to Medicaid recipients; 
    • Expand women's access to contraception; 
    • Restore funding for community behavioral health services; 
    • and much more!   
  • Lay out an agenda for areas that Consumer Health First will be working with its partners. These include, but are definitely not limited to: 
  • Answer your questions.

Don't Wait - Register Now!