Health Insurance Rates: Moving Targets

On Thursday of last week, Consumer Health First submitted a letter signed by 40 individuals and organizations, to the Insurance Commissioner. In the letter, we expressed our concern over the exorbitant rates requested by CareFirst, in particular. We also provided a series of recommendations on steps the Commissioner could take to strengthen the rate review process and stabilize Maryland's individual health insurance market while providing more affordable rates for consumers. These comments will be the basis for the testimony to be given by Consumer Health First President,  Beth Sammis when the Maryland Insurance Administration holds their public hearing. 

Here come the moving targets:

  • That public hearing to get input on the published rates was rescheduled from today to Monday, July 30 from 1:00 to 4:00 pm.
  • On Saturday, CMS put risk adjustment payments on hold. It is unclear at this time what this action will mean for 2019 rates or the short- and long-term stability of the individual market. Read more: CHF letter and  an article in the New York Times.

For further background on the impact of federal actions and particularly the challenges for those above 400% Federal Poverty Level see this Washington Post article that cites the CMS Early Snapshot of 2018 effectuated enrollments and Trends in Subsidized and Unsubsidized Individual Health Insurance Market Enrollment.

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Raise Your Voice on Health Insurance Premiums - Sign Up Has Ended

In May, the Maryland insurance Administration  (MIA) released the insurance carriers' proposed rates for 2019 plans for the individual market. They range from Kaiser's 34.5% request to CareFirst's 91.4% for its PPO. If Maryland receives approval from the Centers on Medicare and Medicaid Services for its State Innovation 1332 Waiver application, then we would anticipate that the carriers will resubmit their requests in time for posting for Open Enrollment, which starts on November 1, 2018. 

Even with reductions in premiums, however, any approved increase will be on top of rates that are already unaffordable for many Marylanders. And, this will happen within the context of the Trump Administration's on-going efforts to sabotage the ACA.

Therefore, as the MIA conducts its rate review process, it is imperative that the Insurance Commissioner hear from consumers. As we have in the past, Consumer Health First is submitting substantive comments to the MIA and we will participate in the public hearing to be announced in early July. In the letter, we provide a number of recommendations on the rate review process as well as other steps we believe could address both short- and long-term challenges in providing affordable coverage options to those in the individual market.


  • Add Your Signature - The deadline is Thursday, July 5 at Noon. Your organization's signature on our letters has made a real difference in the past. Let's do it again.
  • Share this one page fact sheet with others you think would be interested in this issue?  Please ask them to sign on. 

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.