Help Us Celebrate Medicaid Awareness Month

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Advocates from around the country are celebrating Medicaid by making April Medicaid Awareness Month. You can find a variety of resources here and Maryland specific information here.

We at Consumer Health First have even more to celebrate and you can be a part of it. April 30 is a BIG birthday for Leni Preston our Vice-President and co-founder of Consumer Health First. Please join our celebration and give her a birthday she won't forget.  

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Make a donation to support the  Medicaid Supports Maryland campaign in her honor. Whether it is $7, $7,000 - every dollar will make a difference. Click on our donate page to donate now and show that, like Leni, you believe in keeping our Medicaid program strong for the 1 in 5 Marylanders who rely on Medicaid. 

Consumer Health First Applauds State Plan to Win Federal Approval for Health Care Reinsurance Program

Consumer advocacy group calls on insurance companies to release information about causes of soaring insurance premiums in the individual market

BALTIMORE – With the state of Maryland seeking federal approval for a reinsurance program to bring down premium costs in the individual health insurance market, Consumer Health First, the statewide consumer advocacy organization, issued the following statement of support.

“We applaud the Governor and the Insurance Commissioner, the General Assembly and the Maryland Health Benefit Exchange (MHBE) for their efforts to temper premium increases in the individual market by creating a state reinsurance program funded in part by the federal government. If approved by the federal government, a reinsurance program would give money to insurers for high-cost claims, meaning insurers no longer would have to rely solely on premiums to cover the costs of claims. This allows insurers to lower premiums.

“Consumer Health First pledges to work on behalf of consumers to ensure that a state reinsurance program that delivers new monies to insurers is not simply a giveaway. It must be a consumer-centric partnership between government, insurers, providers and consumers to reestablish affordable, high-quality and comprehensive health insurance in the individual market.

“While we support this effort, it is not enough to protect consumers’ access to affordable, comprehensive coverage in the individual market.

“As the largest insurer in Maryland, we call on CareFirst to disclose:

  • The health conditions and health services responsible for the eye-popping premium increases for its PPO and HMO policies in the individual market from 2014 to 2018;

  • The health improvement programs CareFirst has put into place in partnership with

    providers and patients to lower health care costs; and

  • The savings CareFirst expects to realize from the federal tax changes for BlueCross

    and BlueShield companies and CareFirst’s plans to use these savings to benefit consumers in the individual market.

“We call on the Maryland Insurance Administration (MIA) to require CareFirst to:

  • Disclose the information outlined above in its rate filings; and

  • Consider these items in the MIA’s review of CareFirst’s 2019 rates.
    “We call upon the MHBE to design a reinsurance program to reassure consumers that this is not a giveaway to CareFirst by:

  • Designing a reinsurance program equally benefiting customers of both CareFirst and Kaiser – the only two insurance carriers in the individual market; and

  • Requiring CareFirst and Kaiser to provide the same comprehensive benefits that have been available to consumers since 2014.”

Background

The Affordable Care Act created the promise of health insurance for those who had previously been denied it due to a pre-existing condition. In addition, it made health insurance affordable for those not covered by an employer or public plan by providing financial assistant to individuals whose household income ranged from 133 percent to 400 percent of the Federal Poverty Level (FPL). As a result, the number of Marylanders with health insurance through the individual market increased from about 150,000 in 2013 to over 290,000 in 2016.

This expansion resulted in unintended consequence. The rise in health insurance rates from 2014 to 2016 was relatively low. However, since then the rates have increased dramatically as insurance carriers addressed changes in the individual market, including the high claims costs for a relatively small number of individuals. According to data published by the MIA, a silver plan for a 40-year old individual increased from $240 per month in 2014 to $686 in 2018 for a CareFirst PPO policy, from $216 per month in 2014 to $466 in 2018 for a CareFirst HMO policy, and from $312 per month in 2014 to $448 for a Kaiser HMO policy. This has made insurance unaffordable for many Marylanders and particularly those whose income is above the 400 percent FPL level.

Maryland legislature approves plan to stabilize state's ACA Market

There are roughly 150,000 consumers in Maryland's private insurance market purchasing ACA policies. Yesterday, lawmakers approved a $380 million reinsurance program in an effort to keep premiums from rising and save Maryland's Exchange from possible collapse. (read the full story in the Baltimore Sun)

Legislators also charged a new commission with studying the state's health insurance market and are looking into the possibility of an individual mandate for Marylanders to purchase insurance to replace the federal mandate that expires next year.

The $380 million comes from a 2.75% tax on the premiums that insurers sell in the state. It's not a new tax - they have been paying it as part of the ACA, but Congress repealed the tax in the coming year, so Maryland put it back. The proceeds will be used to create a reinsurance program that insurers can then tap into to cover catastrophic claims in the ACA market. Additional legislation approved this week allows Maryland to access federal money to supplement the new state tax revenue and potentially pays for more years of the reinsurance.

This should prevent premiums for people not poor enough to qualify for Medicaid, and not old enough to qualify for Medicare from jumping as much as 50% for another year. Insurance analysts hope to cut expected premiums by half.

Maryland is now the 5th state to create its own reinsurance program and seek federal support for funding it, but Maryland is the only state to create a solution for the lapse in the federal insurer tax by taxing insurers themselves.

Maryland Legislature Approves State Reinsurance Legislation

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Both the Maryland Senate and House of Delegates voted overwhelmingly to approve legislation that would allow the Maryland Health Benefit Exchange to apply for a 1332 waiver, and thereby create a state reinsurance program. The effort would help the state's two Exchange carriers, Kaiser Permanente and CareFirst mitigate their risk in offering plans on the Exchange's private insurance market.

By spreading out risk in this way, carriers would lose less on individual consumers and are better able to keep premium costs down. The ACA included provisions for reinsurance programs, but those provisions were removed by the current Administration.

"Because of the actions and inaction in Washington, the Affordable Care Act was poised to force health insurance rates for Marylanders to increase again by 50 percent or more. That is simply not acceptable," Hogan said during a press conference Monday. "Our administration has been working on potential solutions for more than a year. We came together and rolled up our sleeves to address this crisis head on."

Governor Hogan is expected to sign the legislation into law this week.

It's Crossover Week in Annapolis!

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As bills crossover from one side of Bladen Street to the other this week, we will have a better sense of which bills will and won't pass. (Check out our Legislative Agenda page for updates.) In the meantime, in our arena, the hot action is around the need to address the affordability of health insurance for individuals and the stabilization of that market. Two reports last week highlight the issues:

  • Covered California - provided a national economic analysis of the impact of rising premiums and estimates of the effects of federal policies.  Maryland was ranked as a high-risk state with the potential for further premium increases of 50%. We would note, as Delegate Cullison (D-19) did yesterday at the bill hearing, that these are on top of the already high prices. That would argue for the study for a Medicaid Buy-In that we encourage the Legislature to pass.

The "solutions" being looked at right now in Maryland include:

  • HB 1795: This emergency bill would provide authorization to establish a Health Care Access Program and for the Maryland Health Benefit Exchange (Exchange) and Insurance Commissioner to submit a 1332 waiver to the Department of Health and Human Services. The bill passed out of the House Health and Government Operations Committee (HGO) last Thursday. Read our testimony.
  • HB 1782: This emergency bill would establish the process and funding streams for the Health Care Access Program. It was heard on Monday, March 12, and we provided testimony that included two amendments. In our oral comments, we made a few additional points including the:
    • need to ensure that short-term plans (as described in both reports cited above) are not allowed for sale in Maryland;
    • Exchange must be adequately funded;
    • Exchange's Standing Advisory Committee be actively engaged in the preparation of the 1332 Waiver application. The Waiver process will entail at least two public meetings and a comment period. CHF believes that, in addition, the diversity of expertise on the Advisory Committee could provide the Board and staff with invaluable assistance. 

We very much appreciate the work being done by Chair Shane Pendergrass (D-13) and Delegate Joseline Pena-Melnyk (D-21), as well as the other HGO members including Delegate Ariana Kelly (D-16). Her leadership on HB 1312, our Medicaid Buy-In Task Force bill, is critical as we look at other ways to ensure affordability and access. 

Even as Maryland is taking steps to address the affordability issue, there is also potential action on Capitol Hill as Sam Baker reports in Axios. He cites a new report by Oliver Wyman that looks at the impact of the proposed federal reinsurance program. 

For information on all of the bill's CHF is tracking and our testimony, visit our Legislative Page.

 

Guest Commentary: Allow Marylanders to Buy In to Medicaid Program | Maryland Matters

Consumer Health First Executive Director, Kathy Ruben, Ph.D., authored a guest commentary in Maryland Matters this week.

In it, she advocates for passing a bill that could lead to Marylanders being allowed to “buy in” to the Medicaid program.

"A Medicaid buy-in holds promise to help those struggling the most: middle-class Marylanders – including small business owners – who are increasingly unable to afford ever-climbing premiums and out-of-pocket costs.

Many Marylanders who must buy insurance on the individual market – that is, those not covered through work – can receive a premium subsidy from the federal government. But those subsidies only help individuals earning less than $48,240 or $98,400 for a family of four. Those earning more are working people who are often self-employed – and they must shoulder their entire premium costs."

You can support HB 1312 / SB 878  by signing on to support it here.