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!

Maryland Insurance Administration Issues Proposed Rate Increases for 2019

The Maryland Insurance Administration released preliminary rate proposals for 2019 this afternoon. The rates of most concern are those for consumers for plans sold in Maryland’s “Individual Non-Medigap” (INM) market on the ACA Exchange. The rates submitted by the carriers for the INM market do not include any impacts from a reinsurance program.

House Bill 1795 of the 2018 Legislative Session authorized the Maryland Health Benefit Exchange, to establish and implement a State Reinsurance Program. The Maryland Health Benefit Exchange anticipates submitting a 1332 State Innovation Waiver on May 20, 2018 to the Centers for Medicare & Medicaid Services (CMS) requesting a state-based reinsurance program. A 30-day public comment period for the waiver application began on April 20, 2018 and will close May 20. CHF will be submitting comments and welcomes signatories. Please contact us if you wish to see a copy of our draft comments.  

If CMS approves the waiver, then rate filings will be resubmitted and an additional public hearing will be held.

Consumer Health First has issued a press release regarding the proposed rates, and CHF President Beth Sammis has said:

“We have analyzed the market and strongly believe that implementing a state reinsurance program should result in an across the board decrease of at least 30 percent in rates for both HMO and preferred provider coverages. Such a reduction would bring the rates for CareFirst’s HMO below the rates for 2018 and sharply reduce Kaiser’s Permanente's proposed premium increase – a big win for consumers.

“We caution consumers to remember that the requested rate increases are not final. If the state reinsurance program is authorized by the federal government and implemented in Maryland, consumers will see more affordable premiums in the individual market for the first time in many years. 

Under the current proposed rates, CareFirst BlueCross BlueShield wants to raise rates an average of 18.5% on its HMO products and an average 91.4% on its PPO products, which tend to cover a sicker population. Kaiser Permanente asked to raise its rates an average of 37.4%.

Overall, the average increase is 30.2% above last year's rates, as described by the Baltimore Busines Journal.

A complete list of all proposed rates for 2019 can be found on the MIA Website.


1332 State Innovation Waiver Information

On April 20, 2018, the Maryland Health Benefit Exchange submitted a Draft of the 1332 Waiver Request in accordance with emergency legislation passed into law and signed by Governor Hogan. The law directs the Maryland Health Benefit Exchange to submit a State Innovation Waiver to the U.S. Secretaries of Health and Human Services and the Treasury to establish a State Reinsurance Program.

Under Section 1332 of the Affordable Care Act, states may apply for State Innovation Waivers to waive certain federal requirements with the goal of improving their health insurance markets.

The purpose of the State Reinsurance Program is to mitigate the premium impact of high-cost enrollees on carriers that participate in the individual market. The State Reinsurance Program will reduce rates from what they would have been without the program, creating some relief for Marylanders who have experienced high rate increases on their health insurance premiums.

A series of Public Forums are planned, MHBE has lots of additional information on their website, and they have produced a Fact Sheet to answer the most common questions.

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.”


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.