Mandate fight moves to Maryland
Move for state to require people to have health insurance gains support
Buoyed by the midterm elections in which health care played a key role, lawmakers and advocates for the Affordable Care Act in Maryland say they will push a plan to require more people to get coverage.
The proposal is a response to congressional Republicans’ move to strip enforcement of the federal mandate to buy coverage beginning in the new year.
“The Trump administration has methodically taken steps to dismantle the ACA and all states will have to find a way to respond,” said state Sen. Brian Feldman, a Montgomery County Democrat who is sponsoring the legislation for a second time. “On balance, I think more people are realizing having health insurance is good from a financial standpoint.”
Under the plan, residents would have to pay a state penalty for going without coverage. But unlike under the federal mandate, uninsured residents could choose to use their fine as a down payment on a policy from the state health exchange.
The so-called individual mandate to buy coverage was among the least popular elements of the federal health law known as Obamacare, though supporters said it was crucial to ensure people bought insurance and enough healthy people enrolled.
About 12 million Americans bought plans this year, including about 150,000 in Maryland, and the Congressional Budget Office has estimated that 3 million might skip coverage next year without a penalty. So far during the open enrollment period that begin Nov. 1, sign-ups are down nationally from this time last year but up a bit in the state because more people are renewing policies, according to state exchange officials. New enrollments are flat or down slightly, they said.
State advocates for the health law fear that a drop by the Dec. 15 enrollment deadline will mean higher future premiums, not only for exchange shoppers but also for people who get insurance through employers. People without coverage often seek expensive care in hospitals and any unpaid bills are passed on to all consumers. Since the law took effect five years ago, Maryland hospitals report slashing uncompensated care by $400 million, or about a third.
“Our ‘down-payment plan’ helps get the uninsured to contribute,” said State Del. Joseline Peña-Melnyk, a Prince George’s County Democrat, in a radio ad in support of the state mandate that begins airing today. “They get the care they need while we shrink uncompensated care, holding down insurance costs for everyone.”
Maryland joins other states in exploring ways to cut health costs; only a few states such as Massachusetts and New Jersey have passed insurance mandates. Feldman said Maryland failed to pass a mandate during the 2018 General Assembly session because lawmakers didn’t have a good framework for sending tax information to the exchange so people could buy coverage or sign up for Medicaid, the government health plan for the poor.
Supporters are working on that before the 2019 session begins in January. Feldman also said the legislature had been focused on passing a reinsurance program to help insurance carriers pay for the most costly policy holders. The program is credited with prompting insurers to reduce premiums.
Under the proposed mandate, people would be asked on their state tax returns if they have health coverage and those answering no would pay about $700 or 2.5 percent of household income, whichever is higher, or they could choose to use the fine to buy an insurance policy.
The advocacy group Families USA devised the proposal and is backing it in other states. The group estimates that 78,000 uninsured people in Maryland could buy insurance for no more than the penalty plus federal subsidies; about 75 percent of Marylanders on the exchange qualify for some assistance. The group estimates another 50,000 uninsured could enroll in Medicaid.
Still, the fate of the measure and others remains unclear. Gov. Larry Hogan, a Republican who supported the reinsurance measure, called the federal mandate punitive and a spokeswoman for him said he didn’t want to see a return to that specific measure.
“While we are always open to ideas to make healthcare more accessible and affordable for Marylanders, the governor favors incentives over penalties,” said Amelia Chassé, a spokeswoman for Hogan. “For example, by successfully enacting legislation and securing federal approval of Maryland's reinsurance waiver, premiums on the individual market are decreasing across the board for the first time in decades.”