Of­fi­cials call for health in­sur­ance down pay­ment plan

Penalty for unin­sured would go into statewide fund­ing pool

The Enterprise - - Business - By HAR­RI­SON CANN Cap­i­tal News Ser­vice Thomas R. Nor­swor­thy

Mary­lan­ders without health in­sur­ance would be re­quired to pay a state penalty that can go to­ward pur­chas­ing cov­er­age un­der leg­is­la­tion to be in­tro­duced next year by state Sen. Brian Feld­man and Del. Jose­line Peña-Mel­nyk.

Pro­po­nents touted the plan Nov. 20 at a news con­fer­ence, fol­lowed by a sched­uled leg­isla­tive hear­ing on health care in An­napo­lis.

Un­der the pro­posal, any­one in the state who re­ports not hav­ing qual­ity health in­sur­ance would be re­quired to pay a penalty, sim­i­lar to the fed­eral man­date that will end in 2019 un­der changes to the Af­ford­able Care Act.

Mary­land’s pro­posal would al­low the funds to go to­ward pur­chas­ing a health in­sur­ance plan rather than into a gen­eral pool for all Mary­lan­ders, said Feld­man (D-Mont­gomery). The fed­eral man­date, on the other hand, goes into a gen­eral pool of penalty pay­ments to­ward cov­er­ing ev­ery­one. “We in­tend to make en­act­ment of the Health In­sur­ance Down Pay­ment pro­posal a pri­or­ity for the 2019 Mary­land Gen­eral Assem­bly ses­sion,” Feld­man said. “We must pro­tect Mary­lan­ders’ health care cov­er­age and we know that ev­ery­one ben­e­fits when we ex­pand health care ac­cess.”

Del. Matt Mor­gan (RSt. Mary’s) said dur­ing a phone call Nov. 21 that he is on the com­mit­tee that cre­ated the leg­is­la­tion. He said he agrees with for­mer Pres­i­dent Barack Obama about mak­ing health in­sur­ance cheaper and “peo­ple want health in­sur­ance but can’t af­ford it.” He said about half of 363,000 peo­ple who are unin­sured make too much money to qual­ify for cur­rent fed­eral sub­si­dies.

Mor­gan said leg­is­la­tors should fo­cus on mak­ing in­sur­ance cov­er­age more af­ford­able rather than im­ple­ment­ing an­other “mid­dle class tax.” He said peo­ple shouldn’t be forced to pur­chase a prod­uct they may not use if they are healthy.

Ac­cord­ing to the fis­cal and pol­icy note for House Bill 1167, or the “Pro­tect Mary­land Health Care Act of 2018,” pay­ments may be used as a down pay­ment for pur­chas­ing cov­er­age un­der a new Health In­sur­ance Down Pay­ment Ini­tia­tive. By Jan. 1, 2020, the state comptroller and the Mary­land Health Ben­e­fit Ex­change must de­velop a spec­i­fied sys­tem to fa­cil­i­tate the down pay­ment ini­tia­tive.

If an in­di­vid­ual fails to main­tain health cov­er­age for three or more months of the tax­able year, the in­di­vid­ual must make a spec­i­fied pay­ment with the in­di­vid­ual’s state in­come tax re­turn. The fine could be the greater of ei­ther 2.5 per­cent of the sum of the in­di­vid­ual’s fed­eral mod­i­fied ad­justed gross in­come as well as those claimed on the tax re­turn or $695 per adult and $347.50 per child younger than age 18 on the re­turn. The per in­di­vid­ual rates must be ad­justed an­nu­ally for in­fla­tion.

Mor­gan said there are a va­ri­ety of plans avail­able rang­ing from cop­per to plat­inum cov­er­age.

Del­e­gate-elect Brian Crosby (D-St. Mary’s) said dur­ing a phone call Nov. 21 that he “wouldn’t look at [the penalty] as a fee” but some­thing for peo­ple to in­vest their money into for health care. He said peo­ple can choose to not get in­sur­ance and pay the penalty, or buy in­sur­ance to in­crease the num­ber of peo­ple pay­ing for health care and “change the slope of the cost.” He said pre­mi­ums have been on the rise for over 30 years, “long be­fore Oba­macare.” He said if more peo­ple “are in the pool, it low­ers the risk.”

Crosby said younger peo­ple “need to pony up” the money for a ba­sic in­sur­ance plan to po­ten­tially drive down the cost for oth­ers who have to have more med­i­cal pro­ce­dures. He said the state’s cur­rent “all-payer” sys­tem should be con­sid­ered for a na­tional model be­cause “it’s a more prac­ti­cal ap­proach” than a sin­gle-payer model. “We need ma­jor re­form,” he said.

“I’m not dis­il­lu­sioned by [health care] data from other coun­tries” like those in Europe, Crosby said, adding that those liv­ing in the United States pay “twice as much in pre­mi­ums and have a worse out­come.”

He said “eco­nom­i­cally ... it’s nuts when you think about it.” He said the va­ri­ety of ways peo­ple can pay for health in­sur­ance is a “hodge­podge [and] a Franken­stein sys­tem,” and listed how peo­ple can be covered by sin­gle payer means through Depart­ment of Vet­er­ans Af­fairs, em­ployer-based, Medi­care and Med­i­caid plans.

Nearly 80,000 Mary­lan­ders would be el­i­gi­ble to gain cov­er­age through pay­ing the state penalty, ac­cord­ing to a re­port from the U.S. Agency for Health­care Re­search and Qual­ity and the Mary­land Health Ser­vices Cost Re­view Com­mis­sion.

Feld­man said this is a cre­ative pro­posal that dif­fers from the fed­eral man­date to “en­sure more Mary­lan­ders have health in­sur­ance, and in turn, keeps costs down.”

“When more peo­ple en­roll in cov­er­age, the costs come down for ev­ery­one,” said Peña-Mel­nyk (D-Prince Ge­orge’s, Anne Arun­del). “More young and healthy peo­ple in the in­di­vid­ual mar­ket means that risk lev­els are bet­ter and pre­mi­ums are lower. Fewer unin­sured means lower un­com­pen­sated costs in hos­pi­tal emer­gency rooms, which means fewer of those costs get passed on to the rest of us.”

Although pre­mi­ums have con­tin­ued to in­crease in the last five years, those in­creases are de­clin­ing each year as more peo­ple sign up for cov­er­age.

New data pre­pared by the Mary­land Ci­ti­zens’ Health Ini­tia­tive Ed­u­ca­tion Fund re­veals that an­nual in­creases in the av­er­age small group pre­mium in Mary­land dropped from 5 per­cent to be­low 1 per­cent since the Af­ford­able Care Act went into ef­fect in Jan­uary 2014.

The data, re­ported by the U.S. Agency for Health­care Re­search and Qual­ity and the Mary­land Health Ser­vices Cost Re­view Com­mis­sion, af­firms that since the Af­ford­able Care Act was in­tro­duced in 2014, the unin­sured rate in Mary­land dropped nearly in half, go­ing from about 12 to 6 per­cent in 2017.

The an­nual cost in Mary­land of un­com­pen- sated care — when peo­ple without health in­sur­ance re­ceive treat­ment — fell from about $1 bil­lion to $700 mil­lion in the same time pe­riod, while more than 400,000 Mary­lan­ders re­ceived in­sur­ance.

Peña-Mel­nyk said a plan like this is es­sen­tial for fill­ing the gap where the Af­ford­able Care Act’s in­di­vid­ual re­spon­si­bil­ity is be­ing cut off. She said that if a new in­di­vid­ual man­date isn’t passed, ac­cord­ing to the Ur­ban In­sti­tute, about 69,000 Mary­lan­ders would lose in­sur­ance and in­di­vid­ual mar­ket pre­mi­ums would rise about 16 per­cent.

The Mary­land man­date would be used as a down pay­ment for health in­sur­ance. For some, it would cover the cost; oth­ers would need to sup­ple­ment that amount.

Pub­lic health ad­vo­cates are hop­ing to see those costs drop if more Mary­lan­ders opt in for cov­er­age. Beth Sam­mis, pres­i­dent of Con­sumer Health First, said one of the most dif­fi­cult aspects of get­ting a larger pool is mo­ti­vat­ing young, healthy peo­ple to opt in to cov­er­age.

Last year, state leg­is­la­tors at­tempted to pass the Pro­tect Mary­land Health Care Act of 2018, a sim­i­lar bill that would have re­quired the state to cre­ate an in­sur­ance sta­bi­liza­tion fund and the health in­sur­ance down pay­ment es­crow fund.

Though the orig­i­nal down pay­ment plan never reached Re­pub­li­can Gov. Larry Ho­gan’s desk last year, ad­vo­cates are hope­ful this will be a pri­or­ity in the up­com­ing leg­isla­tive ses­sion.

Thomas “Tommy” R. Nor­swor­thy, 58, of Hugh­esville, passed away Satur­day, De­cem­ber 1, 2018 sur­rounded by his fam­ily and friends.

He is sur­vived by his wife, Joyce Graves-Nor­swor­thy; sis­ter, Paula Fan­ning; brother, John Nor­swor­thy Jr. (Denny); and many other fam­ily mem­bers.

He is pre­ceded in death by his par­ents, John Nor­swor­thy Sr. and Joanne Beers; sib­lings: Mar­garet Blomquist (Dave), Carol Nor­swor­thy, Mary Nor­swor­thy, and Wil­liam Nor­swor­thy.

Tommy grad­u­ated from Ryken in 1979. He was em­ployed with Bob Green Sid­ing for 36 years where he was a fore­man. Tommy en­joyed camp­ing, fish­ing, crab­bing, and golf­ing.

Vis­i­ta­tion will be held at Brins­field in Char­lotte Hall on Fri­day, De­cem­ber 7, 2 p.m. to 4 p.m. and 6 p.m. to 8 p.m.

Ar­range­ments by Brins­field Fu­neral Home, P.A., Char­lotte Hall, MD.

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