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Health Care

Activists to Push for Individual Insurance Mandate in Md.

As President Trump and congressional Republicans aim to eliminate the individual insurance mandate contained in the Affordable Care Act, a push is on in Maryland to buttress the federal mandate — or even create a state mandate.

Vincent DeMarco, the veteran health care advocate, told Maryland Matters he will be seeking sponsors of legislation in the upcoming General Assembly session to create a state insurance mandate. And he’s armed with new polling data showing support for the mandate, which requires people to buy health insurance or pay fines, in Maryland.

DeMarco, president of the Maryland Citizens’ Health Initiative, plans to first float the idea at the next meeting of the Maryland Health Insurance Coverage Protection Commission on Dec. 5. The commission was created by a bill in the last legislative session and is charged with exploring how changes to the ACA, more commonly known as Obamacare, would impact Maryland.

DeMarco serves on the 16-member commission (not including ex-officio members), which includes half a dozen lawmakers, along with medical professionals, Hogan administration officials and others. The co-chairmen are Montgomery County Sen. Brian Feldman (D) and Prince George’s County Del. Joseline Peña-Melnyk (D).

A quick legislative push is not the norm for DeMarco, who is well-known in Maryland for helping to strengthen the state’s gun control laws, increase tobacco taxes to prevent youth smoking, and expand health care coverage for children, among other causes. But those campaigns were multi-year efforts that involved building public and political support for the designated cause in a variety of methodically-planned ways.

DeMarco, in fact, is in the middle of a similar long-term push for enhanced clean energy mandates in the state, which he launched with environmental groups and faith leaders in late summer.

DeMarco said that given the Republicans’ desire in Washington, D.C., to eliminate or weaken several tenets of the Affordable Care Act, including the individual mandate, there is an urgency to act.

“We have to do this next session,” he said. “We have to protect Maryland. There keep being threats to the individual mandate and other things in the ACA.”

If Maryland adopted its own insurance mandate, it would be the second state to do so. Massachusetts was the first, in 2006 — when Republican Mitt Romney was governor and “Romneycare” became the template for the Affordable Care Act.

The Bay State’s individual mandate is more stringent than the federal requirement — which is not DeMarco’s aim for Maryland. “We don’t want to make anything higher than the federal,” he said. “We want to make sure that the federal is protected.”

Whether there is the political will in an election year to tackle such a complex and emotionally-charged issue is very much an open question.

But DeMarco is cautiously optimistic that there will be support for it in the Democratic-controlled legislature. Just last week, House Speaker Mike Busch (D) published an op-ed piece in The Baltimore Sun vowing that the state will compensate for any diminishments to the federal health care law. He argued that health care is not a partisan issue in Annapolis.

“We’ll continue to work with hospitals, doctors, insurers, advocates and our Republican colleagues to attack the opioid epidemic, mitigate the Trump sabotage of Obamacare and protect our state’s health care system and patients.” Busch wrote.

DeMarco also notes that Gov. Larry Hogan (R) has become increasingly critical of congressional Republicans’ attempts to repeal Obamacare; in July he was one of 11 governors — five Democrats, five Republicans and one independent — who penned a letter to U.S. Senate Majority Leader Mitch McConnell (R-Ky.), arguing that a Senate proposal to repeal the Affordable Care Act without any alternative would leave millions of Americans without health insurance.

Hogan has not said much publicly about the tax reform bills making their way through Congress, but the Senate’s current version of the legislation would eliminate Obamacare’s individual mandate, which Republicans are selling as a partial tax cut and revenue generator.

Yet the concept of an individual mandate first gained credence when it was endorsed by the conservative Heritage Foundation more than a decade ago and embraced by Romney in Massachusetts. In Maryland, the idea was regularly promoted by former Del. Donald “Doc” Elliott, a conservative Republican and retired pharmacist from Carroll County.

According to a poll conducted for the Citizens’ Health Initiative, Marylanders strongly support the Affordable Care Act. Sixty-two percent of poll respondents said they favor it, while 28 percent were opposed. When the health law was labeled Obamacare, support dropped slightly, with 58 percent favoring it and 34 percent opposing.

The poll of 850 registered voters was taken Oct. 25-Nov. 7 by OpinionWorks, an Annapolis firm. It had a 3.3-point margin of error.

The poll also found strong support for the idea of an individual insurance mandate. Sixty-five percent of Maryland voters favored the concept and 27 percent opposed it. Asked if Maryland should adopt its own individual mandate if the federal mandate is eliminated or not enforced, 52 percent said they favored that move, while 36 percent said they would be opposed.

“The conventional wisdom is that it’s the least popular part of the ACA, and people don’t want it. But in Maryland, they do,” DeMarco said.

But some critics of the federal health care law have called the individual mandate a tax increase — and if that argument gains a foothold in Maryland it will become difficult for Republicans, including Hogan, to support it, especially in an election year. DeMarco insists that any such argument can be rebutted.

“It isn’t a tax because it’s requiring everybody to chip in to make health insurance work,” he said. “If only sick people have to have insurance, the whole system would be doomed.”

Asked in the Maryland poll whether they considered the individual mandate a tax, 37 percent said yes, 43 percent said no and 20 percent were unsure.

The Maryland Health Insurance Coverage Protection Commission, which is in business until 2020 under state law, is expected to make an interim report on the impact of federal health care reform on Maryland early next year. But it is unlikely to make any recommendations at this early stage for how the state should address any changes to the federal system. DeMarco is hoping to persuade enough commission members to put the idea in front of lawmakers, so they act in the upcoming legislative session.


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Activists to Push for Individual Insurance Mandate in Md.