Opinion: Health Insurance, Now and in the Future

Congressman Elijah Cummings said that his vote in 2010 for the Affordable Care Act (Obamacare) was the most important of his career. Hundreds of thousands of Marylanders and millions across the country would agree.

For many people who live in states like Maryland, which expanded Medicaid, it has meant that they now have access to the health care services provided by this crucial federal/state partnership. Many others with private insurance were once denied a policy because they had conditions as minor as acne. Now they can purchase insurance at Maryland Health Connection.

Friday (Nov. 1) marks the seventh year that Marylanders can renew their coverage, change their insurance plan or sign up for the first time under this program. They will find that health insurance premiums have continued to come down. This is thanks to a reinsurance program put in place through the foresight and hard work of Maryland’s elected officials, policy makers and stakeholders. That program compensates insurance carriers for providing services to their highest cost patients, which prior to its implementation in 2019, was driving up the premiums for everyone.

The reinsurance program should reduce costs through the 2023 plan year. However, a longer-term solution is required and there are options that should be considered to achieve both affordability and market stability. The Maryland Health Benefit Exchange has provided one road map through the work of its Affordability Work Group. Its recommendations were presented to the Health Insurance Coverage Protection Commission earlier this month.

At their meeting, the commission learned of steps being taken in other states, including Massachusetts.

The commission also heard from Chiquita Brooks La-Sure of Manatt Health Strategies. She presented on the “Evolving Public Option/Medicaid Buy-In Models and Considerations” and cited Washington state as well as a promising model from Colorado for a state-based option. This is detailed in the “Draft Report for Colorado’s State Coverage Option.” That study was mandated under House Bill 19-1004 and released this month.

Given the parallels between Colorado and Maryland, commission members should take a close look at this proposal. For example, Colorado’s approach would address similar affordability issues and at the same time foster a more competitive individual market. That would be important to all Marylanders, but particularly so in counties currently served by a single insurance carrier. Colorado has 22 such counties while in Maryland, 13 rural counties have only one carrier — CareFirst.

There are other parallels between the two states which argue for a thorough analysis of the model and its applicability to Maryland. One interesting one is Colorado’s goal of investing in primary care. This is designed to not only improve the health of individuals, but also to lower health care costs across the system. This should sound familiar to those in Maryland who are engaged in implementation of our new Primary Care Program and Total Cost of Care Model.

Maryland’s policymakers speak with pride of our state’s reputation as a national leader on health care reform — and rightly so. Now it is time to step up, once again. They should look closely at the potential of creating a public option in Maryland, whether based on Colorado’s plan or another model. Marylanders deserve nothing less.

— LENI PRESTON

The writer is a consumer advocate and health policy expert and former chair of the Board of Directors of Consumer Health First.

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