Van Hollen Seeks to Expand Maryland’s Check-the-Box Insurance Enrollment Nationwide

U.S. Sen. Chris Van Hollen (D). Photo by Danielle E. Gaines.

U.S. Sen. Chris Van Hollen (D) announced Tuesday that he is seeking to expand access to health insurance to millions of Americans by mirroring an existing state law that allows people to enroll through the Maryland Health Benefit Exchange by checking a box on their tax returns.

“This bill represents American federalism and bipartisanship at its finest,” Stan Dorn, director of the National Center for Coverage Innovation at the consumer health advocacy group Families USA, said at a news conference Tuesday afternoon. “Using the states as laboratories of democracy, Senator Van Hollen is now saying, ‘Let’s take this great innovation in Maryland, let’s make it smoother and more effective in a way that we can only do by changing the rules at the federal level.’”

If enacted, Van Hollen’s Easy Enrollment in Health Care Act would authorize the IRS to share an individual’s personal information with their state’s health exchange marketplace. The health exchange would then send an enrollment letter to the person, enabling them to choose an insurance plan.

According to Van Hollen, there would be a 60-day special enrollment period for people who qualify for free insurance. If they don’t select a plan and don’t opt-out, they would be automatically enrolled in the program that offers the highest coverage with no premiums.

Van Hollen said Tuesday that two out of three uninsured Americans are eligible to receive free or low-cost health insurance under programs like Medicaid, the Children’s Health Insurance Program and Advance Premium Tax Credits.

“That’s 18 million people, including 13 million Americans who would be eligible for free insurance at this very moment,” he said. “This is the enrollment gap, and it’s hurting families across the board.”

Most of those eligible individuals also file federal tax returns, Van Hollen said.

“This type of tax filing system could reach millions and millions of uninsured Americans who know little about these health care programs or their current eligibility to receive health care, including free health care,” Van Hollen said.

According to Michele Eberle, executive director of the Maryland Health Benefit Exchange, 27,000 Maryland households checked the box on their tax returns in 2021, 10% of which resulted in enrollments.

Of those enrolled, 72% were eligible for Medicaid.

“That’s free health insurance,” Eberle said. “They did not even know that they were eligible for it. We got them enrolled.”

Del. Lorig Charkoudian (D-Montgomery) sponsored legislation during the 2021 session that added the check-the-box provision to unemployment insurance applications.

At a virtual event held by the Maryland Citizens Health Initiative last week, Charkoudian said that, to her knowledge, Maryland is the first state to streamline the connection between unemployment insurance and a public health exchange platform in this way.

“That’s really exciting both for Marylanders and, hopefully, for folks across the country,” Charkoudian said.

During a phone interview Tuesday afternoon, Dorn said that Van Hollen’s legislation has the ability to expand access to health coverage nationwide — even in Maryland.

For example, instead of requiring uninsured people to guess what their income will be next year to determine if they are eligible, federal implementation would allow them to enroll in insurance programs based on their taxable income in the previous year.

“What it means is, when you file your taxes you will know what you’re eligible for and it can’t be taken away, guaranteed,” he continued.

Dorn emphasized the bipartisan nature of the state legislation that inspired Van Hollen’s bill, noting that it was implemented with the support of Democrats and Republicans in Maryland and also passed in Colorado and Massachusetts.

“It is a lot of expert consensus across the philosophical spectrum that says, ‘…surely we can all agree that people who are eligible for health [insurance] ought to get it’,” Dorn said.

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