New Medicaid Changes Harm Students and Limit Economic Mobility
Attaining a postsecondary education can greatly increase success in today’s labor market. But it is often out of reach for students from low-income families, who may receive little or no financial family support for school and who have significant unmet need even after receiving financial aid. A policy brief written by Carrie Welton for the Center for Law and Social Policy describes how current proposals to restrict health care access to those who can meet minimum work requirements threaten health coverage for low-income students. Some states do not have exceptions for student status and it can be impossible for students to work the specified number of hours while maintaining academic standing. Health care is essential for students to reach their full potential Programs serving low-income people should promote education as one of their highest priorities—not create new hurdles to completing degrees and credentials.
Early May News Roundup
On behalf of our members, DoTheMostGood submitted a letter to all of the members of the County Council on May 1, urging them to support the Health Care Programs for Low-Income and Uninsured Residents of Montgomery County and fund several recommended enhancements to these programs. The same letter was sent individually to each councilmember. You can read one of the letters here.
On May 7, InsideHealthPolicy reported that, based on initial rate filings, CareFirst BlueCross BlueShield may hike its Affordable Care Act premiums next year by as much as 91.4 percent unless HHS approves the state’s request to create a state-run reinsurance pool. CareFirst said it will refile the rates if and when the Trump administration approves Maryland’s request. Double-digit premium hikes appear to be the new norm for 2019, as demonstrated in preliminary filings from ACA insurers in Virginia and Maryland.
On May 15, Maryland Reporter wrote that, beginning next year, Maryland’s unique all-payer hospital payment model will expand beyond hospital walls. Under a finalized deal with the federal Centers for Medicare & Medicaid Services, the new model will focus on bringing primary care physicians and nursing homes into the program to better manage population health and reduce hospital admissions from chronic conditions. “Everything we have done here before has been hospital-focused,” said Robert Neall, Maryland’s health secretary. “This is an extension into the entire continuum of health care. … People get more access and attention at the front door rather than going to the hospital after something terrible has happened.”
Consumer Health First (CHF) held a webinar on May 11, that included highlights of new Maryland legislation funding a reinsurance program to stabilize rates; creating a pilot project to provide dental care to Medicaid recipients expanding women’s access to contraception, and restoring funding for community behavioral health services. Among its upcoming priorities, CHF included working with its partners on the following the Maryland Insurance Administration’s rate review process for 2019 health insurance plans; the Medicaid Buy-In option study; and the Medicaid Supports Maryland Campaign.
What is single payer?
There is rightfully an increased focus on healthcare, but one term keeps coming up that some people are unclear about. What exactly IS single payer healthcare? “Single payer” is one way to finance health insurance. It implies a health insurance program for the entire country that is run by and paid for by one entity.
In the U.S. and most other industrialized nations, health insurance assures the provision of health care services. Health insurance works like auto, home, and other insurance: the insurer charges the insured a premium, assuming the responsibility (bearing the risk) for providing reimbursement for health care expenses of the insured.
In the U.S. Medicare is a government-run single payer for those over age 65 and for the disabled: it taxes the employed to cover health insurance and administrative costs, it sets premium rates, it determines reimbursement levels for health care professionals and institutions, it contracts with health insurers for administrative functions, and it issues regulations for the program. Medicare covered approximately 55 million beneficiaries in 2015. Medicaid and CHIP two other government health insurance programs cover nearly 70 million people, or 1 in 5 people.
Maryland Lawmakers Pass Short-Term Plan to Stabilize Health Insurance Market
Just days before its legislative session ended April 9, Maryland lawmakers finalized an emergency measure to protect key provisions of the Affordable Care Act for one year. The bill was the result of a compromise between the Democrat-controlled General Assembly and Gov. Larry Hogan, who signed it into law on April 5. It impacts roughly 150,000 purchasers seeking health coverage under Obamacare through Maryland’s private insurance market.
Under this plan, the reinsurance program receives $380 million in funding from a 2.75 percent tax on premiums that insurers in the Maryland Health Benefit Exchange (MHBE) collect. A 2.75 percent federal tax had been levied to insurance companies under the ACA but was set for a one-year reprieve by federal lawmakers; Maryland lawmakers decided to reinstate the tax at the state level to bolster health care access for its citizens. The proceeds will be used to create a reinsurance program that insurers can then tap into to cover catastrophic claims in the Obamacare market. Additional legislation approved this month allows Maryland to seek federal money to supplement the new state tax revenue and leaves open the possibility of funding the program for additional years.
The MHBE targets people who are not poor enough to qualify for Medicaid but too young to qualify for Medicare. Without the new legislation, such Marylanders were expected to see their premiums jump as much as fifty percent when renewed for another year. Insurance analysts hope the program will cut expected premiums by half.
Legislators also asked a commission to study the long-term prospects for the state’s health insurance market and to consider whether to enact an individual mandate requiring Marylanders to purchase health insurance once the federal mandate expires next year.
Policymakers largely agree that additional fixes are required to stabilize the Affordable Care Act. Maryland is one of several states attempting to support their own insurance exchanges after federal lawmakers failed to legislate new improvements for the ACA, repeal it, or release specifics for an alternate federal health insurance policy.
Highlights from 2017
The Way Forward on Healthcare
At a DTMG Healthcare Team meeting on September 6, Kelly Whitener, Associate Professor at Georgetown University’s School for Public Policy Center on Children and Families, outlined the “hot topics” on the national health agenda. Members then went on to brainstorm “what can we do” action steps.
- Topic One: The Children’s Health Insurance Program (CHIP), along with Medicaid, covers about 1/3 of the children in the US. Although this program has bipartisan support, it is in danger of losing its designated funding by the end of September, or at least of having it delayed, because some in Congress feel that it is covered by other funding mechanisms. Funding cuts or a restrictive block grant for this ACA-mandated program would throw a huge burden onto the states. A short-term 3-6 month extension would hamper efforts at long-term planning. This program, which expands Medicaid, is particularly critical for children with disabilities.
- Topic Two: Medicaid State Innovation Waivers allow states to provide services to people in their homes and in their communities rather than in institutions. For instance, some waivers allow funding matches for testing new service delivery systems or researching individual treatment options. A major concern: To save money, especially, if, once again, Congress imposes cuts or limits funding through block grants, states may impose restrictions such as time limits, drug testing, and work requirements.
- Topic Three: The “3 Rs”: Risk Adjustment, Reinsurance, and Risk Corridors provisions protect people with pre-existing conditions and work to stabilize premiums and insurer gains and losses in the early years of the Affordable Care Act.
* Educate people about and help them access the ACA
* Contact Hogan and educate his voters
* Attend forums
* Keep track of pending legislation
* Build connections outside of Montgomery County
* Text 228466 to get Daily Action alerts
Petitions Delivered to Governor Hogan
On June 2, DTMG MoCo traveled to Annapolis to deliver a letter and petitions to Governor Hogan on the impact of efforts to repeal the ACA. The letter expressed our disagreement with Health & Human Services Secretary Price’s views on Medicaid expansion and access to care for our most vulnerable populations, and his contention that he wanted to empower states to innovate in healthcare delivery through Section 1115 Medicaid demonstration waivers when that waiver program has been available to States for decades.
The petition, along with a separate letter, called for Governor Hogan to stand up against the AHCA.
We, the undersigned demand that you Take a Stand and Oppose the American Health Care Act (AHCA). This new plan will raise premiums, reduce coverage, and weaken protections for people with preexisting conditions. It will roll back the progress we have made in Maryland under the Affordable Care Act (ACA), which has reduced the percentage of uninsured Marylanders from 11.3% in 2010 to 6.6% in 2015. While governors of both parties have denounced the AHCA, you have appointed Robert Moffit, a strong opponent of the ACA, as the new chair the Maryland Health Care Commission.
While delivering the letters and petition, our representatives met with the Director of Constituent Services for Governor Hogan and discussed our concerns about repealing the ACA, eliminating the Medicaid expansion and the appointment of Robert Moffitt as Chair of the Maryland Health Care Commission. He indicated he would discuss our concerns with the Governor.
Activist Teach-In on Protecting Our Healthcare
On May 22nd we hosted a Do The Most Good Teach-In for Activists on Protecting Our Healthcare in conjunction with Consumer Health First:
Other Actions and Events
- In April, DTMG delivered a letter to Montgomery County Council members protesting a proposed 1% cut to the Health Care Programs for low-income and uninsured residents of Montgomery County. We met with the chief of staff for Councilmember Marc Elrich. Not long thereafter, the County Executive withdrew the 1% cut proposal.
- In March we attended the Amplify Our Voices rally in Annapolis and held a virtual phone bank in conjunction with Progressive Maryland to ask Maryland voters to call and urge the Governor to preserve the ACA in Maryland.
Maryland Senator Chris Van Hollen joins members of DTMG at the Amplify Our Voices rally in Annapolis.
- In February, we held an ACA strategy and Legislative Training Session, and sent an email to Governor Hogan describing the impact to Maryland of the Repeal of the ACA.
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