The election of Donald Trump raises new uncertainty not only for the nearly 421,000 Marylanders who now have insurance under the Affordable Care Act, but also the state's unique cost-control agreement with Medicare.
Under the lucrative agreement with the federal government, the state sets uniform prices for hospital care, which means Medicare pays more in Maryland than elsewhere. In exchange, the state's hospitals must keep health costs down. But they could lose millions of dollars if the agreement, which is being renegotiated now and expires in two years, went away.
The status of both federal health care programs is in doubt under a Trump administration. The Republican has promised to repeal the Affordable Care Act, also known as Obamacare.
President Barack Obama has blocked past congressional attempts to repeal the law. On Wednesday, House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell said they would help Trump keep his word.
Repeal has been a priority of Republicans since a Democratic Congress approved the law in 2010.
"Restricting the number of options in the market, which is what the Affordable Care Act ending up doing, is not the way to bring rates down," said Rep. Andy Harris, a Baltimore County Republican.
Rep. Elijah E. Cummings, a Baltimore Democrat, warned that repeal "would have devastating effects, especially on voters in states that went most heavily for Donald Trump."
"Eliminating someone's health insurance is not a solution to stem increasing premiums," Cummings said in a statement. "Repealing Obamacare would increase the national deficit by hundreds of billions of dollars, and it would be devastating for the working poor, individuals with pre-existing conditions, and millions of others who only recently were able to obtain health insurance."
Leni Preston, president of the advocacy group Consumer Health First, said any change to Obamacare should be thought out so millions of people aren't just thrown off health insurance without another option.
Officials with the Department of Health and Mental Hygiene declined to discuss the future of Obamacare in Maryland. They said it remains "the law of the land, and it will continue to be implemented in Maryland."
More unclear is what will happen to Maryland's hospital cost-control deal with Medicare.
"I am hopeful that I can work with Governor Hogan and the rest of our congressional delegation to preserve Maryland's unique model and protect the health of Marylanders," Senator-elect Chris Van Hollen said.
Harris predicted Trump would leave that up to his new secretary of health and human services.
"The Medicare waiver in Maryland has really depended on the government control of the pricing of health care," he said. "I think in general that policy is not a philosophy that Mr. Trump has."
Preston said the arrangement could go away if the federal office that oversees it is eliminated by the Trump administration or simply if new staff members are unfamiliar with the program.
Carmela Coyle, president and CEO of the Maryland Hospital Association, said hospitals are watching for signs of changes to the Affordable Care Act and the waiver.
"We've come up with an innovative way to deliver care in a more affordable way," Coyle said. "We should attempt to explain to folks so they understand our accomplishments."
Baltimore Sun reporter John Fritze contributed to this article.