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Maryland makes more progress on Obamacare rates — but there's more to do

For the second year in a row, Marylanders who rely on the Obamacare exchange to buy health insurance have a chance to pay lower rates. The initial rate requests from CareFirst BlueCross BlueShield and Kaiser Permanente aren’t quite as dramatic as last year’s across-the-board reductions — prices for some kinds of policies may go up slightly, but the most popular one, CareFirst’s HMO, will decline by nearly 9 percent. That’s a far cry from the death spiral of ever-escalating prices leading to dwindling enrollment and still higher prices other states have seen. It’s a reflection of good policy choices and an ongoing commitment by both the Democratic General Assembly and Republican governor to make the Affordable Care Act work. But with the Trump administration’s continued hostility toward the ACA, the job here is far from done.

Gov. Larry Hogan today signed a bill that could help. The Maryland Easy Enrollment Health Insurance Plan creates a check-box on state income tax returns for people who are uninsured to seek coverage. Sponsored by Del. Joseline Peña-Melnyk and Sen. Brian Feldman, it authorizes the comptroller to share information with the Health Benefits Exchange to determine eligibility for Medicaid and to automatically enroll Marylanders in the program. The exchange would contact others with information about private health plans and subsidies in hopes of getting them to enroll. It’s a novel approach — no other state has tried anything like it — so there’s no way to know how many of the state’s approximately 400,000 uninsured people will get coverage as a result.

The bill sets up a commission to study its effects and to make recommendations to strengthen it if necessary. We expect it will end up where this bill initially started — with the need to create a state version of the individual mandate President Donald Trump and Republicans in Congress gutted in their 2017 tax legislation. Before it was watered down in the legislature, the Easy Enrollment bill created a state-level mandate but set up a system by which the fine uninsured people were required to pay could be used as a down payment on insurance coverage. It was a great idea that we hope to see resurrected.

Last year, Governor Hogan worked with the legislature to create a funding stream for a state-level reinsurance program — effectively, a mechanism to compensate insurers for extremely sick patients who have a disproportionate effect on overall health costs — and persuaded the Trump administration to allow it. But the funding was a one-time deal, a tax on health insurance premiums in 2019, a year when the federal government had waived its own health insurance premium tax. (That was politically significant to Governor Hogan at the time, as he was running for re-election and seeking to maintain his record of opposing tax increases.) The one-year tax provided enough money to keep the reinsurance program running for about two and a half years, but how Maryland would keep it going through its scheduled expiration in 2023 was unclear.

House Bill 258/Senate Bill 239 (also sponsored by Ms. Peña-Melnyk and Mr. Feldman) would fix that by extending the state premium tax (at a lower rate than the federal one) through 2023, whether the federal government collects its tax or not. The measure passed with a veto-proof majority (and a number of Republican votes, particularly in the Senate), but Governor Hogan has not said whether he will sign it, and the bill did not make the list today when he signed other health measures into law.

In that same category is a bill that would create a Prescription Drug Price Review Board to evaluate the expense of particularly high-cost medications or those subject to big price increases. The board would be empowered to set a cap on the price state and local governments would pay for those medication. That bill has some Republican backing, too — notably from Harford County Executive Barry Glassman. Governor Hogan told the audience at a quasi-presidential campaign stop in New Hampshire that he believes something needs to be done about prescription drug costs, and he referred to a bill Maryland’s legislature passed this year to deal with it, but he hasn’t clearly said whether he will sign or veto the measure.

We urge Governor Hogan to sign both. The continued progress on bringing down health insurance rates on the individual market is welcome, but we are still short of a permanent answer for how to expand coverage to the uninsured and reduce costs for all.

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