A three-pronged approach to widening health care access in Maryland | GUEST COMMENTARY

U.S. President Joe Biden fist bumps former President Barack Obama after Biden signed an executive order aimed at strengthening the Affordable Care Act during an event to mark the 2010 passage of the Affordable Care Act in the East Room of the White House, on April 5, 2022, in Washington, D.C. (Chip Somodevilla/Getty Images/TNS)

At a recent White House event, President Joe Biden joined his predecessor, Barack Obama, to commemorate the 12th anniversary of the Affordable Care Act ’s passage. So much has changed for the better thanks to the ACA: The country’s uninsured rate has dropped dramatically (by half in Maryland), people no longer struggle to get coverage due to preexisting medical conditions, and millions of Americans receive help paying their insurance premiums. But there’s still work to be done to get everybody covered and to ensure they have access to the care they need.

While Maryland has led the way in fully implementing and building on the ACA — insuring an additional 400,000 people in recent years and being the first state in the nation to offer an Easy Enrollment program that allows people to sign up for health care at tax time — 6% of the state’s population remains without coverage, meaning they may go without care. When they do seek care, they tend to go to the hospital emergency room, the most expensive health care setting, which drives up costs for everyone.


Our organization, the Maryland Health Care for All! Coalition, will be reaching out across the state to build support for a three-pronged health care agenda we believe is urgently needed.

First, we want to make it easier to enroll in health insurance. We will be advocating for a mechanism to automatically enroll all eligible Marylanders for free or very low-cost health care plans in health care coverage (while allowing those who want to opt out the ability to do that). An estimated 180,000 Marylanders are eligible for these kinds of coverage but aren’t enrolled. People often don’t know that they have options for coverage or aren’t sure how to get covered. Enrolling them automatically in Medicaid or very low-cost coverage in the private market is a common sense solution.


Our second plank is to make health insurance more affordable. We aim to create state-based subsidy programs to improve the affordability of private coverage to uninsured Marylanders and small businesses who enroll through Maryland Health Connection. We know that such subsidies are helping Massachusetts to keep its uninsured rate below 3%. Here in Maryland, our General Assembly enacted in 2021 a pilot subsidy program for low-income young people, which has so far resulted in over 11,000 first-time enrollments for health care coverage through Maryland Health Connection. And this year, a new law creates a work group to determine how additional subsidies can help small businesses afford health care for their employees. Building on these programs, we can develop a successful subsidy program that would substantially reduce the number of uninsured in our state and save lives.

Our final plank is to promote equitable access to health care. We would eliminate immigration status as a factor in determining eligibility for health coverage for Marylanders who are eligible to enroll in Medicaid or private health plans from Maryland Health Connection. Currently more than 115,000 Marylanders, including children, are ineligible for these kinds of insurance because of their immigration status, while at the same time paying millions of dollars in taxes every year. Without insurance, they and their families face greater health and financial risks. We must ensure equitable access to coverage.

Helping more Marylanders get coverage, improving their health and peace of mind, is the right thing to do. But it’s also the smart thing to do. Once everyone in our state gains affordable, secure access to essential health care, people will get preventive care and prompt treatment of chronic health problems, instead of winding up in the hospital with catastrophic costs that we all wind up paying. We’ll also pay less for uncompensated care, and healthier people will join the insurance pool, lowering premiums for all of us

Under our plan some health care costs will decline. And the federal government will pay most of the up-front cost to expand coverage. But let’s not kid ourselves: If we want to make sure every Marylander gets the care that they need, the state will incur some costs. Like many good things in life, health care for all will not be completely free. But it’s worth it.

We have committed health care champions in the General Assembly. We have one of the best Health Care Exchange teams in the nation. We look forward to working with them in the years ahead to make Maryland an even healthier place in which to live, work and raise a family.

Vincent DeMarco ( is president of the HealthCare for All! Coalition.