Public health is gauged by the prevalence of certain diseases and behaviors, access to care, uninsured rates, health disparities by income and education levels, and other factors. Two respected organizations show overall health in Maryland moving in opposite directions. Use the following links to see how Maryland is moving on specific health measures, and read how the state’s efforts around health care reform might push more measures in a positive direction.
Maryland health ratings
Maryland’s ranking on the Scorecard on State Health System Performance improved from 24th in 2009 to 17th in 2014. The rankings by The Commonwealth Fund compare numerous health measures to arrive at an overall score for each state and the District of Columbia. See Maryland’s most recent scorecard.
In another national comparison – America’s Health Rankings from the United Health Foundation -Maryland is 24th, down four positions from 2012. Positive health indicators include a low smoking rate, a low percentage of children living in poverty, and good availability of primary care doctors and dentists. However, the state’s ranking is weighed down by a high violent crime rate, a high infant mortality rate, and high levels of air pollution.
For more even information, see Key Health Data About Maryland from the 2014 edition of Trust for America’s Health.
Finally, the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin break down public health rankings at the county level.
Maryland and the Affordable Care Act
Maryland politics are dominated by Democrats at the state and federal level, and the Affordable Care Act has broad support among Maryland leaders.
The Maryland legislature approved a state-run health insurance marketplace, and Gov. Martin O’Malley signed the bills into law in 2011. The state marketplace, called the Maryland Health Connection, was one of the first approved by the federal government.
Despite the state’s early start, its marketplace performed poorly. So poorly, in fact, that the state abandoned its technological infrastructure and is moving to the platform successfully used by Connecticut.
Medicaid expansion is a key ACA strategy for reducing the uninsured rate, and Maryland joined 25 other states and the District of Columbia in implementing this measure. As detailed below, Maryland saw significant Medicaid enrollment during the open enrollment period on the marketplace. Medicaid signup continues year-round, so enrollment totals change monthly.
How did the ACA help Maryland?
Maryland experienced a significant drop in its uninsured rate after the ACA’s individual mandate went into effect. According to Gallup, Maryland’s uninsured rate was 12.9 percent in 2013. It dropped 4.5 percentage points to 8.4 percent as of mid-2014. Nationally, the uninsured rate as of mid-2014 is 13.4 percent.
Maryland enrollment in QHPs
Despite the challenges of a malfunctioning website, 67,757 Marylanders enrolled in qualified health plans during 2014 open enrollment.
More than 90 percent of those enrolling in QHPs for 2014 coverage selected plans offered by CareFirst BlueCross BlueShield.
In June, insurers submitted their proposed 2015 rates to the Maryland Insurance Administration. CareFirst is requesting approval for significant increases, while other insurers are proposing decreases from the 2014 rates. Cigna and United Healthcare both submitted filings, indicating they plan to join the marketplace for 2015.
At the beginning of 2014, the Kaiser Family Foundation estimated that 756,000 nonelderly Marylanders were uninsured. Given the state’s decision to expand, Medicaid 40 percent – 302,400 people – now qualify for coverage through the program.
During the ACA’s 2014 open enrollment period, 163,602 Maryland residents qualified for Medicaid or the Children’s Health Insurance Program (CHIP). Medicaid and CHIP signups continue throughout the year.
Learn about Maryland Medical Assistance Programs.
Other ACA reform provisions
The Consumer Operated and Oriented Plan (CO-OP) Program was created through the ACA to spur the creation of nonprofit, consumer-run health insurance companies. Evergreen Health Cooperative in Maryland was one of 24 CO-OPs to receive a federal loan.
Evergreen did not attract many consumers during 2014 open enrollment, in part due to the problems with Maryland Health Connection.
Does Maryland have a high-risk pool?
In the individual health insurance market prior to 2014, applications were medically underwritten in nearly every state, including Maryland. Because medical history was used to determine eligibility for coverage, people with pre-existing conditions often found themselves unable to purchase comprehensive plans in the private market.
The Maryland Health Insurance Plan (MHIP) has been providing coverage since 2003 for people who were denied plans in the private market because of pre-existing conditions, or offered only plans that excluded their pre-existing conditions.
Under the ACA, medical history is no longer an eligibility factor for private health insurance. The need for high risk pools has thus been largely eliminated, but several risk pools – including MHIP – are still operational.
In 2013, MHIP released a plan for transitioning their members to the exchange. But Maryland’s exchange was one of the more technologically challenged during the first open enrollment period, and in December 2013, the MHIP board voted to extend MHIP Standard plans until the end of 2014, and MHIP Plus plans until the end of March, 2014. In January, MHIP also became a temporary insurer for Maryland residents who were unable to secure coverage in the Maryland exchange because of website problems during the first few months of the 2014 open enrollment.
State-based health reform legislation
Here’s a summary of recent Maryland legislation related to healthcare reform: