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Maryland health insurance

MD sees big health improvements since ACA implementation

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 the right direction. Use the following links to see how Maryland is moving on specific health measures, and read how efforts around healthcare reform might be pushing the state in a positive direction.

Maryland health ratings

Maryland’s ranking on the Scorecard on State Health System Performance improved from 24th in 2009 to 18th in 2015. The rankings by The Commonwealth Fund compare numerous health measures to arrive at an overall score for each state and the District of Columbia. Maryland’s scored in the top quartile in measures related to equity, earning particularly high marks for a low percentage of at-risk and older adults going without routine doctor visits and preventive care. See the state’s most recent Maryland scorecard for more details.

The Old Line State fared better in United Health foundation’s 2014 America’s Health Rankings. The state ranked 16th, which was an eight-spot improvement from 2013. Credit may be due to the state’s double-digit decreases in smoking, binge drinking, drug deaths and preventable hospitalizations in recent years.

Maryland ranked second in the nation for access to primary care physicians; however, the state’s rank was negatively impacted by high rates of violent crime and low birthweight as well as high levels of air pollution.

For more even information about health in Maryland, see Key Health Data About Maryland from the 2015 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.

When the ACA was passed in 2010, both Maryland Sens. Benjamin Cardin and Barbara Mikulski voted in favor of the law, as did all but one of the state’s eight U.S. Representatives.

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 has Obamacare helped 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 5.1 percentage points to 7.8 percent by the end of 2014, making Maryland one of the 10 states with the largest reduction in percentage uninsured that year.

By mid-2015, Maryland’s uninsured rate dropped slightly more to 7 percent – the uninsured rate among all states that both created a state-run exchange and expanded Medicaid is 8.9 percent.

Nationally, the uninsured rate as of mid-2015 is 11.5 percent.

Maryland enrollment in qualified health plans

Despite the challenges of a malfunctioning website, 67,757 Marylanders enrolled in qualified health plans (QHPs) through Maryland’s health insurance exchange during 2014 open enrollment. More than 90 percent of those enrolling in QHPs for 2014 coverage selected plans offered by CareFirst BlueCross BlueShield.

By August 13, 2015, effectuated enrollment in QHPs through Maryland Health Connection was 123,673. Nearly 94 percent of those enrolled in coverage through the exchange received financial assistance.

The Maryland Insurance Administration announced 2016 premiums in early September. The overall weighted average rate increase for plans through the state-run exchange has been estimated to be around 18.3 percent, and the weighted average increase for on- and off-exchange plans is an estimated 20 percent.

For the 2016 open enrollment period, Maryland Health Connection has launched a pilot program in which customers who call the exchange will be transferred to brokers for assistance. The program is intended to reduce call-center hold times and allow customers to receive plan selection advice, which only licensed agents and brokers can provide.

Maryland Medicaid

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.

The state saw a 36 percent increase in Medicaid enrollment from 2013 to August 2015, with monthly enrollment reaching 1.16 million. Maryland tied with Arizona for the 12th biggest change in Medicaid enrollment nationwide.

Maryland Medicaid signups continue throughout the year. Visit the Maryland Department of Human Resources website to learn more about the state’s 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. Nevertheless, while other CO-OPs announced their impending closures, as of November 2015, Evergreen remained in operation for 2016 open enrollment.

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 (which has now been phased out)  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 some risk pools 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 2014, 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 2014 open enrollment. MHIP stopped providing coverage as of January 1, 2015.

Medicare enrollment in the state of Maryland

Maryland Medicare enrollment reached 923,389 in 2015 – about 15.5 percent of the state’s population. Nationally, 17 percent of the population is enrolled in Medicare. The state is among those with a smaller percentage of Medicare enrollees who are enrolled as the result of a disability (16 percent). Eighty-four percent of Maryland Medicare recipients qualify based on age alone.

Medicare pays about $11,449 annually per Maryland enrollee, and the state ranks 17th in overall spending with $8.8 billion per year.

Marylanders who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead. A relatively small percentage of Maryland Medicare beneficiaries choose Medicare Advantage plans; in 2015, only 8.7 percent had compared with 32 percent nationwide.

The state sees far more enrollees in Medicare Part D plans, which provide stand-alone prescription drug coverage. Nearly 52 percent of Maryland Medicare recipients have Part D plans, while 43 percent of Medicare recipients nationwide have such Rx coverage.

State-based health reform legislation

Here’s a summary of recent state-based legislation related to healthcare reform: