On June 28, 2012, the Supreme Court confirmed the constitutionality of the Patient Protection and Affordable Care Act (ACA) including the individual mandate and related insurance reforms central to achieving the law’s goal of near universal coverage.

In a ruling that surprised most legal scholars, Court’s decision limits HHS’s ability to enforce the Medicaid expansion by removing a state’s funding from the existing, pre-ACA Medicaid. The Court found that the ACA created a “new” Medicaid program for newly eligible adults that stands alongside, at a state’s option, the existing Medicaid program for previously eligible parents, disabled and elderly adults, pregnant women and children.

The Supreme Court left intact other Medicaid provisions under the ACA, including those that modernize the Medicaid program and ensure coordination between a modern Medicaid program and new Health Insurance Exchanges.  In the future, Medicaid and the Children’s Health Insurance Program (CHIP) will apply the same core income counting rules as apply to determinations of eligibility for premium tax credits in the Exchange. The eligibility and enrollment process for Medicaid, CHIP and premium tax credits—whether or not a state expands Medicaid coverage to the new adult group—will be simple, seamless and technology supported.

 What it means for Maryland

Secretary Sharfstein has indicated that the state plans to move forward with increasing Medicaid coverage levels for adults to 133 percent of the federal poverty threshold beginning in 2014. The department anticipates that more than 100,000 Marylanders will enroll in the first year of the expansion taking effect.

In 2020, the first year in which the state has to pick up 10 percent of the cost for expanding the threshold to 133 percent, the cost to the state would be about $51 million. But in the same year, the state would receive $131 million in federal dollars because the federal government is taking over a financial responsibility the state is currently meeting with a substantial amount of state funding.

 Resources for more information:

 Primary Source: The Supreme Court’s Decision

The original text from the Supreme Court, as well as the archive of the arguments for and against are available on the Supreme Court’s website.

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

 Kaiser Family Foundation

The Kaiser Family Foundation has a special sub-site devoted entirely to health reform policy issues. This site contains valuable resources and information to describing the impact of Supreme Court’s decision within the broader context of the law.

http://healthreform.kff.org/

 State Refor(u)m

State Refor(u)m is an online network for health reform implementation. It is an initiative of the National Academy for State Health Policy, funded by the Robert Wood Johnson Foundation. The site connects state health officials looking for information and assistance with their peers and other experts who have relevant resources and experiences to share.

http://www.statereforum.org/supreme-court-case

Print Version

Based on the feedback from these policy experts and coalition participation in public meetings, we drafted specific policy recommendations and shared them with the Maryland Health Exchange Board. The full report and supporting documents are available below.

Health Care Affordability Proposal

First, we recommend that the Maryland Health Exchange Board use active purchasing authority to encourage competition among insurers and get a better value for Maryland consumers.  We also highlight the benefits of new health care delivery models like patient-centered medical homes which yield better health outcomes and save money.

Next, we explore options to encourage healthy people to participate in the exchange by dealing with adverse selection.

Finally, we discuss the benefits of providing a basic health plan option, simplifying enrollment into health insurance coverage options and investments in public health like health insurance co-ops.   These options will make a big difference for working families who may make too much to qualify for free health insurance but still have trouble paying for a full private plan.

With these options fully implemented, health care in Maryland can be truly accessible and affordable to all.

Resources:

• Health Care Affordability Proposal
• Demystifying Active Purchasing: Tools for State Health Insurance Exchanges (White Paper)
  
• Improving Value and Investing in Prevention:Encouraging Value-Based Insurance Designs in State Health Insurance Exchanges (White Paper)
  
• Seizing the Opportunity: How to contain costs in Taft-Hartley and employer healthplans by re-engineering delivery of care to your members (Publication by America’s Agenda)

The Lorraine Sheehan Alcohol Tax Coalition commends the Maryland General Assembly for voting to raise an alcohol specific tax for the first time in 40 years.  We urge Governor Martin O’Malley to sign this life-saving measure.

This historic public health measure will save numerous lives by reducing underage drinking and preventing thousands of alcohol related harmful incidents. It will also raise significant revenue that will help fund chronically under funded programs for people with developmental disabilities. In future years, we will work with the Governor and General Assembly to use this revenue to help fund all the critical needs identified in the original Lorraine Sheehan legislation (health care coverage, programs for people with developmental disabilities and mental health needs, drug, tobacco and alcohol abuse prevention, cessation and treatment, and health care worker training).

The coalition, which was formed in honor of the late hero of the unheard, Lorraine Sheehan, is thrilled today to stand together and celebrate this great victory for Maryland.  We give special thanks to our lead sponsors from the beginning — Senators Verna Jones-Rodwell and Rich Madaleno and Delegate Jim Hubbard.

“We join national public health leaders (see comments on back) in thanking the Maryland General Assembly for taking this courageous action to reduce underage drinking and alcohol abuse in our state,” said Vincent DeMarco, President of the Maryland Health Care for All! Coalition. “We will work closely with Governor O’Malley and the General Assembly to ensure that the revenue raised will be used for critical health care and community service needs.”

Revenue generated by this increase in the alcohol tax will provide desperately needed services to people with developmental disabilities across Maryland. Carol Fried, with the Developmental Disabilities Coalition, said, “Having a child with developmental disabilities, I know that this new funding will bring a lifeline of services to many people in crisis who have languished on a waiting list far too long. Families and people with developmental disabilities are grateful for the leadership of the General Assembly in taking a big step forward to meet people’s needs”.

“This is a great victory,” stated Nancy Rosen-Cohen, Executive Director of the Maryland Chapter of the National Council on Alcoholism and Drug Dependence.  “Alcohol abuse and alcoholism devastate individuals and families throughout Maryland and this small price increase will have a tremendously positive impact.”

“With the passage of the alcohol tax, the Maryland General Assembly has led the way nationally by enacting prudent fiscal policy that both addresses the heightened need for disability services and accomplishes the public health goal of reducing alcohol abuse,” said Linda Raines, Chair of the Maryland Mental Health Coalition.  “We applaud our state senators and delegates for protecting people with disabilities in these tough economic times.”

“At a time when other states are abandoning their most vulnerable residents, Maryland is showing it’s possible to be fiscally responsible and protect vital public services like mental health care and support for people with disabilities,” said John Reid, executive vice president of the Maryland/DC Division of 1199SEIU-United Healthcare Workers East. “This long overdue adjustment to the alcohol tax is a wise investment in a healthy Maryland.”

Statements by National Leaders Praising Maryland Alcohol Tax Increase

Baltimore, MD – The historic passage of the alcohol tax increase bill in Maryland is laudable and long overdue. Taxes on liquor have not been raised since 1955 in Maryland and were among the lowest in the nation.  Over the next decade, this tax will raise hundreds millions of dollars.  It will also save hundreds of lives and prevent thousands of cases of alcohol abuse, alcohol dependence and other alcohol-related problems.  Because it is a sales tax, it will rise with inflation, unlike existing alcohol excise taxes, so its public health and revenue benefits will persist in to the future.  The research literature on this subject is huge and overwhelmingly shows that alcohol taxes promote health and safety of our citizens, raise needed funds for cash-strapped states, and improve productivity and are good for the state’s economy.

David H. Jernigan PhD,

Director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health

New York, NY – The passage of the alcohol tax increase bill in Maryland, long supported by NCADD, is an important victory for families and individuals fighting the stigma and the disease of alcoholism and other drug addictions. A portion of the projected hundreds of millions of dollars this tax will raise over the next decade could and should be used to fund alcohol abuse prevention and treatment programs for youth and adults, as well as provide other needed health services. Research studies have shown that an increase in alcohol taxes results in less drinking across the board—from young people to heavy drinkers—, which in turn leads to decreases in alcohol-related deaths and injuries. Research further indicates that reduced alcohol consumption as a result of the 3 percent increase in the sales tax on alcohol will prevent close to 6,000 cases of alcohol dependence or abuse in the state each year. The estimated decline in alcohol-related problems, accompanied by a boost in revenue for alcohol treatment and recovery advocacy programs resulting from the new alcohol tax, will prove that Maryland cares about the health and safety of all its citizens.  NCADD would like to congratulate our state Affiliate, NCADD Maryland, and all of their partners for their effective education and advocacy campaign, which formed the foundation of support needed for action by the legislature.

Robert J. Lindsey, M.Ed., CEAP

President/CEO, National Council on Alcoholism and Drug Dependence, Inc. (NCADD)

Baltimore, MD – The passage of the alcohol excise tax increase bill shows that Marylanders care about reducing drunk driving, underage drinking and other manifestations of alcohol dependence and abuse. Quite simply, raising alcohol taxes lowers the rates of alcohol-induced deaths and accidents. According to a recent study, doubling the average state tax on alcohol would cut traffic fatalities by 11 percent and alcohol-related mortality by 35 percent. Raising Maryland’s alcohol sales tax by 3 percent will cut alcohol consumption by nearly two percent, including among heavy drinkers and young people, and save at least three lives per year on Maryland’s roadways. This historic tax increase is good for our state, good for our families and children, and helps to make the state a safer place for all of us.

Caroline Cash, Executive Director, MADD Maryland

March 24, 2011

In a great victory for public health in Maryland, the Senate Budget and Taxation Committee today voted favorably on life-saving legislation to increase an alcohol specific tax for the first time in forty years. Sponsored by Senators Verna Jones-Rodwell and Rich Madaleno, Senate Bill 994 will over the next three years, by reducing underage drinking and alcohol abuse, save numerous lives and lessen by over 10,000 the number of harming alcohol related incidents.

We strongly urge the full Senate and the House of Delegates to join in passing this measure.  We also strongly urge the Governor and the General Assembly to use the money raised by SB 994 to fund the critical health care and community service needs laid out in our original Lorraine Sheehan proposal (sponsored by Senators Jones-Rodwell and Madaleno and Delegate Jim Hubbard).

We also urge the General Assembly to add an additional one percent tax on alcohol to be consumed on the premises as the District of Columbia already does.  These new revenues should fund state health care needs and health care worker training, as well as programs for people with developmental disabilities and mental health needs, and state programs to reduce addiction to alcohol, drugs and tobacco.

Happy Birthday
Patient Protection and Affordable Care Act!

Today marks the first anniversary of federal health reform and there is much to celebrate!  On March 23, 2010, President Barack Obama signed historic legislation into law that reforms America’s broken health care system.  In just one year, thanks to the leadership of Governor O’Malley and Lt. Governor Brown, Maryland has made great progress in implementing federal reform and the Maryland Health Care for All! Coalition has participated in the process as a voice for health care consumers. While other states focus energy on repealing the reform, Governor O’Malley knows that Marylanders have much to gain from increased access to care.  Not only will hundreds of thousands of currently uninsured Marylanders get health care coverage, but the state will also save $850 million over the next 10 years thanks to this new law.  Some Marylanders are already benefiting from reform, including:

• 700,000 Medicare enrollees who are now eligible for free preventive services and free annual wellness visit
• 54,723 seniors in the Medicare “donut hole” received a $250 rebate check to help with prescription costs
• 25,700 young adults who can now stay on their parents’ insurance up to age 26
• 320,000 children who cannot be denied coverage due to a pre-existing condition
• 76,796 small businesses that provide health care to employees are now eligible for a federal tax credit

About 350,000 Marylanders will gain health care coverage by the time this law is fully implemented in 2014. Stay tuned!

Not sure how health reform helps you and your family?

More than 140 candidates pledge to back increase

Politicians typically are loath to raise taxes in an election year, but that’s not the case when it comes to Maryland’s alcohol tax.

More than 140 candidates running for the General Assembly have signed on to a proposed dime-a-drink tax increase, with an eye toward using the money for health care for childless adults and programs for developmental disabilities, mental health and addiction treatment and prevention.

The proposal, laid out in a resolution sent last month to candidates for all 188 legislative seats, would raise the state’s alcohol tax, among the lowest in the nation.

The tax hike would bring in $214 million for the state while saving $249 million in health care costs associated with alcohol abuse, said Vinny DeMarco, president of the Maryland Citizens’ Health Initiative, which drafted the resolution. Those estimates are based off a 2009 study by two Johns Hopkins University professors, who found that “alcohol excise tax increases save lives, reduce health care costs, create and preserve jobs, and prevent alcohol-related problems.”

Among the 146 candidates to sign by the Aug. 27 deadline were 63 incumbents– 18 senators and 45 delegates. In addition, 17 candidates who did not sign the resolution supported the tax increase via a Progressive Maryland questionnaire, including Del. Sheila E. Hixson (D-Dist. 20) of Silver Spring, who chairs the House Ways and Means Committee.

But at a time when the nation’s economy still is lagging and the state is facing a budget crisis, some lawmakers remain opposed to any tax hike.

“I don’t think it’s appropriate in this economy to be increasing taxes of any kind,” said House Minority Leader Anthony J. O’Donnell (R-Dist. 29A) of Lusby. “People are out of work, small businesses are having hard time keeping their doors open, and increasing consumption taxes will tend to push people across our borders to do their commerce in other states.”

Alcohol currently is taxed by the gallon– 9 cents for beer, 40 cents for wine and $1.50 for spirits. The proposal would raise the per-gallon rates to $1.16 for beer, $2.96 for wine and $10.03 for spirits, or roughly 10 cents-per-drink for all three, DeMarco said. Rates have been stagnant for spirits since 1950, and for beer and wine since 1972.

Del. Sue Kullen (D-Dist. 27B) of Port Republic said she would not vote for an increase to the alcohol tax if revenues were earmarked for specific purposes, even if they are mental health or disabilities programs, which she supports. Kullen noted she could vote for a general increase to the alcohol tax, but not one as drastic as the dime-per-drink proposal.

Kullen, a developmental disabilities consultant and president of the Maryland Women’s Caucus, signed onto a bill similar to the proposal last session because it was a caucus initiative, but the legislation never made it out of committee.

The increases seem dramatic “because [current rates are] so low, and it hasn’t been raised in all these decades,” DeMarco said. “We have to bring our alcohol tax rates into the 21st century.”

DeMarco expects continued pushback from a “very powerful” alcohol lobby, but thinks the campaign put on by his and other health care advocacy groups, modeled after a successful push for a $1 increase to the tobacco tax in 2007, will bear fruit in the 2011 session. He cited a recent poll by OpinionWorks that shows 71 percent of registered voters support a dime-per-drink tax increase if its revenues are dedicated to health initiatives.

A number of organizations have endorsed the proposal, including the AARP, National Association for the Advancement of Colored People, the American Heart Association, the National Association of Social Workers, Mothers Against Drunk Driving and the Mental Health Association of Maryland.

“I think we are poised in 2011 to enact this life-saving measure,” DeMarco said.”We think the Maryland General Assembly will agree with the people of Maryland that it is good policy and good politics.”