The Baltimore Sun
January 9, 2018
Erin Cox

Maryland lawmakers, worried about skyrocketing insurance premiums, have proposed creating a state-level individual mandate — and using fines levied on the uninsured to help put more people on the insurance rolls.

Last month, congressional Republicans repealed the federal individual mandate at the heart of the Affordable Care Act. Now that it’s going away, a coalition of Democratic state lawmakers say the best solution is to have the uninsured pay Maryland a fine that would be used as a “down payment” on health insurance coverage on the state’s exchange.

“Doing nothing is not an option,” said Sen. Brian J. Feldman, a Democrat from Montgomery County who is co-sponsoring the bill. “We’ve got to do something about stabilizing the insurance market.”

Lawmakers are hopeful that creating a state-level mandate not only will encourage young and healthy people to buy insurance — driving down premiums for everyone in the individual insurance market — but that the money can be used in a novel proposal to get more people on the insurance rolls.

In what health care advocates called a first-in-the-nation plan, the lawmakers proposed automatically enrolling uninsured people who qualify for coverage for less than the cost of the $700 fine.

Advocates estimate that about 60,000 of Maryland’s 200,000 uninsured people could receive health care at or less than that. The uninsured whose premiums are higher than that would be contacted by the state during open enrollment with a notification that $700 was available for them to defray the cost of insurance, how much federal subsidies would reduce their out-of-pocket costs, and a menu of health care options available to them.

“It’s very, very innovative,” said Sen. Thomas “Mac” Middleton, the Charles County Democrat who chairs the Finance Committee that will consider the legislation. He promised to start hearings on the proposal next week.

The idea came out of a commission the Democrat-dominated legislature created last year to study the effects of changes to the Affordable Care Act.

Democrats from both chambers were joined by clergy, heath care advocates and Dr. Leana Wen, Baltimore’s health commissioner.

Democrat Del. Joseline Pena Melnyk, a Montgomery County lawmaker co-sponsoring the bill, said the proposal was “one of many” ideas being debated to help reduce the cost of insurance.

“We are ready to roll up our sleeves and get to work,” she said, adding that they’re calling on Republican Gov. Larry Hogan to help.

Hogan told reporters later in the day that he had not seen the details of the proposal, but in general that he considered the individual mandate “basically a tax.” He said he was “much more in favor of incentives” that could help reduce the cost of health care. And if Democrats had ideas about how to do that, “We’re all ears.”

Last modified: January 10, 2018