From The Baltimore Sun

By Meredith Cohn and Pamela Wood

April 11, 2019

Health coverage will be easier to secure for uninsured Marylanders and prescriptions could become cheaper for government workers under legislation passed by the General Assembly, which took up a slate of related measures before adjourning for the year.

One law would require the uninsured to check a box on their state tax returns to say whether they’re interested getting health coverage through the state. The other would establish a board to study the controversial idea of capping prescription costs for state and municipal employees.

Among other health-related bills passed, the legislature also enacted a patient’s bill of rights and sustained funding for a reinsurance program that helps insurers offset costs for the biggest health care users.

Some of the legislation was scaled back to gain passage, but supporters say even incremental steps are needed to protect consumers as the Trump administration works to undermine the Affordable Care Act, which covers millions of Americans and hundreds of thousands of Marylanders.

The administration recently told a federal appeals court that it agreed with a lower court ruling that the law was unconstitutional. Officials asked that the entire law be tossed out.

“We knew the Trump administration and the Republicans in Congress would take away health insurance from people. We said: ‘We have to protect people in Maryland, even if Trump wouldn’t protect us,’ ” said state Sen. Jim Rosapepe, chairman of the Senate’s Democratic Caucus.

Rosapepe said the bills collectively will make a significant difference in improving access and affordability of health care.

Many of the bills won strong bipartisan support, though Gov. Larry Hogan, a Republican, has not said what he will sign. His spokeswoman, Shareese Churchill, said he “looks forward to reviewing this legislation when it reaches his desk.”

Among the bills that passed:

« The enrollment bill would require those without insurance to check a box on their state tax returns indicating whether they want state officials to determine their eligibility for Medicaid or subsidized health care under the Affordable Care Act and provide information.

Vincent DeMarco, who leads the Maryland Citizens Health Initiative, said the “easy enrollment” bill will cost the state very little, but could help 120,000 Maryland residents gain insurance.

Sponsors say 50,000 people could qualify for coverage under Medicaid, the federal-state health program for those with low incomes, and 70,000 could obtain enough federal subsidies to cover private health insurance. Another 70,000 would likely qualify for partial subsidies.

Under the ACA, known as Obamacare, the state has already covered close to 380,000 Marylanders, cutting the percentage uninsured in half to about 6 percent.

A state-level mandate to buy insurance or face a penalty, similar to one stripped out of federal law by Republicans, was dropped.

« Legislators scaled back plans for a new state board to curb prescription costs.

One version would have allowed the board to cap drug prices deemed excessive. The legislation now calls for the board to conduct a two-year study to determine ways to control high drug costs, including capping drug prices in state and local government health plans.

If the board is given authority to cap those drug costs, it could eventually cap prices in all insurance plans in the state, said state Sen. Brian Feldman, a Montgomery County Democrat who sponsored or supported much of the legislation.

The potential for such price controls faces opposition from the Pharmaceutical Research and Manufacturers of America, or PhRMA.

“If the Maryland legislature had mandated price controls, state and local employees could have lost access to their choice of medicine or been forced to wait years longer for critical medicines like cancer treatments,” Nick McGee, a PhRMA spokesman, said in a statement. “At the same time, there would have been a chilling effect on new innovation and the thriving biotech industry that supports thousands of jobs in Maryland.”

He said the group believes the commission will “determine price controls are the wrong approach — that this dangerous policy is unconstitutional, would put patients’ access to medicines in danger and cannot be implemented effectively.”

McGee said the board should look instead at others potentially boosting the cost of drugs such as insurers, pharmacy benefit managers and other middlemen.

Another pharmaceutical group successfully sued to stop a 2017 Maryland “price-gouging” law that would have allowed the state’s attorney general to challenge big price increases.

DeMarco said the prescription drug board, though scaled back significantly, could serve as a first step toward limiting drug prices.

“We’re going to learn a lot and see if there’s really justification for these skyrocketing prices,” DeMarco said.

« The legislature voted to extend a tax on insurers to fund a reinsurance program until 2023. Along with a federal match, the money offsets costs to insurers from the biggest health care users. It also reduces premiums for everyone who buys insurance on the state’s health exchange.

The state program was passed last year after the Trump administration cut a federal one, but it was running out of money. The two large insurers on the state health exchange lowered rates somewhat in response, stemming massive increases from past years that brought protests from consumers.

« Another bill that passed the legislature was a patient’s bill of rights. The bill requires hospitals to inform patients and caregivers of their rights to be involved in care decisions and appeals processes, as well as provide interpreters and other accommodations.

“The bill is a big win for our most vulnerable consumers — hospital patients,” said Anna Palmisano, who leads Marylanders for Patient Rights, a coalition of 26 advocacy groups. “When the Governor signs the bill into law, it will ensure that all hospital patients are informed of their rights in a manner they understand. Hospital patients will know that they should be treated with compassion and respect, and that they can be a part of decision making about their own health.”

« Several other health-related bills passed the legislature. One creates a special open enrollment program for pregnant women so they can access prenatal care and delivery services. Another offers cost controls for consumers whose insurers change their drug pricing. A third gives protections for those on medications for chronic conditions who change insurance.

The legislature also extended the life of a commission that studies ways to insure more Marylanders and maintain benefits. A measure to codify consumer protections afforded by the ACA in state law was dropped.

“The General Assembly’s actions this year demonstrate its continued commitment to building on the gains we’ve achieved under the Affordable Care Act and continuing to make the health insurance system work better for consumers,” said Beth Sammis, president of the advocacy group Consumer Health.


Last modified: April 15, 2019