The politics of health care on Capitol Hill seem to change hour by hour, causing much confusion and worry. Although no one can predict how the system might be altered in the near future, it bears stepping back to look at the ‘big picture’ of who gets which types of health insurance to assess the possible impact of the changes under discussion.
By far most people in Maryland (63% in 2015) have health insurance coverage provided by an employer. The main effect of the Patient Protection and Affordable Care Act (known as ‘the ACA’ or ‘Obamacare’) on these private plans was to mandate a comprehensive set of benefits, such as free preventive services, without lifetime limits or the exclusion of pre-existing conditions. Repealing the ACA could result in these insurance plans being scaled back again.
Another 15% of people in Maryland are covered by Medicare, including more than 87,000 people over 65 in the nine counties of the Eastern Shore. The ACA increased Medicare’s prevention benefits as well as its coverage of drug costs. These expansions are at danger of being reversed. Some legislators go further and insist the nation could never afford the size of Medicare even before ACA expanded it.
Recent discussions in Congress have generally focused on the remaining population—mostly young, lower-income and disabled people. Before the ACA was implemented in 2014 some were helped by Medicaid and other government programs but most simply did without any kind of health insurance or steady source of health care.
Since the ACA became operational the number of people without health insurance in Maryland has been cut in half to about 6.6%. This was accomplished in two main ways: by increasing the number of Marylanders receiving health care at no cost through Medicaid from 1 million to 1.3 million; and by helping individuals obtain private insurance coverage through Maryland Health Connection, our name for the health benefit exchanges set up by the ACA.
The state reports that 30,509 people in the nine Eastern Shore counties are currently enrolled in Medicaid, about 8% of our population of 367,000. Attempts in Congress to drastically cut Medicaid would result in many of our friends and neighbors losing their access to health care.
Another 10,897 people on the Eastern Shore obtained private health insurance through Maryland Health Connection in 2017. For most of them, the government subsidizes the cost based on their income: too high to be eligible for Medicaid but not high enough to be able to afford insurance without some help. These are the “working poor” and 30% are young people between 18 and 34.
The prospect of the ACA being repealed or scaled back has caused much uncertainty in the health insurance industry. Many companies have decided not to participate in the state-run exchanges or to increase the cost of their plans. For 2018, people on the Eastern Shore will have only two plans to choose from through Maryland Health Connection: 1) CareFirst Blue Choice, an HMO plan that will cost 34% more than it does in 2017; and 2) CareFirst of Maryland, a separate PPO type of plan that will cost 50% more. (As most of the people obtaining these plans are being subsidized, the impact on their individual pocketbooks is not as great as it appears.)
The recent decision by President Trump to eliminate Cost Sharing Reduction (CSR) reimbursement payments to insurance companies has cause much consternation nationwide. However, Maryland anticipated the possibility of this happening and the decision is not expected to affect the price of plans available in 2018.
Title image: Pond at Pickering Creek Audubon Center, Talbot Co. Photo: Jan Plotczyk