Twitter: @4consumerhealth @leni6306 Marylanders Speak To Governor Hogan 4 October 2017 Leni Preston, President www.consumerhealthfirst.org www.facebook.com/ConsumerHealthFirst Twitter: @4consumerhealth @leni6306 #healthcarekeepit © 2017 Consumer Health First

Who We Are 2006 - Maryland Women’s Coalition for Health Care Reform founded 2016 - Transformed to a nonpartisan, statewide 501(c)(3) nonprofit with new name & same mission: Work collaboratively to promote health equity through access to comprehensive, high quality, & affordable health care for all Marylanders Key Strategies: Put consumers first on legislation, regulation & policy Educate, engage, & empower with advocacy & action © 2017 Consumer Health First

© 2017 Consumer Health First Governor Hogan: How do you plan to ensure that Marylanders continue to have access to high-quality, affordable & comprehensive health care? © 2017 Consumer Health First

Health Care is … Complicated! © 2017 Consumer Health First

#1 Preserve Medicaid & CHIP: The Facts 23% population under 200% FPL ($40,840 for family of 4) MD uninsured rate: 11.3% (2013) to 6.1% (9/17) Medicaid/CHIP cover 1 in 5 Marylanders - 1,252,304 Children = 592,836 Elderly & Disabled = 136,709 ACA - Medicaid Expansion: 291,000 enrolled Medicaid Appropriation - $11.3 Billion $3.2 Billion (GF) $1 Billion (SF) $7 Billion (FF) © 2017 Consumer Health First

#1 Preserve Medicaid & CHIP: The Threats Federal Block grants or other restrictions on state allocation Decreased funding over time with potential for eligibility or benefit cuts CHIP reauthorization (federal) – # of children covered by CHIP alone = 142,326 (2015) State Lower provider reimbursement rates to cut costs Limitations on eligibility/access through a “waiver:” Premiums Time limits; work requirements; drug testing © 2017 Consumer Health First

#1 Preserve Medicaid & CHIP: State Solutions Maintain or expand eligibility levels Maintain and/or expand benefits to include dental Work with Administration & Congress to secure reauthorization of CHIP Ensure that provider networks, including those for behavioral health, are adequate Ensure that provider reimbursements are competitive and at appropriate rate © 2017 Consumer Health First

#2 Stabilize Individual Insurance Market: The Facts 230,000 = current enrollees in individual market 150,000 enrolled (2017) through Maryland Health Benefit Exchange 100,000 receive subsidies ($300 million federal funds) Payment of cost-sharing reduction payments – 78% enrollees received these in 2017 Two insurance carriers: CareFirst & Kaiser Permanente Rising Premiums – CF average 34.5% increase – up to 49.9% (PPO) “Uncertainties” created by Federal level action/inaction © 2017 Consumer Health First

#2 Stabilize Individual Insurance Market: The Threats Federal Repeal and replace the ACA Failure to pay cost-sharing subsidies Elimination, or non-enforcement of the individual mandate Shortened Open Enrollment Period Proposal to allow sale of plans across state lines State Continued rate increases resulting in higher rate of uninsured & adverse selection Decreased funding for consumer assistance © 2017 Consumer Health First

#2 Stabilize Individual Insurance Market: State Solutions Maryland individual mandate or state-enforcement of federal mandate State-based Reinsurance Program Strengthen the rate review process by requiring greater accountability from insurance carriers Two additional solutions to consider: Public option, for example, open Medicaid to those above ACA-eligibility level who cannot afford private insurance Support adequate funding for the Maryland Health Benefit Exchange to expand pro-active outreach and enrollment efforts © 2017 Consumer Health First

#3 Ensure Mental Health & Substance Use Disorder Services: The Facts 33% of Maryland adults report having poor mental health status Suicide rates – 553 deaths in 2015 [rank 48 in nation] Substance Use Disorder: 2,089 deaths related to alcohol & drug intoxication (2016) Opioid deaths on the rise - 350 (1st quarter 2016) to 475 (1st quarter 2017) 85.2% = those 12 & older who did not receive require treatment for illicit drugs (2010-2014) Opioid treatment: Program enrollees doubled since 2014: 10,365 to 20,815 Est. 431 lives saved in 2016 due to Medicaid-covered Naloxone © 2017 Consumer Health First

#3 Ensure Mental Health & Substance Use Disorder Services: The Threats 66% increase in alcohol and drug intoxication deaths from 2015 to 2016 Medicaid: Drug testing &/or time limits for eligibility Elimination of expansion Block grants or per capita caps = decreased funding Private Insurance: Lack of providers who accept insurance Barriers to private health insurance coverage of substance use disorder services Other private insurance barriers to accessing treatment © 2017 Consumer Health First

© 2017 Consumer Health First #3 Ensure Mental Health & Substance Use Disorder Services: State Solutions Fully enforce the Mental Health and Addiction Equity Act Increase state funding for mental health & substance use disorder treatment Improve Behavioral Health crisis system Ensure there are no cuts in the Behavioral Health benefit in the Medicaid program © 2017 Consumer Health First

#4 Create a Consumer-Informed Delivery System: The Facts Only 12% of US population has literacy skills to make informed decisions Both Feds & State involved in multiple transformative delivery system models that must fit together like jigsaw puzzle All-Payer Model & Progression Plan = Total Cost of Care Model Primary Care Model Duals (Medicare/Medicaid eligible) Program Multiple stakeholders Consumers/patients Hospitals/providers Insurance carriers Federal government (Medicare, Medicaid, CHIP) State government (MDH & LHDs, HSCRC, MHCC, MDS) © 2017 Consumer Health First

#4 Create a Consumer-Informed Delivery System: The Threats Federal Repeal and/or replace of ACA Lack of CMS contract with funding State Marylanders’ lack understanding of delivery system & its transformation: purpose, design & implementation Consumer Protections: challenges in understanding, accessing, and enforcement Access to care for vulnerable populations – adequate funding for community-based organizations and providers Reauthorization required for funding community health centers © 2017 Consumer Health First

#4 Create a Consumer-Informed Delivery System: State Solutions State-wide education & public awareness campaign Accessible path for consumer complaints, grievances & appeals Permanent and effective mechanisms for consumer participation in the design and implementation at multiple levels Adequate funding for safety net providers Transparency and a clear line for accountability © 2017 Consumer Health First

© 2017 Consumer Health First What’s Happening Now Joint Resolution – The Protection of the Federal Affordable Care Act Maryland Health Insurance Coverage Protection Act Commission to monitor and respond to federal action Budget Reconciliation and Financing Act Language requires stakeholder input on any Medicaid changes Family Planning Services – Continuity of Care State required to provide $s if Congress eliminates Planned Parenthood funding © 2017 Consumer Health First

© 2017 Consumer Health First www.consumerhealthfirst.org Select Resources Maryland Consumer Health First www.consumerhealthfirst.org National Center on Budget Policy & Priorities www.cbpp.org Families USA www.familiesusa.org Kaiser Family Foundation www.kff.org National Health Law Program www.healthlaw.org © 2017 Consumer Health First

Leni Preston, President leni@mdchcr.org www.consumerhealthfirst.org www.facebook.com/ConsumerHealthFirst Twitter: @4consumerhealth @leni6306 #healthcarekeepit © 2017 Consumer Health First