1. Twitter: @4consumerhealth @leni6306
Marylanders Speak To
Governor Hogan
4 October 2017
Leni Preston, President
@leni6306
#healthcarekeepit
© Consumer Health First

2. Who We Are
Maryland Women’s Coalition for Health Care Reform founded
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
© Consumer Health First

3. © 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?
© Consumer Health First

4. Health Care is … Complicated!
© Consumer Health First

5. #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)
© Consumer Health First

6. #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
© Consumer Health First

7. #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
© Consumer Health First

8. #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
© Consumer Health First

9. #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
© Consumer Health First

10. #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
© Consumer Health First

11. #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 (1st quarter 2016) to 475 (1st quarter 2017)
85.2% = those 12 & older who did not receive require treatment for illicit drugs ( )
Opioid treatment:
Program enrollees doubled since 2014: 10,365 to 20,815
Est. 431 lives saved in 2016 due to Medicaid-covered Naloxone
© Consumer Health First

12. #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
© Consumer Health First

13. © 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
© Consumer Health First

14. #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)
© Consumer Health First

15. #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
© Consumer Health First

16. #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
© Consumer Health First

17. © 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
© Consumer Health First

18. © 2017 Consumer Health First
Select Resources
Maryland
Consumer Health First
National
Center on Budget Policy & Priorities
Families USA
Kaiser Family Foundation
National Health Law Program
© Consumer Health First

19. Leni Preston, President leni@mdchcr.org
@leni6306
#healthcarekeepit
© Consumer Health First