Maryland seeks to turn health care mandate into down payment

ANNAPOLIS, Md. (AP) — Maryland lawmakers want to create an individual health care mandate at the state level — in response to Washington gutting it at the federal level — and turn it into a down payment for people to pay for health insurance.

Supporters outlined the proposal Tuesday, a day before the Maryland legislative session begins, adding it could also work in other states to help keep insurance premiums from skyrocketing. The Maryland General Assembly is controlled by Democrats.

The federal tax overhaul approved last month removed the federal penalty that was charged to people without health insurance. Under Maryland legislation, the state would offer people without insurance a choice: pay a tax penalty or use the money as a down payment on insurance.

"We're saying instead of just paying the penalty and being off the rolls, we're going to take those dollars and deploy them in such a way as to use it as a down payment to allow you to make a decision to actually purchase health insurance," said state Sen. Brian Feldman, a Democrat representing a district in Maryland's most populous county.

Feldman co-chaired a state commission created last year to monitor federal changes to the health care law. He said the legislation is an innovative approach to help stabilize Maryland's individual insurance market, after actions at the federal level threaten to disrupt it. Supporters say more than 200,000 uninsured Maryland residents could be affected. They also say the measure would help hold down rates to help those who buy insurance directly.

State Sen. Jim Rosapepe, a Democrat, said the plan would affect everyone who buys their insurance directly instead of through their employer in Maryland, because insurance rates will go through the roof once the federal changes take effect.

"If we don't pass this bill, hundreds of thousands of working people who already have insurance will see their insurance premiums skyrocket," Rosapepe said.

But state Sen. Michael Hough, a Republican, said the proposal is a terrible idea and that he's surprised to hear his colleagues propose it.

"It penalizes people who can't afford health insurance," Hough said.

Stan Dorn, a senior policy adviser with the national health consumer advocacy group called Families USA, said nine other states and the District of Columbia, which have an income tax and a health care exchange, could consider adopting the idea. He said those states are California, Colorado, Connecticut, Idaho, Massachusetts, Minnesota, New York, Rhode Island, and Vermont.

Massachusetts had an individual mandate before and during the Affordable Care Act provision. The state individual mandate was essentially superseded when the federal one went into effect, but it will go back into full effect when the federal mandate comes off the books.

In Washington state, lawmakers are considering a measure requiring residents to ensure that they and any of their dependents maintain minimum essential health care coverage each month, unless they are exempted.

Dorn also said about 10 other states could consider the proposal, but would likely require additional steps because they have a hybrid state health exchange.

Maryland Gov. Larry Hogan, a Republican who opposed the GOP effort in Washington to repeal the health care law entirely, said he hadn't seen the new plan pitched by Democratic lawmakers in the state and would keep an open mind.

"If the legislature has some good ideas about what the state can do to make up for problems where Washington has failed or made mistakes that are going to hurt people in Maryland we're all ears," Hogan said. "We look forward to sitting down with them and listening to what they have to say."

Associated Press Writers Bob Salsberg in Boston and Rachel La Corte in Olympia, Washington, contributed to this report.