State seeks to buck national trend, provide more health insurance

As the seventh open enrollment period begins Friday on the Maryland health exchange, state leaders hope changes made in the past year will continue to boost the number of people who sign up for health insurance under the Affordable Care Act.

There are hundreds of thousands of Marylanders and millions of Americans who do not get coverage through work and can buy policies sold on the health exchanges, also known as Obamacare.

This year's enrollment period begins as the federal law passed in 2010 faces another legal challenge that could upend the coverage as 18 state attorneys general with backing from the Trump administration push a case that won an initial ruling that found the law unconstitutional.

Maryland officials also have derided what they see as the Trump administration's ongoing assault on Obamacare in smaller ways through rules changes that allow, for example, plans with far fewer benefits and cuts to funding to stabilize the insurance market.This may have contributed to recent declines in coverage nationwide, though not in Maryland. The state was one of the few where the number of insured increased this year even as federal numbers dropped.

"Based on renewals this year, a lot more people are sticking with health insurance," said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which runs the online insurance marketplace called the Maryland Health Connection. "This year, they will have more affordable options."

Close to 157,000 people bought plans this year on the exchange and another 250,000 qualified for Medicaid, the federal-state health plan for low-income residents. About 8.4 million enrolled on the federal exchange serving 38 states this year, down from 8.7 million last year.

Most people receive federal subsidies nationally and in Maryland to buy coverage. But Maryland also replaced a crucial reinsurance program eliminated at the federal level that helps the state's insurers pay for their most expensive policyholders.

That has helped the state lower premiums for the second year. Premiums will go down an average of 10 percent this year, according to insurance regulators. The average payments will range from $334.52 to $626.82 a month, with the most people opting for an HMO offered by CareFirst Blue Cross Blue Shield that will average $340.94 for a 40 year old in a mid-priced "silver" plan.

New this year, exchange officials also will automatically notify residents that they may qualify for free or low-cost health insurance based on information from their tax returns.

The state also will offer new plans that pay for some visits and other benefits before deductibles are met.

"We are fortunate to live in Maryland where there is a strong commitment to providing our residents with affordable and comprehensive health insurance," said Leni Preston, a long-time health care advocate.

"For the second year in a row, health insurance premiums are dropping and there are more plans to choose from," she said. "These include new 'value' plans with more services covered before the deductible kicks in, making these an affordable option for many individuals. And, the Maryland Health Benefit Exchange has made it easier than ever for Marylanders to understand their health insurance options and to buy insurance that meets their needs, such as with a mobile app, in-person assistance, and a new health literacy brochure."

The state program, however, has had its challenges. Those not subsidized still face sometimes unaffordable premiums that skyrocketed for years before dropping. Out-of-pocket expenses remain high.

Insurance officials also have been trying to attract more insurers than the two that currently offer plans in the state in an effort to increase options and competition.

"While we have been able to bring down the number of people who lack health insurance in Maryland significantly over the past several years, about 290,000 still lack coverage," said Vincent DeMarco, president of the Maryland Citizens' Health Initiative. "We are optimistic that we can continue to bring that number down even further this year, which strengthens our overall insurance marketplace and gives more Marylanders peace of mind as they cope with health issues."

The open enrollment period last 45 days, until Dec. 15.