More than 16,400 Southern Maryland residents lack health insurance coverage, and rising out-of-pocket costs and a lack of options in the region could be discouraging many of them from seeking it, according to data from the state’s insurance exchange.
Maryland Health Connection, the state’s exchange for health care insurance through the Patient Protection and Affordable Care Act, believes that nearly 4,200 of those residents are eligible for Medicaid coverage and another 8,000 are eligible to receive tax credits that would help make insurance coverage more affordable.
Key to changing that, said Andrew Ratner, the exchange’s chief of staff, is improved outreach and education.
Nearly 6.4% of Maryland residents currently lack health insurance coverage. Ratner said that the exchange is seeking to drive that number below 6% through a combination of targeted outreach to young adults between the ages of 18 and 34, uninsured people in minority communities and rural communities.
Due to its small population, Southern Maryland represents just 4.4% of the total number of uninsured Marylanders, just slightly more than far western Maryland and the lower Eastern Shore. But that’s not to say the exchange isn’t making a concerted effort to reduce those numbers even further.
Data provided by the Maryland Health Connection showed that during the most recent open enrollment period which ended in mid-December, Calvert County experienced a 1% decline in health care insurance enrollments and Charles County saw a decline of just 0.2%, while St. Mary’s saw a dramatic 21% increase in enrollments.
“We definitely have room to improve, and I think we’re going to try to do that in the coming years,” Ratner said.
Ratner shared the insurance exchange’s strategies during a 90-minute forum May 14 before an audience of health care providers and advocates at the Waldorf West library in St. Charles. The forum was one of six scheduled across the state to share and collect information on health care insurance outreach.
Maryland is outperforming much of the rest of the nation in enrollment growth on the health exchange, which was established in 2013. Much of that growth was driven by two pieces of emergency legislation passed last year by the Maryland General Assembly and signed into law by Gov. Larry Hogan (R) as a way to reduce the financial risk to health insurance providers that participate in the health insurance exchange.
One of the bills, spearheaded by former state senator Thomas M. “Mac” Middleton of Charles County, established a reinsurance program to help stabilize the state’s health benefits exchange before spiraling costs forced the exchange’s two remaining insurance providers — CareFirst BlueCross BlueShield and Kaiser Permanente — to withdraw from the exchange. The second bill, also sponsored by Middleton, pumped money into the exchange to help keep insurance rates from skyrocketing.
As a result, when CareFirst and Kaiser announced their annual rates for individual health plans for 2019, they were cuts rather than increases.
Rates for Kaiser’s health maintenance organization plans fell by 7.4%, while rates for CareFirst’s two preferred provider organization plans decreased by 11.1% and its HMO plan decreased by 17% effective as of this past January.
Without the legislation, rates for some people would have nearly doubled and spiraling costs might have forced both insurance companies to withdraw entirely from the state’s individual health insurance exchange.
Last week, the Maryland Insurance Administration announced the 2020 rates proposed by CareFirst and Kaiser. CareFirst BlueChoice is seeking an 8.9% decrease, while CareFirst’s PPO would see a 9.1% increase. Kaiser is seeking a 3.9% increase in its HMO rates.
Although some of the rates are increasing next year, the rise has been dampened significantly by the state’s reinsurance strategy; in 2018, for example, CareFirst’s HMO and PPO plans saw increases of 58.2% and 76%, and Kaiser’s HMO plans went up 43.4%.
Southern Marylanders have fewer choices in plans on the health insurance exchange, however. While CareFirst covers all of the region, Kaiser Permanente’s coverage area extends only into northern Calvert and Charles counties adjacent to the Prince George’s County line.
The one-two punch resulting from the lack of choice and the news of higher premiums, Ratner said, is discouraging many people from seeking health insurance even when they believe they should have it.
“For many of them, that’s enough not to pick up the phone,” he said.
The result is that many people are seeking health care through the emergency room, which drives up costs for everyone.
“This has a larger effect for all of us,” Ratner said. “When people aren’t paying their hospital bills, that money is going to have to come from somewhere.”
John-Pierre Cardenas, Maryland Health Connection’s director of policy and plan management, said that it makes sense for the exchange to engage in an active education and outreach campaign to try and change that, because right now one in six Marylanders get their health insurance through the exchange. One of the initiatives being rolled out by Maryland Health Connection is a special 90-day enrollment period for pregnant women that is retroactive to the start of their pregnancy.
“Think of all the things that we could prevent,” Cardenas said. “It improves the financial well-being of the woman but also the child she’s carrying.”
“It’s an equity issue,” Cardenas said.
Cardenas said that this year’s General Assembly succeeded in authorizing the rate-stabilization efforts for an additional three years, through June 30, 2023, and established a work group to monitor federal health insurance policy to head off any destabilization at the state level. In Southern Maryland, the insurance exchange contracts with a nonprofit community development organization, the Structured Employment Economic Development Corporation, or Seedco, to help local residents enroll in a health insurance plan.
Mark Romaninsky of Seedco said that the organization has seven full-time “navigators” who conduct enrollments on a daily basis in all three Southern Maryland counties. Two of the navigators are fluent in Spanish.
“[Navigators] can sit down with families and really make sure that they get the right determination, that’s going to determine the right program they’re eligible for and the right tax credits,” Romaninsky said. “They are well educated ... about the different plan offerings so that families can decide what’s best for their health needs, which plan is best for their budget.”
Romaninsky noted that reaching people in person is more difficult in rural areas, so Seedco is focusing more on online enrollments and enrollment events at businesses, medical practices, clinics and pharmacies and job fairs.
“Our navigators continue to face a lot of negative and inaccurate information that’s out there,” Romaninsky said.
Michele Eberle, Maryland Health Exchange executive director, pointed out that there is significant overlap between pockets of uninsured people in rural areas and federally designated “opportunity zones,” which are economically distressed census tracts in which state and federal governments offer tax incentives to private investors to encourage them to develop there. Calvert and Charles each have three opportunity zones