Despite Setbacks, Affordable Care Act Helping MDers Obtain Health Coverage

Well over 85,000 Marylanders obtained health coverage through Maryland’s implementation of the Affordable Care Act (ACA) since the state began carrying out key components of the health reform law three weeks ago, according to the Maryland Department of Health and Mental Hygiene. For many of these enrollees this marks the first time they have been able to afford coverage in a long time, or ever.

Maryland has been a leader in implementing the ACA, a law with many complementary elements that are designed to both provide health coverage to millions of Americans that currently go without care, as well as improve the value of existing plans. To do so, the ACA establishes health insurance exchanges, or marketplaces where citizens can view and compare health insurance options, find out if they are eligible to receive federal subsidies to purchase a plan or qualify for Medicaid, and enroll. Anyone with income up to 400 percent of the federal poverty level ($45,960 for an individual; $94,200 for a family of four) is eligible for federal subsidies to purchase insurance through the exchanges.

The nationwide rollout of the Affordable Care Act (otherwise known as Obamacare) has been fraught with missteps. Glitches associated with HealthCare.gov, the federal insurance marketplace operating in 34 states, have been well documented. Other reports have emerged of potential unintended consequences, including a recent story in the Sun about Maryland community colleges cutting the hours of adjunct faculty in order to avoid having to comply with the requirement that large employers provide health insurance to employees that work 30+ hours per week.

Maryland set up its own exchange, the Maryland Health Connection. This too has had a rocky start, with technical difficulties of its own that have prevented many residents from being able to sign up or view the various options available to them. Nonetheless, these problems are less severe than those of the federal exchange and are being repaired more rapidly. Indeed, the Maryland Health Connection reports that the site has been increasingly able to handle the high demand for coverage, demonstrated by the more than 300,000 unique visitors to the exchange website and 33,000 calls to its call centers since opening on October 1. Of these visitors, more than 40,000 people have created identity-verified accounts for their households, and more than 27,000 have learned whether or not they are eligible for subsidies. Further, as of October 23, more than 3,100 Maryland households have successfully enrolled in an insurance plan through the Maryland Health Connection.

While these results are inadequate to meet the needs of Maryland’s 800,000 uninsured residents, who comprise 14 percent of the state’s population, they are promising nonetheless. The Maryland Health Connection’s data shows that enrollment has been increasing steadily since its debut on October 1:

Cumulative Household Enrollment through the Maryland Health Connection

Source: Maryland Health Connection weekly reports

(click to enlarge)

Further, interest among younger adults, whose enrollment is considered key to keeping premiums low on plans sold through the exchange, is relatively high. According to the Maryland Health Connection’s most recent report, the 25-29 age group has created the most accounts, followed by the 30-34 age group.

Another important element in the ACA’s effort to expand health coverage is the expansion of Medicaid eligibility to anyone whose income is at or below 133 percent of the federal poverty level ($15,282 for an individual; $31,322 for a family of four). The Supreme Court made expansion optional for states, and Maryland is one 26 states that have chosen to move forward with this expansion. The Maryland Health Connection reports that 82,473 currently uninsured Marylanders are signed up to be automatically enrolled in Medicaid coverage beginning in 2014. And while a recent article in the Wall Street Journal raises concerns that Maryland’s “aggressive” approach to enrolling residents in Medicaid coverage will “siphon off” younger, healthier residents from the exchanges, the Maryland Health Connection’s data thus far suggests this is not the case. Further, because the federal government is picking up 92 percent of the costs of expanding Medicaid over the next ten years, Medicaid expansion is an efficient way to provide health coverage to low income residents that also saves money in Maryland’s state budget.

The problems that have emerged since the launch of the state and federal health insurance exchanges are important to identify and address as quickly as possible. Nonetheless, Maryland’s leadership in implementing the ACA has to date resulted in well over 85,000 newly covered residents. And while the numbers of Marylanders that have signed up for coverage through the Maryland Health Connection remain relatively low in light of official expectations that 150,000 people will in the first year, the state’s data suggests that these numbers are steadily increasing as repairs are made to the exchange’s website. Further, the experience of Massachusetts, whose state insurance exchange served as the model for the ACA, suggests that many will sign up towards the end of the open enrollment period, which closes on March 31, 2014. Success will be measured by who is signed up at the end of the enrollment period, not the first few weeks. During this time, it is important for Maryland to continue its proactive push to implement and improve the Affordable Care Act to ensure that all of its residents have access to the care they need.