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Brief Report on the Conference: “What Does Health Reform Mean For You, Your Business or Nonprofit”

Hosted by Johns Hopkins Bloomberg School of Public Health
June 25, 2010

Panelists from AARP, Families USA, Maryland Association of NonProfit Organizations, Maryland Health Care for All! and the Small Business Majority

I went to the Friday session. The main presenters were Cheryl Fish-Parcham from Families USA, Lynda Flowers and Lynn Nonnemaker from AARP and Terry Gardiner from Small Business Majority.

The topic was to tell us how the Patient Protection and Affordable Care Act (PPACA) relates to Maryland. In general I thought that the conference skimmed the surface of the complexities in the law; some of this is due to the fact that the Department of Health and Human Services (HHS) needs to create a lot of regulations to interpret the law. But, also there was little analysis of how the law is going to affect Maryland before the main pieces of the PPACA (the Medicaid expansion and setting up the exchange) go into effect in the year 2014, 3 ½ years from now. Near the end of the Q and A, an emergency room nurse stated that there were lots of people coming to her facility without health insurance and asked what could she do to help them get insurance. The representative from Families USA suggested that she call her organization and they would help out. As there are no easy answers, no specific solutions were mentioned. Vinnie Demarco (Healthcare for All) bragged that the Medicaid population in Maryland would increase by 170,000. What he failed to mention is that while some of the increase is due to the Maryland Law that opens up Medicaid to parents and caretakers between 40% and 116% of the federal poverty limit; a lot is also due the expected increase in Medicaid enrollment that occurs during all recessions. DHMH has reported enrollment of 52,000 in the new eligibility category created by the Maryland law from July 2008 to November 2009.

The presenters often avoided salient facts about the effect of the interim programs in Maryland. For example, Terry Gardiner in reviewing the small business landscape failed to mention that the current state small business program that offers insurance subsidies has been a failure with less that 1200 lives covered and the number of participating businesses in decline because of rising premiums and cuts in coverage. In this environment without cost controls on insurers, it is unlikely that the new federal tax deduction for health insurance premiums that is now available to small business will expand the number of small businesses able to cover their employees.

The new temporary federal high-risk insurance pool, which will be run by MHIP (Maryland Health Insurance Program), is going to be small. Maryland gets $85 Million dollars over 3 1/2 years; amounting to less than 10% of MHIP’s budget. While MHIP is open to the uninsured with pre-existing conditions immediately, in order to be eligible for the new federal high-risk pool you must have been uninsured for 6 months first. The conflict between the two programs is clear. MHIP has remained small, 18,000 members, because the premiums are often unaffordable.

Maryland Medical Assistance (Medicaid) has been the pride of incremental reformers because enrollment has increased; for three reasons – tax returns are being used to inform parents that there children are eligible for Medicaid, the Maryland Medicaid expansion (starting July 2008) that I already mentioned and the great recession which nationally has produced the largest increase in Medicaid enrollment of any economic downturn. Because of the American Reinvestment and Recovery Act (the Obama Stimulus) and fortuitous timing, Maryland has financed much of the Medicaid expansion with the additional $1 billion dollars it received from the federal government starting in mid-2008. There is a temporary increase in the federal medicaid match from 50% to 61.65% that runs out 12/31/2010; unless congress extends it. But in spite of this, the North Carolina Institute of Medicine has estimated that even with the Medicaid expansion, the overall number of uninsured in Maryland has increased since the downturn in the economy.

Some irritations of omission at the conference:

One of the questioners asked about the supply crisis of primary care providers, the answer was that things had worked out better than expected in Massachusetts when they set up an exchange because most people could identify a medical home. No mention of the poll showing that people in Massachusetts were still having difficulty actually getting to see a provider.

When discussing the exchange it was mentioned that because of no pre-existing conditions insurers could not base premiums on health status when the exchange goes into effect in 2014; what was not mentioned is that they can increase premiums up to 400% based on age. Further, insurers find other ways to avoid those with pre-existing conditions by limiting networks and covered services.

Hopefully, the Congress will continue the increased Medicaid match or the state could be facing a $380 Million Dollar hole in the budget which will inevitably lead to cut backs in the Medicaid program – this can only be done with a waiver from HHS. If you write your congressman to ask for a continuation of the increase federal Medicaid match; you could also mention that we could save over $300 Million dollars by eliminating Health Choice (the private part of Medicaid) and expanding the publicly administered part of Medicaid; that represents the difference in administrative costs and profits between the two programs.

Eric Naumburg, M.D., M.P.H.
enaumburg@hotmail.com
Howard County Healthcare-Now
Physicians for a National Health Program

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