Republicans might have pulled the American Health Care Act, but stakeholders in Maryland’s health care community remain wary of any future reform efforts that could come out of the Trump administration or Congress.
The Maryland Hospital Association and the Maryland chapter of AARP, among other groups, welcomed the non-vote in Washington but still anticipate efforts to undermine the Affordable Care Act.
“We’re not in any way taking for granted that this is over,” said Hank Greenberg, director of AARP Maryland. “I believe it’s actually quite the opposite. It’s not over.”
Concerns about potential reforms, Greenberg added, now move to protecting the 400,000 Marylanders who signed up for health care when the state expanded Medicaid.
Carmela Coyle, president of the Maryland Hospital Association, said the Medicaid expansion portions of the Affordable Care Act could remain at risk if, for example, Republican seek to convert Medicaid to a block grant system or use per capita caps on spending.
“I think that conversation is not over,” she said. “It will continue in perspective of the budget.”
Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, agreed.
“Even though the Ryan-Trump bill failed, they’re still going to do everything they can to weaken the ACA – Trump administratively, maybe legislatively,” he said.
DeMarco’s group is supporting legislation pending in the General Assembly to create the Maryland Health Insurance Coverage Protection Commission, which would monitor how federal health care changes would affect the state.
Senate Bill 571 passed the House of Delegates on Monday night, with some amendments that will need to be reconciled with a version of a bill passed by the Senate earlier this month.
The state hospital association remains concerned about the future of Maryland’s demonstration project under the ACA, which provides the authority for the state’s all-payer hospital budgeting system, formerly known as the Maryland Medicare Waiver. The demonstration project expires in December 2018.
“We as a state need an answer now because these are very large organizations,” Coyle said. “They need to understand now what the destination is and how much runway they need to get there.”
Coyle said the state has begun discussions with the federal government about the extension but that they’re still in the beginning stages, leaving the association in monitoring mode.
“We will continue to have to be hyper-vigilant,” she said. “I think that’s just the federal environment right now.”
Concerns about the budget also extend to the public health sector.
“I’m greatly relieved that the so-called replacement did not go through,” said Baltimore City Health Commissioner Dr. Leana Wen. “We are not taking a breath of relief yet because there are many unknowns regarding the federal budget.”
Approximately 80 percent of the health department’s budget comes from state and federal resources, Wen said, and many of the state resources originate from the federal government.
While spending on public health programs means more money spent up front, the programs ultimately decrease health care costs down the line, Wen added.
“A commitment to public health is a commitment to fiscal responsibility,” she said.
Room for improvement
Health care officials said they would be open to President Donald Trump continuing to pursue health care policy by reforming the Affordable Care Act rather than completely repealing and replacing it.
“I don’t think there’s anyone who says that there isn’t the need for improvement,” Greenberg said, adding he would like to see Democrats and Republicans come together on potential reforms.
DeMarco said reforms to decrease health care costs for consumers should be considered.
“We should look at things like increasing the subsidies for people in the exchange more and reduce those deductibles and copays,” he said.
Coyle agreed that health care costs could be an area for improvement to the Affordable Care Act, where the insurance markets have not been “as stable as people would like to see and not as affordable for many.”
Change is inevitable in the health care industry, she added, which is why it is important to focus on what the change looks like.
In the public health sector, more flexibility for prevention efforts would help communities improve their health, Wen said.
“The more focus that we can get upstream, the better,” she said.
Wen also would like to see a reduction of non-health care costs to include increased access to food, housing and care coordination.