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Mandate, consumer protection provisions stripped from Md. health insurance bills

Vincent DeMarco, a leading advocate for mandating insurance coverage for Maryland residents, says he's happy that the bill that has advanced at least gives people an opportunity to signal their interest in coverage. (File Photo)

Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, says he’s happy the bill that has advanced at least gives people an opportunity to signal their interest in health insurance coverage. (File Photo)

Multiple pieces of health care legislation are moving forward in the Maryland House of Delegates, but they have been amended to exclude some of their key elements.

Bills originally drafted to put the Affordable Care Act’s consumer protections into state law and a bill to enroll more people on the state health exchange using a state-based individual mandate were both unanimously approved by Health and Government Operations Committee this week — but only after they were stripped of the consumer protections and the mandate.

The mandate legislation would have recreated the Affordable Care Act’s individual mandate penalty in Maryland while also allowing the state comptroller and the Maryland Health Benefit Exchange to work to enroll people who could qualify for subsidies. People who paid the penalty could use it as a “down payment” on a health plan.

When people file their taxes, they can check a box that says they do not have insurance but are interested in getting health insurance. The comptroller’s office would send that person’s information to the exchange to help them get insurance.

Vincent DeMarco, president of the Maryland Citizens’ Health Initiative that has championed the proposal, said he would have preferred the mandate to remain in the legislation but called the remaining bill, “a great step forward.”

“It really is exciting to us because we will be the first state in the country to actively use the tax system to help get people enrolled,” he said. “I think it could be a model for other states.”

The legislation would now create the Maryland Early Enrollment Health Program, DeMarco said. He estimates it could still get an additional 50,000-100,000 people in the state insured just by finding people who are eligible for Medicaid or federal tax subsidies that would give them free or nearly free health insurance.

The amended legislation removes the mandate but keeps the enrollment elements of the bill. The mandate had been a target of Republican lawmakers, who saw the penalty as an added cost to people who could not afford health insurance, not something that would entice them to get insured.

The loss of a mandate could also help the bill receive approval from Gov. Larry Hogan, who has repeatedly said he prefers legislation that encourages people to get insured without using penalties.

The mandate legislation was one of the bills suggested by the the Maryland Health Insurance Coverage Protection Commission.

That commission also recommended that the legislature take concrete steps to put the Affordable Care Act’s consumer protections into state law following a federal judge’s decision last year to rule the act unconstitutional. He stayed his decision pending appeal.

The legislation proposed by Del. Shane E. Pendergrass, D-Howard, would have put popular consumer protections from the federal health law into state law, including protections for people with preexisting conditions and allowing young adults to stay on their parents’ health plan until they turn 26 years old.

But the amended legislation does not put any of those protections into state law. Instead, the bill says, “The General Assembly finds and declares that it is in the public interest to ensure that the health care protections established by the federal Affordable Care Act continue to protect Maryland residents in light of continued threats to the federal Affordable Care Act.”

The bill also instructs the health insurance coverage protection commission to create a work group to monitor activity at the federal level, including court cases, that may hurt Affordable Care Act protections.

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