A week after President Donald Trump reasserted his desire to see the Affordable Care Act go away, Maryland lawmakers have passed or are poised to pass legislation designed to protect the landmark health law.
In theory. The reality is that amendments to most of the bills have left the measures with a narrower scope than when they were introduced.
The changes mean hoped-for provisions like a state-based individual mandate or putting the Affordable Care Act’s consumer protections into state law will not happen this year. Nonetheless, consumer advocates remained optimistic about the legislative session’s outcomes.
“They did take these important steps to make sure that Maryland is protected and the Affordable Care Act remains,” said Beth Sammis, president of Consumer Health First.
As the legislative session began in January, leaders included protection for people with preexisting conditions and a measure to curtail rising drug prices among their priorities.
To address preexisting conditions, Del. Shane Pendergrass, D-Howard, and Sen. Brian Feldman, D-Montgomery, sponsored legislation that would have placed into state law the Affordable Care Act’s consumer protections, which also include allowing young adults to stay on their parent’s health plan until they turn 26 years old and prohibiting lifetime limits on coverage.
For rising drug prices, a bill sponsored by Del. Joseline Peña-Melnyk, D-Prince George’s and Anne Arundel, and Sen. Katherine Klausmeier, D-Baltimore County, would have created a board to review the cost of high-priced prescription drugs and set an upper limit on what Marylanders could pay for those drugs.
Another high-profile bill would have brought an individual health insurance mandate to Maryland, including a penalty for those without coverage. The bill also included a provision that proactively encourages people who indicate on their state taxes that they do not have insurance to get coverage, especially people who could be eligible for Medicaid or tax subsidies that make their coverage essentially free.
As the legislative session wore on, these bills went through the committee process and came out looking different than they went in.
The consumer protection legislation now declares the legislature’s intent to protect consumer protections and refers the issue to a commission for study this fall. That bill has already passed the legislature.
The drug board bill, which has passed the House, now only applies to drugs for state, county and local employees after lawmakers questioned about whether the courts would let Maryland regulate drug prices more broadly.
And the bill that would have created a mandate now just focuses on the opt-in portion of the legislation. That legislation has passed in each of its respective chambers but must still pass the opposite chamber.
Changing bills as they go through the legislature is part of the process to make sure things are done right, said Pendergrass, who chairs the House Health and Government Operations Committee that all of these bills have gone through.
The mandate bill was an example of legislation where lawmakers took what they knew could get support, the opt-in portion of the bill, and tried to build more support for a mandate in the future. They believe 120,000 uninsured Marylanders could get free coverage through Medicaid or tax subsidies alone.
“We felt that the big benefit in that bill was the big number (of people who could get insurance) and then we can see what we need to do for the last bucket” of people who make too much money to qualify for subsidies, Pendergrass said. “Let’s make a good start at making it very very easy for people who get free or almost free insurance to get in and get that insurance.”
Feldman still hopes Maryland can put a mandate in place in the future.
“I’m somewhat disappointed, but I think what we’ve come up with here is a pretty interesting first step,” he said. “We could use this as a building block to revisit a mandate down payment down the road.”
But just as the legislature is finalizing its work this year, Trump declared that he still wants to see the Affordable Care Act gone and replaced with an unspecified alternative. The Department of Justice also said it supported the decision of a federal judge in Texas to throw out the Affordable Care Act, but that decision is on hold pending appeal.
Still, consumer advocates agreed that it was more important to get Maryland’s protections right than to get it done now.
Sammis, a former acting insurance commissioner in Maryland, said the consumer protections were too complicated to force into law this year, with cross-checking needed by both the Maryland Office of the Attorney General and the Maryland Insurance Administration.
“I know how hard it is to take those protections that are codified in both the Affordable Care Act statute and the interpretations and move them into Maryland law,” she said.
Putting those protections into state law will be studied by the Health Insurance Coverage Protection Commission during the interim session. Pendergrass and Feldman both said they intended to pass a law putting them into state statute next year.
Consumer advocates are also confident that the Supreme Court will continue to uphold the Affordable Care Act, which it has twice already with Chief Justice John Roberts siding with the majority.
But if the Supreme Court did throw out the Affordable Care Act before Maryland could act?
“I also have faith that Maryland would call a special session and do something,” Sammis said.
She remains satisfied with what Maryland has done so far but hopes the state will take more steps to get people insurance in the future.
“We think there is still work to be done, to bring more choice, to drive prices down,” she said. “We are pretty confident that the structure of the ACA will remain intact and we will continue to be able to build on that.”