Ensuring Access to Affordable Coverage

July 22, 2019 By: Bob Atlas

Affordable health care coverage is essential for people to have access to the care they need. It is particularly important in Maryland, where our success under the Total Cost of Care Model rests on improving the health of the state’s entire population. We can’t prevent unnecessary hospital use unless more Marylanders can afford coverage. 

Last week, the Maryland Insurance Administration (MIA) held its public hearing on 2020 insurers’ premiums. In the individual market the average rate reflected a 2.9% decrease. This is good to see, though it is almost entirely attributable to the effects of the reinsurance program begun last year. For the small group market, it was a 4.3% increase. MIA will decide on rates ahead of the new rate year in January. 

Your Maryland Hospital Association testified at the hearing and wrote to the MIA outlining several concerns: 

  • Payers’ requests, in some cases, were not based on accurate hospital trend data, which is discernible under the HSCRC’s global update process.
  • Savings under the Model are not being passed to consumers, who are experiencing higher out-of-pocket costs. This finding is backed by independent analysis and published in May’s issue of MHA Insight.
  • Reliance on the reinsurance program to subsidize high-cost patient claims is not sustainable. Payers need to invest in meaningful care management. 

We continue to urge insurance regulators to review rate requests holistically These efforts are working. MIA is starting to gather data on insurers’ care management programs to gauge their effectiveness. MIA is also looking into the spike in out-of-pocket costs.

These are promising steps toward ensuring that all Marylanders can afford health care. We will continue to push for more insurer accountability.