Protecting the Affordable Care Act

GOAL:  Passage of the Health Insurance Down Payment Proposal.  This proposal would replace the Patient Protection and Affordable Care Act (ACA’s) individual mandate eliminated in the recent federal tax reform legislation with a Maryland health insurance down payment plan. The federal individual mandate was a program that charged fines for individuals if they were not enrolled in a qualified health insurance plan.  The Health Insurance Down Payment Proposal would allow a tax payer who is faced with a fine for not having qualifying coverage at tax time to have the option for this fine to go toward their health insurance in the Maryland Health Exchange.  The work of UULM-MD will be in conjunction with Health Care for All and Consumer Health First as we are members of these coalitions.  Senator Brian Feldman and Delegate Joseline Pena-Melnyk are the lead sponsors.

WHY:  This is Maryland’s innovative response to federal attempts to roll back the ACA by ending the enforcement of the ACA’s individual mandate.  This proposed legislation would replace the expiring federal mandate with down payments to help the uninsured get coverage while lowering costs of individuals that buy their own insurance.  Doing this would increase the number of younger and healthier people in the insurance pool and allow for them to obtain federal subsidies if their jobs do not provide insurance or their incomes are not adequate to purchase insurance.

Maryland decreased the number of uninsured to 6.6% in 2015 from 11.3% after the ACA was implemented in 2013.  However, there are still thousands of Marylanders eligible for the ACA who have not been enrolled.  It is necessary to maintain those now covered by the ACA and increase the numbers.   If this legislation is not passed, this will not be feasible as rates will increase and it will be harder to maintain and expand those insured. 

Prescription Drug Affordability Board Act
 
UULM-MD is also supporting the proposed Prescription Drug Affordability Initiative to help make all drugs, including brand name and specialty drugs more affordable.

Marylanders across the state are struggling to afford the prescription drugs they need, often having to choose between their medication and other necessities, like rent and groceries. As prescription drug costs continue to soar, it is critical that the Maryland General Assembly take action to help ensure that all Marylanders have access to affordable medications, because drugs don’t work if people can’t afford them.
 
What can Maryland do? Maryland can create a Prescription Drug Affordability Board, an independent body with the authority to evaluate high cost drugs and set reasonable rates for Marylanders to pay. The Prescription Drug Affordability Board will look at prescription drugs with costs that greatly impact Marylanders, including high-cost, brand name medications. High costs can prevent Maryland patients from accessing the prescription drugs they need, cause significant affordability issues for the state, and threaten public health.
 

How a Prescription Drug Affordability Board works: The Board is composed of five members (plus a Stakeholder Council and staffing support) appointed by the following:
• one member by the Governor,
• one by the Senate President,
• one by the Speaker of the House,
• one by the Attorney General, and
• the Board Chair to be jointly appointed by the President and Speaker.

The Board will review prescription drugs that meet any of the following criteria:
• New brand name prescription drugs which enter the market at $30,000 or more per year or course of treatment;
• Existing brand name medications which increase in price by $3,000 or more per year or course of treatment;
• Generic medications which increase in price by $300 or more per year or course of treatment; and
• Any prescription drug that creates affordability challenges to the Maryland health care system, including patients.

 
The Board will consider a broad range of economic factors when setting appropriate payment rates for reviewed drugs, allowing pharmaceutical manufacturers the opportunity to justify existing drug costs. Once a fair payment rate is determined, the Board sets an upper payment limit that applies to all purchasers and payer reimbursements in Maryland, ensuring that lower costs benefit consumers.
 

FOR MORE INFORMATION:

  • Health Care for All! Coalition (MD) healthcareforall.com – Information on legislation to improve health care--UULM-MD is a coalition member.
  • Consumer Health First http://www.consumerhealthfirst.org  -- information about MD Health Connection and ACA; formerly the Maryland Women's Coalition for Health Care Reform; UULM-MD is a coalition member.
  • Maryland Health Connection marylandhealthconnection.gov  or call the Consumer Support Center, 1-855-642-8572 for information and to sign-up
  • Kaiser Family Foundation ACA info for consumers - http://kff.org/aca-consumer-resources