Health insurance mandates won't help uninsured

Originally published in the Baltimore Examiner

By Marc Kilmer
Published on Wednesday, January 31, 2007
BALTIMORE - With the opening of a new session of the General Assembly, we can be assured of action that will address the issue of those who lack health insurance in Maryland. One proposal that has fans from all sides of the political spectrum mandates health insurance for everyone in the state. Unfortunately, this popular proposal is a poor cure for our state’s health insurance ills. The path for this type of plan has already been blazed in Massachusetts, where former Gov. Mitt Romney pushed though a health insurance plan that imposes a number of mandates on individuals and businesses as well as provides subsidies for those who cannot afford insurance. It was popular with both Democrats and Republicans and is now being implemented. Massachusetts plans to use the funds otherwise going to pay the bills of the uninsured to provide these individuals with financial assistance and access to insurance. This will be accomplished by individual mandate, where uninsured residents will lose personal exemptions on their state tax returns; by employer mandate and risk of a fine; and subsidies for residents whose income is below 300 percent of the federal poverty level. Read More »

Mandating Health Insurance: Would The Massachusetts Plan Work For Maryland?

By Marc Kilmer
Published on Tuesday, January 16, 2007
Recent surveys indicate roughly 16 percent of Maryland’s population has no health insurance. Only 22 states have a greater percentage of their population who lack insurance.[1] This has led to the call for new public policies to extend insurance coverage to the uninsured. Some elected officials have looked to Massachusetts as a model for how Maryland should deal with this issue. In 2006, Massachusetts Governor Mitt Romney pushed through a plan mandating that all residents of Massachusetts have health insurance. The idea animating this bill is to require everyone to have health insurance, and then to use the funds otherwise going to pay the bills of the uninsured to provide these individuals with financial assistance and access to insurance. The plan proposes to accomplish this through the following means: Individual Mandate: State residents are required to have health insurance or face the loss of their personal exemption on state taxes. Employer Mandate: Employers are mandated to provide health insurance for all of their employees or pay a fine. Connector: The state will set up a system to help residents find insurance through a “Connector” that will help the uninsured find insurance policies. This will theoretically lower prices by pooling the uninsured to give them group rates. Subsidies for Low-Income Residents: Subsidies will be provided by the government for residents whose income is below 300 percent of the federal poverty level. [1]Council for Affordable Health Insurance, “ State Health Insurance Index 2006: A 50-State Comparison of the Nation’s Health Insurance Market,” October 26, 2006. The data referenced here was found in the methodology paper that accompanied this report.   Read More »

Reforming Medicaid by making users share its costs

Originally published in the Examiner

By Marc Kilmer
Published on Wednesday, November 15, 2006
WASHINGTON - During the campaign season, little attention was focused on the largest item of the state budget — Medicaid. This program has grown dramatically the past six years and promises to grow even more the next decade. Unfortunately, our elected officials are offering few ideas as to how to control the program’s growth. Instead of avoiding the issue, they need to be considering how to fundamentally restructure Medicaid in Maryland. One step in the right direction would be to introduce cost-sharing requirements for some Medicaid users. Currently, there is little or no cost for Medicaid users in Maryland. Since health care is essentially free to them, some Medicaid beneficiaries tend to overuse the system, which drives up costs for the taxpayers who are funding the program and unnecessarily burdens Maryland’s health care system. Read More »

Cost-Sharing to Reduce Medicaid Costs in Maryland

By Marc Kilmer
Published on Tuesday, October 31, 2006
In February of 2005, the Deficit Reduction Act (DRA) was signed into law by President Bush. Among the many features included in the bill were provisions allowing states to take steps to reduce Medicaid spending. Unlike some other states, Maryland has not yet utilized these opportunities to help control its rising Medicaid expenditures.   One of the most significant provisions in the DRA is the allowance of limited cost-sharing for Medicaid beneficiaries. States that choose these cost-sharing options will recoup some of the costs for providing Medicaid services. More importantly, these states will also reduce utilization of services. Some may view this reduction as a negative consequence of cost-sharing, but evidence indicates that the reduction in services is not accompanied by a reduction in a person’s health quality. Instead, the reduction in services will reduce over-utilization. Read More »