Maryland: Gov. Hogan signs "Easy Enrollment" bill into law...could be a big deal next year

Back in March, I wrote about a clever and absurdly simple (on the surface) bill being passed through the Maryland state legislature which could result in the state lowering their uninsured rate substantially...by as many as 120,000 people:

In early 2018, Maryland state legislators introduced a bill which included a twist on the coverage mandate penalty--those who failed to sign up had another option: They could either pay the penalty or they could choose to have the penalty amount be used to automatically enroll them in the lowest-cost insurance policy available. If they qualified for ACA subsidies, those would even be baked into the equation as well. This was a clever way of softening the blow, while also increasing enrollment and helping out the ACA risk pool.

...Stan Dorn is a Senior Fellow at Families USA, and apparently he's been hard at work on helping push through a revised version of the "Down Payment" bill, which seems to have a much better chance of making it through the process and becoming law:

Maryland would use state tax forms to identify uninsured residents and refer them to options for no-cost or low-cost health care under a bill moving forward in the General Assembly.

The bill, if approved, would add a question on state tax returns asking taxpayers if they have health insurance. Those who answer that they don’t have health insurance would be referred to the state's Medicaid program or the health exchange, where individuals can buy health insurance plans.

...Dorn explained to me that the way it would work is much more than that: The state tax returns would include a new line where uninsured filers would be required to check off one of two boxes:

Box 1: "Have the exchange determine my eligibility for free or low-cost insurance"

Box 2: "I prefer to remain uninsured."

When the tax form goes to the state treasury department, if they checked Box 1, their data is forwarded to the Maryland Health Benefit Exchange, which now has permission to check their status. If they qualify for Medicaid, they're auto-enrolled. If they qualify for a subsidized exchange plan, the exchange will then contact them and let them know what sort of plans they're eligible for.

This may not sound like that big of a deal, but it could be:

The program is expected to identify about 50,000 people eligible for Medicaid, the government health insurance program for those with low incomes, according to the Maryland Citizens’ Health Initiative.

An additional 70,000 Marylanders could buy insurance at little to no cost through the state’s health exchange with the help of government subsidies, according to the organization.

Well, not only did the "Easy Enrollment" bill pass through both the state House and Senate easily, it was just signed into law by the Republican Governor, Larry Hogan:

Maryland Gov. Larry Hogan signed a first-in-the-nation measure Monday to make it easier for people without health insurance to find out if they qualify for low-cost insurance after they file their taxes.

The new law will create a box for people to check on state income tax returns. If a taxpayer checks the box, the state's health care exchange will see if the person qualifies, based on information in the tax return. Those who qualify for Medicaid will be enrolled automatically. The exchange will reach out to people who qualify for private coverage.

Hogan, a Republican, highlighted bipartisan work in the General Assembly, which is controlled by Democrats, on other health-related measures he signed Monday. One of them raises the smoking age from 18 to 21 and includes vaping in the definition of tobacco products.

"We've been continuing to look for bipartisan ways to get more Marylanders health insurance," Feldman said. "We've made a lot of strides. About six or seven years ago, we had about 760,000 people without health insurance. Now, we're down to 360,000, and in light of what's happening at the federal level — the dismantling of the Affordable Care Act, the elimination of the mandate, we're starting to see some backtracking on that. So, we came up with an idea here that's first in the nation that you can use the state income tax return to check a box, and it will immediately opt in."

Medicaid expansion enrollment is available year-round (which makes sense...the only reason to have limited enrollment periods is to prevent attempts at gaming the system, but Medicaid is essentially free at the point of service for the enrollee in most states, so there's little to be gained by limiting the time period to sign up), so that's not an issue. As for those earning more than 138% of the Federal Poverty Line, they'd normally have to wait until November to enroll for ACA exchange coverage starting the following year, but the new law clarifies that those who are found to be eligible for subsidized exchange coverage by the state tax dept. will also be eligible for a new Special Enrollment Period:

(A) IF AN UNINSURED INDIVIDUAL IS NOT DETERMINED TO BE ELIGIBLE 2 FOR THE MARYLAND MEDICAL ASSISTANCE PROGRAM OR THE MARYLAND CHILDREN’S HEALTH PROGRAM UNDER § 31–205 OF THIS SUBTITLE, THE EXCHANGE SHALL DETERMINE, IN ACCORDANCE WITH § 31–204 OF THIS 5 SUBTITLE, WHETHER THE UNINSURED INDIVIDUAL IS ELIGIBLE FOR PREMIUM TAX CREDITS OR COST–SHARING REDUCTIONS AS DETERMINED UNDER THIS SECTION.

(B) (1) (I) A SPECIAL OR OTHER ENROLLMENT PERIOD FOR THE INDIVIDUAL MARKET SHALL BEGIN ON THE DATE AN INCOME TAX RETURN IS FILED BY OR ON BEHALF OF AN UNINSURED INDIVIDUAL THAT INCLUDES THE CHOICE DESCRIBED IN § 2–115(C)(3) OF THE TAX – GENERAL ARTICLE, IF THE RETURN IS FILED ON OR BEFORE THE DATE SPECIFIED BY THE EXCHANGE.

Anyway, a huge shout-out to Stan Dorn, Healthy Maryland, the Maryland legislators behind this bill and everyone else involved. It'll be fascinating to see how effective this ends up being in the coming years.

For comparison, Maryland enrolled around 157,000 people in ACA exchange policies this year, so if they were to max out that 70K figure they'd increase exchange enrollment by a whopping 44%. I doubt they'll hit that in 2020, but hopefully it'll ramp up quickly.