New State Health Partnership

By Mark R. Smith, EDITOR-IN-CHIEF

Vincent DeMarco said that there are anywhere from 700,000 to 800,000 uninsured citizens in Maryland.
But today, he's starting to feel better when confronted with that fact.
DeMarco, president of a grassroots organization called Maryland Health Care for All! Coalition, is working for just what his employers claims as its goal after the state recently announced that it is expanding health insurance coverage opportunities for working families and small businesses.
In coordination with the Maryland Department of Health and Mental Hygiene (DHMH), Maryland Health Care Commission (MHCC), participating insurance carriers and advocates, the state is working to enroll members in the Health Insurance Partnership with a new, $15 million subsidy program for small businesses.
"We think it's great," DeMarco said. "During the special session last November - which was not all about slots, as most people thought- Maryland passed a landmark health care expansion law that will provide health care coverage to tens of thousands of Marylanders."
He's hailing that move as "an historic achievement" that he hopes will prove to be a model for other states to follow. "More than 100,000 people who are not covered will now get health care, most through a concurrent Medicaid expansion, but about 15% through the small business partnership.
"That's a lot of businesses and a lot of people who are going to be helped thanks to Gov. [Martin] O'Malley," he said.

The Deal
During the General Assembly's Special Session of 2007, O'Malley was joined by leaders of the Maryland General Assembly to support the enactment of the Working Families & Small Business Health Coverage Act. The act, which went into effect on July 1, called for the creation of a subsidy that would encourage more small employers to offer health insurance to their employees. It also expanded Medicaid to cover parents with incomes up to $20,500 for a family of three, which is 116% of the federal poverty level.
Under the terms of the partnership, a small business that has from two to nine full-time employees, hasn't offered health insurance to its employees during the previous 12 months and has an average wage below $50,000 is eligible to receive a subsidy of up to 50% of the premium.
The total subsidy is divided between the employer and the employee, based on the contribution each makes toward the cost of coverage.
The partnership is expected to enroll more than 1,500 businesses in its first year, said Nicole Stallings, chief, government relations, for the MHCC.
"We think this will make a real difference in the lives of working families," Stallings said, "because the subsidy will cover half of the cost of the premium. So we hope it will help the employers offer health insurance for the first time and it will help the employees afford the health insurance premiums."
This month, insurance agents and brokers will begin enrolling small businesses in health plans offered by CareFirst BlueCross BlueShield, Coventry Health Care, United HealthCare and Aetna. All health plans eligible for a subsidy will encourage wellness by offering a health risk assessment and by providing employees with incentives for preventive care, wellness activities or disease management. Coverage will begin Oct. 1.

Moving Forward
In explaining that the partnership is available on a first-come, first-served basis, Stallings said, "If we have done our job and designed it correctly, enrollment will be capped to stay within existing funding.
"We expect to get 1,500 businesses enrolled," she said, adding the state "had the advantage of looking at similar programs in other states, then trying to craft a program that highlights the best part of each. We want this to be easy to understand, easy to enroll in and easy to administer."
Stallings also stressed two main points about the program.
"One thing that differentiates us is that we give employers a choice of carriers and a choice of plan, and we have four of the top five largest carriers in the small group market participating [as noted above]. Much of the administration of the program falls on these carriers," she said.
"That makes it easier for us to get the program up and running, and that's why we call it a partnership," Stallings continued. "It's between the state, the employers and the insurance companies. And, overall, this program fosters growth of small business so ultimately we think it will help keep the economy stronger."
She's confident that the program will do what it's intended to. "This is not a panacea," she said, "but it's a good first step."

A 'New' Benefit
While his company is not eligible for the program as it has been initially presented, Brian England, president of British-American Auto Care in Columbia, thinks the partnership is a great idea for small businesses, especially new entities that have not been able to offer health care.
"It's a way for people to get into it and grow their business to the point that they can provide health care for all of their employees who work 30 hours a week or more," he said.
However, England called it "a shame" that single proprietors are not eligible for the program at present. "If it gets off to a good start, maybe it will be in the near future if the response is good. It's a great thing for small companies if they can integrate health insurance into their business model."
He also said that it's important that the public realize that the insured are paying, through rising premiums, for the uninsured's care. "If everyone paid their part, we would not have so much uncompensated health care," England said.
That point was not lost on Ronald Sroka, M.D., the president-elect of MedChi, the Maryland State Medical Society. He said that his group is "very much in favor of expansion of health care to the uninsured" and it "applauds all of the efforts and wants all such plans to be equitable to all involved."
He did offer a word of caution, however. "This is basically an expansion of the medical assistance program, as I understand it," said Sroka. "If this is the case, the concern is that the reimbursement would be similar - and most practices would not be able to remain in business" at that rate.
Sroka said that observers at MedChi feel that, to some degree, the program may burden the physician in sustaining a large portion of the cost due to low reimbursement, "perhaps even an unfair portion."
But Sroka stressed that that's not to say that the association is against the program.
"We just want to ensure that reimbursements are fair for the doctors, because historically, reimbursement levels have not been fair to doctors so they could provide a financially viable business operation," he said.

Get in Line
For his part, DeMarco thinks Maryland's new plan "should be a national model because of the excellent way the O'Malley Administration is implementing it. We pledge to work closely with the administration to make sure that businesses are eligible for these grants apply for them.
"While many other states are going backwards, Maryland is going forward," he continued.
While allowing that the program will take "a couple of years until the law is fully implemented," DeMarco is hopeful that it will work so well that the legislature will expand it next year.
For now, it sounds like another shoe may drop beforehand. "Our goal is health care for all people, so we'll keep pushing until we get there," said DeMarco, adding, "We will announce our new Health Care for All plan before the end of the year to build on the success of the debut of the Medicaid and small business program."