Health exchange slated to enroll Marylanders in 2013

by Margie Hyslop

Staff Writer

Maryland should be able to cut the number of uninsured by half and garner $850 million in savings during 10 years through changing how health care is paid for and delivered, a state health official told a House committee Monday.

Officials and consultants are figuring out how to do that now, as they work out details of how to operate, finance, promote and enroll residents for coverage they can afford through the Maryland Health Benefit Exchange, which was mandated in legislation passed in the 2011 regular session of the General Assembly, Carolyn Quattrocki, executive director of the Governor’s Office of Health Care Reform, told the House Health and Government Operations Committee.

The exchange will create a single point of entry that can be used by Marylanders to look for more affordable health care insurance, with computer-based navigation tools and advisers available to help them find and assess plans for which they qualify.

Developed to mesh with national health care reform law, the exchange is not slated to begin enrolling people until October 2013.

Through it, federal assistance is expected to be offered to applicants with household incomes as much as four times the federal poverty level.

Based on federal poverty-level incomes set for 2011, an individual with an annual income of as much as $43,560 and family of four with an income of as much as $89,400 would be eligible.

Four advisory committees charged with making recommendations to the legislature by Dec. 23 are working to determine what plans should be offered outside the exchange; how much choice employees should have; user and licensing fees; how to make it self-sustaining by 2015; and how to prevent waste, fraud and abuse.

They also are working to recommend in what languages information about the plans should be offered.

“How the exchange is financed almost certainly will require legislation,” Joshua Sharfstein, the state health secretary, told the committee.

Sharfstein said his department is working to integrate the programs into a new financing model that rewards hospitals “for value instead of volume.” Some hospitals in the state in a pilot program now are getting paid for service under a patient outcome-based, rather than procedure-based, model.

The goal, Sharfstein said, is to control costs in ways that are “constructive.”

Del. Donald B. Elliott (R-Dist. 4B) of New Windsor asked how all the work the state is putting into the plan would be affected if the U.S. Supreme Court overturns the federal health care reform mandate.

Quattrocki said she thinks the law will be upheld, but that if it were overturned, much of the work could be incorporated into the state’s own plans for reform.

The state has had to move ahead to meet federal deadlines as well as its own, she said.

mhyslop@gazette.net