Obamacare – Sandy Rosenberg

A newcomer to this process

January 24, 2018 | by delsandy | Sandy's 2018 Legislative Diary | No Comments

I’m a newcomer legislatively when it comes to health insurance.

My focus has been on the public health side – lead poisoning, family planning, and mental health.

However, with the changes to Obamacare in the federal tax bill and regulatory actions by the Trump administration, 240,000 Maryland families will likely become uninsured.

“Implications of Federal Health Insurance Policy for Maryland” was the topic of a briefing for my committee today.

What did this newcomer learn?

All parties must be involved in seeking a solution.

By parties, I mean all of the players in the health care system, most notably insurers.

I also mean Democratic and Republican parties.

A solution will require a revenue source.

We’ve been in this place before

March 1, 2017 | by delsandy | Sandy's 2017 Legislative Diary | No Comments

The fate of Obamacare, and with it Medicaid, is one of those Washington issues that will affect Maryland.

States could get less money but more freedom in running their Medicaid programs if the Congress decides to block grant the program.

That’s what happened under federal welfare reform.

Since Fiscal Year 2011, Maryland’s program has run a deficit. The ending balance over the last four years has averaged minus $15 million.

Several Republican governors are devising proposals that would require many Medicaid recipients to have a job, participate in job training, or perform community service, according to the New York Times.

When we adopted a drug testing requirement as part of Maryland’s welfare reform, I asked Peter Beilenson, then the Baltimore City Health Commissioner, for his advice.

I did so again this week.

Peter responded: “I’ve come to the conclusion that work requirements for vital social service programs are, most of the time, short-sighted, particularly with medical services. Imposing work requirements for Medicaid will push many so-called able-bodied individuals off the Medicaid rolls due to inability to find jobs (mentally ill, substance users, under-qualified for any livable wage jobs, etc) and these people who lose Medicaid coverage will cost far more due to uncompensated care for untreated chronic conditions than if they had stayed on Medicaid.”

January 19 – Repeal and re-fund

January 19, 2017January 19, 2017 | by delsandy | Sandy's 2017 Legislative Diary | No Comments

A big number and two words.

If the Congress reduces the federal portion of the cost of the expansion of Medicaid coverage under Obamacare, the cost to Maryland would be $1.27 billion.

For more than 30 years, Maryland’s all-payer system has meant that all patients pay the same rate for hospital care, whether they have private insurance or are on Medicare or Medicaid. If a person doesn’t have health coverage, the rates increase for those with insurance to cover that uncompensated cost of care.

If the federal government were to end its contract with us for this all-payer system, $2.3 billion in annual federal payments to Maryland hospitals would be jeopardized.

That’s $3.57 billion. Per year.

The need to provide for that health care will not disappear. Nor will the need to compensate health care providers.

The two words: special session.

No one expects the Congress to “repeal and replace” Obamacare before we adjourn in April.

A gap in funding of this magnitude – and its effect on the provision of health care, would need to be addressed immediately.

And in a bipartisan manner.