Future of Affordable Care Act in Maryland is Uncertain

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While President-elect Donald Trump vowed to repeal the Affordable Care Act on the campaign trail, his recent promises to maintain key components of the law have reassured Marylanders, though many still feel the law’s future is questionable.

Members of Maryland’s Democratic congressional delegation have warned Trump about interfering with Obamacare, though the president-elect has said he plans to keep parts of the law that ensure coverage for people with preexisting conditions and grant people younger than 26 permission to remain on their parents’ plans.

“I think Republicans need to be very careful because the reality is that the uninsurance rate in Maryland and around the country is at a low,” Senator-elect Chris Van Hollen, D-Kensington, told WBAL News.

In Maryland, 120,145 people were signed up for coverage under the Maryland Health Connection exchange as of February 2015, and people covered under Medicare have saved almost $230,365,408 on prescription drugs with Obamacare since the program was started, according to the U.S. Department of Health and Human Services.

In 2009 — before Obamacare took effect — 24 percent of people living in poverty in Maryland were uninsured, while in 2014, 15.7 percent were uninsured, according to data from the U.S. Census Bureau.

Bruce Oppenheimer, a public policy professor at Vanderbilt University, said people who would be stripped of their Affordable Care Act benefits might feel more concerned.

“They do not want uncertainty, so they’re going to be asking for — where is it going to go,” Oppenheimer told the University of Maryland’s Capital News Service. “Okay, you’re stripping this away. What are we going to have left? Are we returning to health care the way it was before the Affordable Care Act, or is something else going to come in its place?”

With a Republican White House and a Republican Congress, it’s possible that legislation to repeal the Affordable Care Act could be introduced as early as next year.

Medical professionals in Maryland are in favor of Obamacare’s expansion of Medicaid, but are looking to the new administration to consider some changes within the Affordable Care Act, said Gene Ransom, the chief executive officer of MedChi, the Maryland state medical society.

“We don’t want to keep things that create barriers between a physician-patient relationship,” he said. “We’re seeing this as an opportunity to look at it and maybe try and make things better.”

Among the components MedChi is looking to roll back include the Independent Payment Advisory Board, a panel responsible for enforcing a limit on Medicare spending increases.

“We don’t think the government bureaucrats should be deciding what services are delivered to the patient,” said Ransom. “It should be decided by the physician and patient, not someone sitting in an office in Washington.”

But any changes to the Affordable Care Act aren’t going to happen overnight, said Leni Preston, president of Consumer Health First, an organization launched in May to continue the work of the Maryland Women’s Coalition for Health Care Reform.

“When we woke up on Wednesday morning (after the election), our agendas changed completely,” she said. “Instead of continuing to move forward, we are now looking at an agenda that requires us to look carefully at those state laws and those state regulations and make sure that we can provide policies and advocacy to make sure that Maryland keeps moving forward.”

Maryland’s use of a state-based exchange might work in the state’s favor to ensure some protections under the Affordable Care Act, but nothing is for sure, said Preston.

“It’s incredibly complicated; there are a lot of players from the president-elect on down and there are a lot of moving parts that people are going to be watching out for,” she said.

If the Affordable Care Act were to be completely repealed, it could be salvaged at the state level — but only if Gov. Larry Hogan decided Maryland would cover the cost of the program.

Currently, the federal government covers 59.8 percent of the cost of the program in the state, while Maryland is responsible for the other 40.2 percent of the funding, according to data from the Kaiser Family Health Foundation.

However, Maryland is “several months out” from being able to tell just exactly what Trump’s impact on Obamacare will be, said Chris Garrett, the director of communications for Maryland’s Department of Health and Mental Hygiene.

“It’s way too premature for us to be able to lay out specific changes to the Medicaid program as it pertains to the new administration, because the president-elect hasn’t been inaugurated yet,” he said.

Sen. Dick Durbin, D-Illinois and minority whip, is hoping that Trump’s softer comments about Obamacare during his Nov. 13 interview with CBS News’ “60 Minutes” could mean reform to the law instead of complete eradication.

In the interview, Trump called the stipulation to ensure coverage to people with preexisting conditions one of the program’s “strongest assets,” in addition to the rule that allows people younger than 26 to remain on their parents’ plans.

“If President-elect Donald Trump is serious about pre-existing conditions, he has just really taken a major step toward keeping a big element of Obamacare,” Durbin said. “You cannot have that protection without a large pool of insured people.”

By Hannah Lang and Maya Pottiger

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