Vincent DeMarco, right, president of the Maryland Heath Care for All! Coalition, joined Howard County Executive Calvin Ball to launch the first of a series of statewide forums focused on prescription drug affordability in September 2022. (TBM / George Berkheimer)

The Maryland Health Care for All Coalition is celebrating a hard-fought battle to improve health care options and insurance coverage for vulnerable residents and make high-cost prescription drugs more affordable.

Five of the six bills backed by the Coalition during this year’s General Assembly session passed and were signed into law by Gov. Wes Moore in April.

They include the automatic enrollment of SNAP recipients in Medicaid, extension of a pilot program that provides health care subsidies for young adults, fully funding the Prescription Drug Affordability Board, confirming the PDAB’s authority, and initiating a study on expanding health insurance benefits to income-eligible residents regardless of immigration status.

The Access to Care Act, co-sponsored by Sen. Clarence Lam (D-Dist. 12), did not advance. That bill would have allowed eligible residents to purchase health coverage from the Maryland Health Benefit Exchange regardless of immigration status.

Prescription drugs

Although the work to advance these particular bills was concentrated over the last six months, the coalition has spent the past five years working to strengthen the Prescription Drug Affordability Board.

The General Assembly established the PDAB in 2019, the first such board of its kind in the nation. That same year, the coalition began traversing the state holding public forums about board’s tasking and to raise support for its mission and funding.

New legislation approved $1 million in additional funding for the board and confirmed that it has the authority to examine the high cost of prescription drugs and ascertain how to make these costs more affordable for Marylanders, beginning with procedures to put upper payment limits on high-cost drugs for state and local governments.

“We’re a little behind where we wanted to be because of former Gov. Larry Hogan’s veto of the bill in 2020 to give the board the authority to put an assessment on drug manufacturers,” said Vincent DeMarco, president of the coalition. “That’s why we needed this extra money, the Board had to borrow money, but they’re on track now.”

Many states across the country are now working to replicate Maryland’s drug affordability strategy, he said.

Expanding coverage

Legislation to automatically enroll SNAP benefits recipients into Medicaid who are eligible but not yet enrolled was targeted at reducing paperwork and helping an estimated 60,000 uninsured Marylanders get the health coverage they need.

“This is especially important because the COVID-19 Public Health Emergency is ending in May and some currently enrolled people will have to reassess,” DeMarco said. “This will allow people on SNAP and Medicaid to quickly and easily re-enroll and prevent a gap in their coverage. We need federal waivers to do this, but I think it will happen.”

Likewise, the law to extend the health insurance subsidy program for lower-income young adults ages 18 to 34 also helps prevent currently insured individuals from losing coverage.

“We think 46,000 people have benefited from it, including 17,000 newly-enrolled individuals,” DeMarco said. “The next step for the legislature is to study how to make it permanent.”

Immigration question

While coalition members are disappointed the legislature didn’t pass the Access to Care Act to open the Maryland Health Benefit Exchange to residents regardless of immigration status, the study on expanding Medicaid and Children’s Health Insurance Program coverage to all income-eligible Marylanders and expanding subsidies for private health coverage will allow the issue to continue to be discussed.

Lam, who sponsored the Access to Care Act, agreed that the study could be helpful in providing more information on that issue.

“I think that’s what some of the folks who had reluctance to pass this were pointing to,” he said. “On the other hand, I don’t think the depth of the information the study brings back is actually required to move forward.”

The Exchange and Department of Health could simply decide to apply for this waiver without the need for legislation.

“Other states have moved forward that way, including California and Colorado within the last two years,” Lam said. “The intention is to have conversations and discussions with the Department and the Exchange later this year to see if we can still move forward with this initiative without legislation.”

As DeMarco and Lam see the issue, the sticking point over subsidizing health care for immigrants is moot.

“Their option is to go to the Emergency Department where they receive more expensive care with the least best outcomes, and the cost of that uncompensated care is subsidized by covered individuals through increased premiums,” Lam said. “Ideally they would have a primary care provider they can see on a regular basis that keeps them out of the Emergency Department where care is very expensive, helping keep premiums lower for everyone.”

 Affordable health care advocates didn’t get everything they wanted this year, “but it’s significant progress forward,” DeMarco said. “Maryland continues to be at the forefront of making health care affordable for everyone. We will not rest until we go from 6% uninsured to 0%, including covering immigrants.”