Maryland: Single-Payer Commission
Upshot
H.B. 610 and S.B 493 would establish a Commission on Universal Health Care tasked with developing a plan for a state universal health care program for all state residents.
The plan would be required to consider how to incorporate health care equity, reduce health disparities, increase health care access, and advance alternative payment models.
The legislation died in Committee. This was the legislature’s second attempt at advancing such legislation.
Background
Maryland operates a state-based Marketplace and three insurers offered plans in 2022. The state received approval for a reinsurance program in 2019 and also operates an easy-enrollment program, which allows individuals to enroll in health coverage at the time of tax filing. For the 2022 open enrollment period, 181,000 residents enrolled in coverage.
Notably, Maryland is the only state that operates a Total Cost of Care Model, which sets benchmarks for Medicare hospital spending and holds the state accountable for meeting targeted saving amounts. Towards a more incremental approach of improving coverage and access, Maryland has also approved legislation to establish workgroups on insurance subsidies for small businesses and on primary care access and quality
Summary
The legislation, H.B. 610 and S.B 493, calls for the establishment of a Commission on Universal Health Care, which would be required to develop a plan for the state to establish a single-payer system that would provide benefits to all state residents. The single-payer system would be designed to advance the following goals:
Incorporate health care equity as a goal of the plan;
Reduce health disparities; and
Increase health care access, particularly in urban and rural setting with limited access.
Additionally, the program would be required to have the following components:
Accessibility: Provide comprehensive, affordable, and high quality publicly financed health care coverage for all resident of the state in an equitable manner, regardless of income or immigration status;
Benefits: Include a benefit package covering primary care, preventive care, chronic care, acute care, reproductive care, and hospital services;
Leverage Federal Funds: Recommend how to ensure that all federal payments provided in the state are paid to the universal health care program through applicable waivers.
Health Promotion: Contain costs by providing incentives for residents to receive preventive care
Alternative Payment Models: Contain costs by establishing innovative payment mechanisms to health care professionals and reducing unnecessary administrative expenditures.
The plan would also provide a timeline for establishing the program and plans for how to transition from the current system to the universal health care program. The Commission would propose an operating structure for the Universal Health Care Program and estimate cost projections for the program. An interim progress report would be due by June 1, 2023, and a final plan would be due by October 1, 2024. The intended implementation date of the Universal Health Care Program would be July 1, 2025