ANNAPOLIS – Maryland children’s advocates fear a new law that takes effect July 1, will hurt a successful health program for the state’s poor children and pregnant women and force many of them to go without coverage.
The Maryland Children’s Health program was designed to extend health coverage to low-and moderate-income families who do not qualify for Medicaid but cannot afford traditional health insurance.
Comprehensive health services are provided to children until they are 19 and to all pregnant women whose family income is at or below 200 percent of the federal poverty level.
About 44,000 children and expectant mothers have enrolled in the program since last July.
“(That) goes beyond the most optimistic forecast we could have made. We are beyond what we expected and are doing a great job of providing outreach,” said John Folkemer, director of health services analysis and evaluation for the Department of Health and Mental Hygiene.
But Folkemer, and others believe the new law, which requires families with incomes between 185 and 200 percent of the federal poverty level to pay a premium and move off the program and into a private insurance plan, will do more harm than good.
On Tuesday, a Senate bill to repeal both provisions will be heard in the House Economic Matters Committee, which has already killed a House version.
Last year, the General Assembly approved the health program after a political struggle between the two chambers. Senate members wanted to include as many poor families as possible; House members wanted individuals with some income to contribute a share of the costs.
Ultimately, a compromise was reached. The first year, the Senate model was followed. But in the second beginning July 1, families with the targeted incomes – $30,895 to $33,400 for a family of four – will be required to pay a yearly contribution, or premium, equaling 1 to 2 percent of their total annual family income.
They also will be required to move off of the health program and into a private insurance plan offered by an employer or an individual health plan that meets federal and state requirements. There are about 3,000 Maryland children who fall within the targeted income level.
Bobbie Seabolt, executive director of the American Academy of Pediatrics, worries the new law presents a serious obstacle to program’s progress.
“If a premium is introduced, we’re afraid people will not enroll in the program or will drop out because they cannot afford to pay,” she said.
But more pressing is a lack of availability of private insurance, according to Sen. Thomas Bromwell, D-Baltimore County, who introduced the Senate bill. No private companies are bidding to be a part of the plan.
“This private insurance option is not working. We can’t tell people they have to go to private insurance when the private insurance isn’t there,” Bromwell said. “What I’m concerned with is what will happen to those 3,000 kids who have to leave the program for private insurance.”
Children who sign up for the program by June 30, 1999, won’t have to switch to a private plan because of a grandfather clause, Folkemer said. Those children not covered by the clause will remain in the program until a private insurance company is found.
The reason private insurance companies have shied away from the plan is because of mandates, such as providing a comprehensive wellness care package and restrictions on charging families a deductible or co-payment, according to Deon Johnson, a lobbyist for Golden Rule Insurance Co., an indemnity company based in Illinois.
The mandates, Johnson said, would simply cost insurers too much money for such a small group of people to cover.
“Our position is if these changes are made, we think several carriers in the market, including Golden Rule, would take a serious look at the private sector option. Without changes, it’s not advantageous for us to get involved,” he said.
Despite these setbacks, Delegate Michael P. Gordon, D-Montgomery, vice chairman of the House Economic Matters Committee, and other House members want their agenda met. Gordon said Bromwell’s bill likely will be killed. State Department of Health and Mental Hygiene Martin P. Wasserman, said he hopes that doesn’t happen. “My absolute concern is that we will lose people if (Bromwell’s) bill doesn’t pass and that will be most unfortunate,” Wasserman said. “If it (fails), we will follow the law and know what steps that will have to be taken for implementation. I hope it doesn’t come to that, though.”