ROCKVILLE, Md. — Maryland is trying a unique solution to a common problem: how to get thousands of Medicaid-eligible state residents enrolled in the Medicaid program.
The state currently has 50,000 residents who are eligible for Medicaid but haven’t signed up for various reasons, state senator Brian Feldman (D-15) said here at a town hall Thursday evening. In addition, another 170,000 uninsured Marylanders are eligible for either low- or zero-premium health plans through the state’s Affordable Care Act (ACA) insurance exchange.
State lawmakers originally wanted to incentivize these residents by requiring them to either sign up for some form of insurance — if they weren’t eligible for Medicaid — or pay a penalty, but didn’t want the state to keep the money, or to have the penalty be seen as a punishment, Feldman said. Instead, “we were going to let you use those same penalty dollars as a down payment to purchase health insurance for you and your family.” That idea “took off, but at the end of the day, there were some logistical challenges, so we decided to scale it back a little bit.”
They came up with another idea: residents who agree — by checking a box on their state income tax return — to share their income information with the state will have that information analyzed to see whether they are eligible for either Medicaid or for federally subsidized private coverage through the ACA exchange. “So about 200,000 people, by checking a box and sharing their financial information … for little or no cost, will get health insurance,” Feldman said. And since the state also will save money on uncompensated care, “it’s in everybody’s interest to get as many people on the insurance rolls as possible,” he added.
That bill passed in the state legislature — including a unanimous vote in the state senate — and was signed “enthusiastically” by Maryland governor Larry Hogan (R) last week, Feldman said. “So there are things in the healthcare space you can achieve on a bipartisan basis.”
Drug Price Commission
State lawmakers also passed a law in their most recent session to create a new commission to set drug prices in the state, explained State Delegate Joseline Peña-Melnyk (D-21). “People are making decisions every month whether to pay their rent or mortgage, buy food, or buy prescription drugs. We’re not saying pharmaceutical companies cannot make a profit — [especially since] they spend a lot of money on development and research — but when you look at our [drug spending] compared to other countries, we’re subsidizing [them],” she said. “Are we fools? Something is wrong with that picture. Since the federal government is not acting … states are the ones that are acting.”
Maryland’s new Prescription Drug Affordability Board would look at the pharmaceutical distribution and payment system, as well as policy options implemented in other states and countries, said Peña-Melnyk, who noted that the drug industry hired 11 lobbyists and spent $1 million in an unsuccessful attempt to kill the legislation. The bill would go into effect this year, but the board would not start its work until 2022, she said.
The board would review drug prices in the state for medications that meet one of the following criteria, Peña-Melnyk said:
- New brand-name drugs that cost $30,000 or more annually per course of treatment
- Existing brand-name medications whose price increases by $3,000 or more in the course of a year or a course of treatment
- Existing generic medications whose prices increase by 200% or more per year or course of treatment
- Any prescription drug that creates an affordability challenge to the healthcare system, including for patients
“Let’s be clear; we’re not controlling the price,” she said. “We’re not telling pharma … ‘This is what you can charge in Virginia and Delaware’; we’re just saying that in Maryland, this is what we’re willing to pay.” Lawmakers sought an opinion from the office of Maryland Attorney General Brian Frosh (D) before passing the bill and were told that because it would only apply to Maryland, it would not violate the Commerce Clause in the Constitution, which covers only interstate commerce, she said. Hogan, the governor, has until the end of May to sign the law authorizing the board, veto it, or let it become law without his signature.
The legislature also voted to preserve pre-existing condition protections for Marylanders even if the Affordable Care Act is eventually overturned in the courts, and the state’s new healthcare commission is planning to consider a single-payer “Medicare for All”-type program in the state, Peña-Melnyk added.
Opioid Lawsuit Filed
Frosh also spoke at the town hall; he discussed a lawsuit he filed Thursday along with four other attorneys general against members of the Sackler family, which owns Purdue Pharma, the maker of oxycodone (OxyContin). “They have, along with some other manufacturers of opioids, managed to change the medical culture about painkillers,” beginning back in the 1980s when they convinced people that opioids were not addictive, he said.
Now, with the opioid crisis, “in at least four counties in Maryland, in the last year for which we have statistics, there were more prescriptions written for opioids [in a single year] than there were people in those counties,” he said. “And not surprisingly, we have seen opioid deaths skyrocket … The sale of OxyContin and other [opioid] medication contributed to this in large part, [as] we allege in our complaint.”
Congressional Democrats Make Their Drug-Pricing Move
Rep. Jamie Raskin (D-Md.), who organized the town hall, arrived late, explaining that he had come from Capitol Hill where the House had just passed — along party lines — a package of bills addressing both drug prices and healthcare reform. The first part of the package included the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, which would require brand-name drugmakers to provide samples of their products to generic manufacturers seeking to develop a generic version of a particular drug.
The House also passed the Protecting Consumer Access to Generic Drugs Act, which prohibits “pay for delay” deals in which a brand-name drug company pays a generic manufacturer money to delay the entry of a generic version of a particular drug into the market. “We’re basically trying to build a real market in prescription drugs so there will be access to entry and won’t be blockades for [generic] companies trying to get in,” Raskin said.
Although many Republican house members were on board with the drug-related bills, they were not as happy, he added, with two other bills included in the package: one to restore funding for outreach and marketing for the Affordable Care Act’s health insurance exchanges — funding that was cut by the Trump administration — as well as a measure to rescind the administration’s expansion of short-term, limited-duration health insurance plans, which are exempt from including many of the benefits required under the ACA. “Those last several measures … were too much for my Republican colleagues,” Raskin said.
The package of bills will now move to the Senate, where chances for consideration or passage are unclear. Senate Majority Leader Mitch McConnell (R-Ky.) has been moving very few bills in recent months, according to press reports, concentrating instead on confirming conservative judges for the federal circuit.
Source: MedicalNewsToday.com
