Maryland Health Connection: A New Insurance Marketplace

By: Linda Harder

Photography By: Tracey Brown

An Interview with Rebecca Pearce, Executive Director, Maryland Health Benefit Exchange

As this issue went to print, the date to launch enrollment for families and individuals in Maryland Health Connection was looming for Executive Director Rebecca Pearce and her staff. Ms. Pearce talks about how this new service will change healthcare coverage for many, as well as its potential impact on physicians.

Q: What is Maryland Health Connection?

The Health Connection is a new health insurance marketplace designed to make it easier for Marylanders to shop for, compare and purchase quality health coverage. We’re not federal health insurance; we’re the conduit – the “store” – for carriers to put their products on our shelves. A single, streamlined application determines eligibility for Medicaid or private insurance. Consumer assistance will also be available through our call center or in person throughout the state in local health departments, departments of social services and a network of consumer assistance organizations known as “Connector Entities.”   

Q: What was one of your greatest challenges?

Even though Maryland started early compared to many states, we had lots of policy decisions to make. And, we had to set up an entire organizational structure – we started with just me. Today, our state agency has grown to more than 50 people.

Q: Who do you expect will purchase insurance in the Health Connection?

The first year, we expect about 250,000 newly eligible people to enroll, which includes about 100,000 people who will be newly eligible for Medicaid when it expands from 116% to 138% of the federal poverty level. Maryland Health Connection will determine if a person qualifies for Medicaid or commercial insurance. At the end of 2015, we expect that all of the 1.2 million people on medical assistance will use the marketplace.

In Phase 2, our long-term goal is to have the non income-based Medicaid population go through it as well – that is, long-term care, disability and also social services.

We’ve done 12 focus groups around the state. There’s a misnomerthat people don’t want health insurance. We found that people want to have health insurance and want to know that they can see a physician when needed. When we presented them with a price and the value of the insurance they would get through Maryland Health Connection, and what the federal subsidies might be, they were willing to give up amenities like their cable television to get health insurance.

Q: Which insurers are participating in Maryland Health Connection?

Currently, we are working with CareFirst BlueCross BlueShield, Kaiser Permanente, United HealthCare and Evergreen Health Cooperative. The 2011 legislation requires that insurers making a certain dollar level outside of the exchange must participate in Maryland Health Connection. We’re also hoping to see MCOs [Medicaid Managed Care Organizations] starting in 2015; they’ll need to obtain a license first.

Q: Discuss the rates that will be charged under the Health Connection.

Maryland’s rates are among the lowest of the 12 states with approved or proposed rates – on a dollar-to-dollar basis, they’re lower than all but one plan in New Mexico. New York, for example, decreased their rates 50% but they are still higher than ours. And three out of four Marylanders are expected to qualify for federal tax credits.

You can’t do an apples-to-apples comparison to rates in the past year because this is the first year that we will be offering essential health benefits under the new marketplace due to the ACA. Because of self-selection, the individual market has historically had a lean set of benefits. It’s like comparing buying a hatchback to buying a sedan.

Everyone is hoping the marketplace will attract younger people. They are often overlooked as the people who will get subsidies through the marketplace, but because many of them are not making large salaries, they will benefit. The federal subsidies apply to individuals making up to $44,000 a year. Someone making the federal poverty level of about $22,000 will pay a maximum of 6.5% of their income, or about $114 per month, out of pocket for insurance because the federal government is giving subsidies.

We don’t control the fee schedules that carriers pay providers, but they should be similar to other fee schedules.

Q: For physicians who run small businesses, what are the options and requirements?

The Small Business Health Options Program (SHOP) will open in January 2014 and provide small businesses a choice of quality insurance plans and carriers. Companies with up to 50 employees are eligible, but not required, to purchase insurance through Maryland Health Connection. There is no penalty for employers of this size. And the federal government just said that there is no penalty for any size employer in year one.

Employers can only access federal tax credits if they purchase coverage through SHOP beginning in 2014. Our website includes a Small Business Tax Credit Calculator to help them determine if they qualify for a tax credit for providing insurance for employees.

Q: Will those using Maryland Health Connection be able to see their doctor?

In fact, we created the ability to search online for a list of participating health plans by doctor. You can bring up all of the plans that include your doctor. We’re the only place you can do that.

Q: How will providers be affected?

We would love to partner with the physician community; we recognize that they’re going to be touching the people we’re bringing in. We want to understand from them what they are seeing. They may see an influx of people who may not be used to using primary care. So there may need to be some education on their part – for example, they may see a 40-year-old who has used ERs, not a primary care physician, to date.

We are working directly with FQHCs [Federally Qualified Health Centers] and community providers, and especially the mental health providers to let them know that, as people get insured, they need to contract with the carriers in Maryland Health Connection, and here’s what you need to do to change your business model. And we’re talking to the carriers as well. We’ve been trying to bridge that gap between those two sets of providers. And the governor’s office is working to address provider shortages.

Q: How will you educate and enroll the 180,000 people that you anticipate?

We have multiple ways to enroll people. The first way is through insurance brokers. About 1,500 insurance brokers in the state have provided notice of their intent to use our Health Connection. They have to be licensed by the Maryland Insurance Administration to participate, and authorized by us to sell through Maryland Health Connection. With about 180,000 newly insured people, it’s a growth opportunity for brokers. We’ve been partnering with them since 2011 – we want to supplement them, not replace them.

We also are establishing a customer support center with a toll-free number, and we awarded grants to six consumer assistance organizations (Connector Entities) state wide to provide individual enrollment assistance. They will reach the underserved and hard-to-reach populations, including those with disabilities.

We’re hiring a total of 300 people to provide in-person assistance; 150 of whom are navigators who provide education and outreach, as well as enrollment in both Medicaid and qualified health plans. The remaining 150 people are known as assisters; these individuals also conduct education and outreach. They can also enroll people in Medicaid, but not private insurance.

We are also working with the Department of Health and Mental Hygiene and Department of Human Resources to train the caseworkers and eligibility workers in the local health departments and departments of social services state wide. These 2,500 people, who currently enroll people in Medicaid, will receive in-depth training on the use of Maryland Health Connection and enrollment.

We just received our final funding, and contracts started July 1, 2013. In August we’re training staff, then they’ll hit the street around September, and about the same time we’ll be rolling out a state-wide advertising multi-media campaign. We’re also receiving requests to speak at hospitals and medical societies.

Q: How has your experience on the insurance side been helpful?

Having knowledge of insurance programs has been hugely helpful in my current role. I understand how people purchase insurance and what’s important to them. At Kaiser Permanente, I spent lots of time negotiating and facilitating the communication between employers, insurers and doctors, and getting all of the stakeholders to agree upon what benefits would provide the best solution for a group’s employees. 

Q: How has being a woman affected your career?

I discovered early on that you have to make decisions based on facts, not feelings. I realized that people make decisions in business based on data. I’m often the only woman in the room, and I’m leading meetings with male CEOs, many of whom head multi-million-dollar companies. There have been weeks on end when I haven’t been home in time to put my daughter to bed. I couldn’t do this job without having an understanding husband and family.

Q: Will you be able to relax a bit once enrollment begins?

I tell people that we’re racing to the start, not the finish. Open enrollment runs for six months.  After October 1, we need to be focused on how to make what we put in place for the start better, and make sure we have as many Marylanders enrolled by March 31 as possible. 

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