It’s been a fascinating CSG/ERC state capitol visit in
Annapolis over the last two days. In meetings with policymakers I’ve heard a
range of opinions and emotions on MD’s insurance exchange – from optimism that
eventually it will start working to calls to scrap it and
revert
to the federal exchange. By all accounts,
the
exchange has not met early expectations that MD would be a national model. Many
legislators expressed anger but some are optimistic that the problems will be
worked out. Yesterday the legislature
passed
emergency legislation to cover people who tried to sign up through the
state’s high risk pool. Policymakers were very interested in hearing about the
experience of other states, Medicaid outreach tools, and eager to get policy
tools that control costs while improving quality.
Most are carefully optimistic about Medicare’s approval
of MD’s new waiver
for all-payer hospital rate setting. Rather than limiting payments by
admission, the new plan places a limit on per-capita growth in hospital costs
(inpatient and outpatient) at 3.58% for the next five years. The new plan does
not change the fundamental entitlement to Medicare and Medicaid and makes no
changes to covered benefits. The plan also includes important goals to reduce
readmissions and preventable admissions. Legislators had lots of questions
about MD’s SIM process and plan expected in the next month.
