Health insurance

A simple tool brought Medicare to thousands

This story also appeared in Stateline, an initiative of The Pew Charitable Trusts.

Maryland and Massachusetts, soon to be followed by other states, now allow taxpayers to start purchasing health care coverage on their tax returns, in a bid to lure many residents into low-cost plans or no fees that they may not know they qualify for. .

The effort aims to bring together many of the last Americans – more than 28 million of them – still without health insurance, despite gains achieved by the Affordable Care Act of 2010.

Carmela Peterkin-Wilson, a navigator with the Maryland Health Connection, enrolled a resident in a health insurance plan in 2019. That year, the state passed a law allowing the use of state income tax returns for begin the process of enrolling uninsured Marylanders in health matters. plans. Other states are following suit.

A quarter of those people are eligible for Medicaid, the public health plan for low-income Americans, according to an analysis of uninsured people by the Kaiser Family Foundation. And more than a third could get federal tax grants to help pay at least part of the premiums for private plans.

“Surprising as it may sound, many people are unaware that there are insurance options available for them,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, a state agency that helps enroll residents. “People just survive there. They don’t know what is available to them.

Republican Gov. Larry Hogan enacted Maryland’s first such measure in 2019. For the past two years, Maryland income tax forms have included a box that taxpayers can check off to indicate they don’t. have no health insurance. With the permission of the taxpayer, the state comptroller submits data on household income and family size to the state health insurance stock exchange for possible enrollment in Medicaid or subsidized private insurance. .

The Massachusetts legislature passed a similar measure this year, which will be implemented next year.

Other states are following suit.

Colorado and New Jersey have passed legislation, both with strong bipartisan support, to implement their own easy enrollment plans through tax returns. Colorado Democratic Governor Jared Polis signed the bill. In New Jersey, Democratic Gov. Phil Murphy has said he strongly supports the measure, but has called for some small technical changes, which the legislature is likely to pass next month.

The idea is also gaining ground, be it legislative or administrative, in New Mexico, Pennsylvania and Virginia.

Meanwhile, in Congress, US Senator Chris Van Hollen, a Democrat from Maryland, introduced a bill last month that would put a similar checkbox on federal tax returns.

Van Hollen cited success in Maryland, which has enrolled nearly 7,000 residents in the past two years, according to the Maryland Health Benefit Exchange. The state’s uninsured rate was 6% in 2019, the latest year for which statistics are available. Nationally, according to last year’s census, the percentage of people without health insurance is 8.6%.

President Joe Biden’s Build Back Better bill before Congress would increase federal subsidies for health insurance and make millions more people eligible for Medicaid. Supporters say that a checkbox on federal tax returns would alert many of these taxpayers to their options and get them into medicare plans.

In 2020, the first year of Maryland’s Easy Enrollment Program, 60,645 Maryland taxpayers checked the box indicating they did not have health insurance. The state determined that 53,146 were eligible for Medicaid or a federal tax credit. Of these, 4,015 people, or 7.6%, eventually signed up for a health plan.

This year, 29,020 people checked the box, 27,223 were deemed eligible and 2,962, or 10.8% of those deemed eligible, registered.

“We’re happy with that 10%,” Eberle said. “Although it seems small, it’s 10% more than we would have gotten otherwise. “

Most of the other taxpayers did not respond to the state’s outreach. Nonetheless, Eberle said the information gathered from tax returns could help his office better target its marketing and education campaigns.

Maryland now puts this checkbox on its tax returns to initiate a process to register residents for health insurance. Image Credit: Maryland Health Benefit Exchange

Of those who signed up for health care plans through their Maryland tax return, Eberle said nearly a quarter identified as black and 20% identified as Latino. Over 40% were between the ages of 18 and 34, a group known for its low insurance rates.

Almost three-quarters of new registrants have joined Medicaid. The rest signed up for business plans and about 95% of them were eligible for federal tax credits, Eberle said.

Kentucky has found another way to leverage the functions of a government agency to help increase health insurance enrollments.

Last year, as thousands were made redundant in the first months of the pandemic, the Kentucky Medicaid agency followed up on those who applied for unemployment benefits to enroll them in health plans. . Eric Friedlander, secretary of the Kentucky Cabinet for Health and Family Services, said in an interview that awareness has contributed to an increase of 130,000 people on the state’s Medicaid lists during the pandemic.

Friedlander called Maryland’s easy listing a “great model” that he hopes Kentucky will someday adopt as well. And Eberle said Maryland is also considering leveraging jobless claims for health insurance enrollment.

In Massachusetts, which has the lowest rate of residents without health insurance at 3%, officials have been frustrated by barriers preventing everyone from participating in health plans, said Audrey Morse Gasteier, chief policy officer. and strategy at the Massachusetts Health Connector, the state health service. insurance stock exchange.

“We’ve put a lot of resources and effort into marketing, outreach and community engagement to get people to sign up,” she said. “This remaining 3% is very upsetting to us, and we remain committed to reaching this population.”

With that goal in mind, the administration of Republican Gov. Charlie Baker pushed for a new law that will introduce a program like Maryland’s next year.

The concept of easy enrollment in Maryland originated from the Maryland Health Insurance Coverage Protection Commission, a panel of lawmakers, hospitals, and other providers and consumer advocates that the legislature created to recommend measures to improve access to health care in Maryland.

One of the goals of the commission, said Vinny DeMarco, commission member and chair of the Maryland Citizens’ Health Initiative, was to recoup the remaining 6% of Marylanders without health insurance.

And one way to do it, he said, was to take advantage of residents’ interactions with government bureaucracy, like tax collection agencies.

“The ACA’s success is tremendous, but we have to do the rest of health care for all Marylanders and Americans,” he said.

Stateline is a project of the Pew Charitable Trusts.