5 Things Maryland: Prescription Drug Affordability Board, What You Missed, Proposed rate increases

While DJ is out of office chasing a much deserved vacation, I’ll be bringing you this edition of 5 Things We’re Watching. I’m the managing editor here at State of Reform where I have my eye on health care in Maryland and a number of other states.

In this edition of 5 Things, we bring you some of the great conversations and keynotes that took place at the 2021 Maryland State of Reform Health Policy Conference last month. In case you weren’t able to join us, take a look at our What You Missed video to get a sense of the sights and sounds from the event.

And, feel free to email me any feedback or tips on what you think we should be covering. We always appreciate hearing from our readers and the work they are up to.


Emily Boerger
State of Reform

1. The ACA ruling in context

This week, the US Supreme Court found that states arguing for the repeal of the ACA lacked standing. In what DJ writes as “a stroke of unintended irony,” by zeroing out the individual mandate, Congressional Republicans undermined the case by Republican AGs. With the penalty at zero, Justice Breyer writes “Neither logic nor evidence suggests that an unenforceable mandate will cause state residents to enroll in valuable benefits programs that they would otherwise forgo.”

This marks the third edition in the “trilogy” of cases brought to repeal the law, each perhaps a uniquely creative ruling. The NFIB case in 2012 said the penalty was not a penalty but a tax, therefore within Congress’s power. It also re-wrote policy to make Medicaid expansion voluntary rather than required. The King v Burwell case said the federal government was really like a state, so it too could deliver marketplace subsidies otherwise expressly reserved for the states. And in this case, Texas v California, the Court chose to set aside questions of Constitutionality by stopping at the procedural step of standing.

The ACA has at least three lives, having dodged (most of) each of these threats. We’ll see if there is a fourth test to come.


2. Q&A: Prescription Drug Affordability Board

Dr. Andrew York is the Executive Director of the Maryland Prescription Drug Affordability Board, which is tasked with “protecting Marylanders and the Maryland health care system from the high costs of prescription drug products.” In this Q&A, Dr. York offers an update on policies the board is exploring to lower prescription drug costs, and where their work will take them in the latter half of 2021.

Dr. York says one of the biggest challenges in lowering the costs of drugs is the complexity of the supply chain. “Navigating a very complex supply chain and very engaged stakeholders with their own priorities – I think it’s going to be pretty interesting.” He says the board will look at existing policies in other states to see how they might apply to Maryland, but he anticipates considering “completely novel ideas and policies.”


3. What you missed at this year’s conference

We captured a lot of great content at our 2021 Maryland State of Reform Health Policy Conference, which is now available for your review. In one highlight from the day, our “Opportunities to maximize the waiver model in Maryland” conversation hosted four experts talked through how best to continue to improve on Maryland’s model of care and where efforts at system improvement will yield the best returns.

We’ve made available the full video of our “Addressing Racism as a Public Health Issue” panel which touched on a wide range of issues including the social determinants of health, maternal health, the health care workforce, and access to care. We also have coverage of our “Regulations & Reimbursement: Is telehealth here to stay?” panel where attendees got an update on efforts to expand and improve telehealth services in the state.

4. MIA announces 2022 proposed premium rates

The Maryland Insurance Administration (MIA) announced last week carriers have requested an average rate increase of 3.5% in the Individual Non-Medigap market, ranging from a 7.3% decrease to a 7.9% increase. In a statement, Insurance Commissioner Kathleen Birrane says: “Though this year’s filings seek an average increase of 3.5% in the INM market, rates in that market as filed would still be down by -30.8% over the four-year period from 2018 through 2022 (filed)” due to the state’s reinsurance program.

Carriers in the Small Group market requested an average rate increase of 7.2%, with averages by carrier and product ranging from a 22.5% decrease to a 16% increase. MIA says “across all markets, rate adjustments by carriers to account for COVID-19 ranged from zero to 14.1%.” MIA will host a public hearing on the proposed premium rate changes on July 20, and is expected to issue a decision on rates and products no later than Sept. 7, 2021.


5. Video: Keynote conversations

Be sure to also check out our Morning Keynote conversation with US Sen. Chris Van Hollen on Maryland’s economic recovery and the health policy conversations taking place in his caucus and in the Senate Budget Committee. Van Hollen says he thinks Congress needs to focus on creating a public option within the ACA and making the new premium tax credit supports permanent.

During our Afternoon Keynote, we hosted a conversation focused on how different silos in Maryland’s health care system can center health equity in their work. The conversation, which featured insights from Del. Joseline Peña-Melnyk, Dr. Letitia Dzirasa at the Baltimore City Health Dept., Dr. Mohan Suntha at the University of Maryland Medical System, and Brian Pieninck, CEO of CareFirst BlueCross BlueShield, is available to watch here.