DOVER – A Senate resolution introduced today could ultimately help Delaware become the first state to implement a “public option.”
Senate Concurrent Resolution 70, sponsored by Senate Majority Leader Margaret Rose Henry, D-Wilmington East, would create a study group to evaluate the particulars of a Medicaid Buy-In program for roughly 24,000 health care consumers in Delaware’s individual marketplace.
While many states, including Delaware, offer Medicaid buy-in programs, those programs are narrowly available to specific groups of health care consumers, such as working adults with disabilities. No state currently offers a broader Medicaid buy-in option for middle class consumers, although the State of Nevada recently came close.
Sen. Henry, who is retiring at the end of the 149th General Assembly, says her legislation could be the beginning of a leap forward on health care in Delaware.
“Health care is a human right. The question is how we can deliver it,” said Sen. Henry. “Being a small state can be a challenge, because we’re sometimes at the mercy of national politics and a global economy; but being a small state is an advantage when it’s time to innovate.”
“Creating a public option by letting anyone pay for Medicaid could be a game-changer for thousands of young adults, working people, and middle class families, and over the long run it could save us money. I’m proposing a study group because this issue deserves more than lip service. If we take the time to develop a serious policy, Delaware has a real opportunity to be a pioneer on health care and to help thousands of people in the process.”
A recent KFF poll shows national support as high as 75 percent for the concept of a public option.
The study group would be charged with evaluating potential buy-in models for consumers whose incomes are too high to qualify for the Affordable Care Act’s Medicaid expansion. That evaluation would include levels of coverage, eligibility criteria, positive and negative consequences of a potential implementation, and premiums that the State would need to charge in order to keep its Medicaid budget stable.
SCR 70 also allows the Governor and the Secretary of Health and Social Services to apply for an innovation waiver under Section 1332 of the Affordable Care Act to implement a Medicaid buy-in program, including possible approval of federal premium tax credits to defray premiums for buyers between 138 percent and 400 percent of the federal poverty level.
“Having access to affordable health insurance is the most important connection to quality health care we can provide,” said Department of Health and Social Services Secretary Dr. Kara Odom Walker, a board-certified family physician. “I am committed to exploring options for Delawareans who get their coverage through the Health Insurance Marketplace, because I am worried that rising premiums will force many of them to go without insurance. That’s when people start to put off doctor visits, use the emergency room for primary care, and end up with more involved illnesses and injuries that need extensive treatment to get them back to good health.”
Highmark Delaware, currently the only commercial insurer available on Delaware’s individual marketplace, increased individual marketplace premiums this year by 25 percent.
Above and beyond providing a coverage alternative that is affordable for consumers, Medicaid’s record of cost-effectiveness could have an important impact on the broader health care economy in Delaware, where health care expenditure growth was the nation's fourth-fastest from 1991 to 2014 (7.2 percent).
Data from the Centers for Medicare and Medicaid Services shows that from 1987-2015, Medicaid spending per beneficiary grew by only 4.1 percent, compared to 6.9 percent for private insurance in the same period. The Urban Institute reports that an average adult on Medicaid costs about 22 percent less than one covered by private insurance, despite an essentially identical likelihood of receiving health care.
“Delaware Medicaid is a very well-run program, providing high quality medical coverage to our state’s residents helping those with disabilities, who are low-income, or who have exhausted their assets and require nursing home care. As this legislation notes, it’s so well run that its per person cost is most often notably lower than private insurance,” said House prime sponsor Rep. Paul Baumbach, D-Newark. “This task force would examine the advantages, disadvantages, and process to make Delaware’s Medicaid program available to Delaware residents at cost. This helps our residents, reduces the expensive cases of uninsured residents by leveraging our successful Medicaid system.”
"Medicaid buy-in offers a unique path forward for progressive state health care reform, offering people affordable coverage with comprehensive benefits. Delaware is playing a critical role in advancing our health care system by studying this issue. Medicaid may represent the future of the American health care system - and Delaware will be on the front lines of building that future," said Ari Ne'eman, a national policy expert on Medicaid and CEO of MySupport.com.
If the Senate and House pass SCR 70, the Medicaid Buy-In Study Group will be required to hold its first meeting by September 10, 2018. A final report on the group’s findings and recommendations would be due to the Governor and the General Assembly by January 31, 2019.