What's Re-insurance About? Five Key Points

The State of Maryland has approved re-insurance legislation for the purpose of stabilizing the individual insurance market. What does this mean for taxpayers, and what does it mean for the future of healthcare in Maryland?

1. Without interference, the individual market will collapse.

There are two insurers left on the individual market, down from eight. Kaiser makes up a third of Marylanders insured in this way, with CareFirst covering the remainder. Because of pent-up demand and an economic incentive for healthier consumers to forgo coverage and pay a fine, the individual market has a higher risk population. Premiums on the individual market have been exploding, and it is now at risk of failure. Were the individual market to fall apart, the number of uninsured Maryland residents (currently at 7%) would increase. Maryland’s Medicare waiver, which allows for higher hospital rates, would also be at risk.

2. A bipartisan bail-out of private insurers, paid for by taxpayers.

Under SB387 (Individual Market Stabilization Maryland Healthcare Access Act of 2018), which has now passed, Maryland would pay insurers for the costs of individuals’ medical experiences between $100K-250K (Corridor). A similar plan was originally part of the ACA but was phased out.

To stabilize premiums in the individual market, Maryland estimated it would need $350 million annually. Insurers in the Maryland Health Benefits exchange have been paying a federal tax (2.75% of premium revenues) to cover the cost of running the exchange. For 2019, the federal government put a moratorium on this tax. SB387 institutes a state tax that will collect these revenues from private insurers and Medicaid MCOs and directs the money to a re-insurance fund. 

1. Without interference, the individual market will collapse.

There are two insurers left on the individual market, down from eight. Kaiser makes up a third of Marylanders insured in this way, with CareFirst covering the remainder. Because of pent-up demand and an economic incentive for healthier consumers to forgo coverage and pay a fine, the individual market has a higher risk population. Premiums on the individual market have been exploding, and it is now at risk of failure. Were the individual market to fall apart, the number of uninsured Maryland residents (currently at 7%) would increase. Maryland’s Medicare waiver, which allows for higher hospital rates, would also be at risk.

2. A bipartisan bail-out of private insurers, paid for by taxpayers.

Under SB387 (Individual Market Stabilization Maryland Healthcare Access Act of 2018), which has now passed, Maryland would pay insurers for the costs of individuals’ medical experiences between $100K-250K (Corridor). A similar plan was originally part of the ACA but was phased out.

To stabilize premiums in the individual market, Maryland estimated it would need $350 million annually. Insurers in the Maryland Health Benefits exchange have been paying a federal tax (2.75% of premium revenues) to cover the cost of running the exchange. For 2019, the federal government put a moratorium on this tax. SB387 institutes a state tax that will collect these revenues from private insurers and Medicaid MCOs and directs the money to a re-insurance fund. 

1. Without interference, the individual market will collapse.

There are two insurers left on the individual market, down from eight. Kaiser makes up a third of Marylanders insured in this way, with CareFirst covering the remainder. Because of pent-up demand and an economic incentive for healthier consumers to forgo coverage and pay a fine, the individual market has a higher risk population. Premiums on the individual market have been exploding, and it is now at risk of failure. Were the individual market to fall apart, the number of uninsured Maryland residents (currently at 7%) would increase. Maryland’s Medicare waiver, which allows for higher hospital rates, would also be at risk.

2. A bipartisan bail-out of private insurers paid for by taxpayers.

Under SB387 (Individual Market Stabilization Maryland Healthcare Access Act of 2018), which has now passed, Maryland would pay insurers for the costs of individuals’ medical experiences between $100K-250K (Corridor). A similar plan was originally part of the ACA but was phased out.

To stabilize premiums in the individual market, Maryland estimated it would need $350 million annually. Insurers in the Maryland Health Benefits exchange have been paying a federal tax (2.75% of premium revenues) to cover the cost of running the exchange. For 2019, the federal government put a moratorium on this tax. SB387 institutes a state tax that will collect these revenues from private insurers and Medicaid MCOs and directs the money to a re-insurance fund. 

Screen Shot 2018-04-23 at 5.14.51 PM.png

3. This plan only works for 2019. 

SB387 is emergency legislation and was negotiated by Governor Hogan, Speaker Mike Busch, and Senate President Mike Miller. Maryland intends to apply for a re-insurance waiver for 2020. But this approach is extremely risky. The federal government was encouraging states to apply to CMS for 1332 re-insurance waivers under the ACA in early 2017 - but approval time has been longer than promised. The guidelines for these waiver are: no increase to federal deficit, must maintain comprehensive coverage, no decrease to the number of insured, and no increases to premiums. So far, the CMS has only given out three re-insurance waivers: Alaska, Minnesota, and Oregon. CMS has put off other states and Minnesota’s waiver caused them to lose $375 million in pass through funding.

4. Maryland’s re-insurance plan showcases the failures of the individual marketplace.

This legislative session, the “Improve the Affordable Care Act” camp was initially divided into two approaches. The first, proposed by civil society groups closely connected to the center of the Democratic party, argued that the reason for higher premiums was that healthy people were not being punished enough for not buying insurance and called for a re-instatement of the mandate penalty. Healthcare is a Human Right took a firm stance against this bill, with Anne Arundel County chapter leader Robert Smith testifying that his income couldn’t provide for the costs of a monthly premium - and that the suggestion that this made him a selfish non-contributor to the general welfare of Maryland’s risk pool was an insult to many people in the state who haven’t been able to buy into the marketplace. The real problem, as we all know, is our for-profit healthcare system.

The other approach - the re-insurance plan - was introduced more quietly, with many decisions made in back rooms and without public input. Co-written by the two insurers that remain in the individual market, the re-insurance plan deserves a great deal of public scrutiny as industry-funded politicians continue to assert that the shortcomings of the Affordable Care Act can be fixed. 

5. Public hearings offer an opportunity to spread the message that the only way forward is Medicare for All.

The state has announced four public hearings in April and May. We encourage our members and supporters to attend these hearings to make the case that this is a last-minute solution from a political class that is out of ideas, and that pretending that the status quo is sustainable puts many people at risk after it runs its course in 2019 - in addition to the 70% of Marylanders already insured. We deserve better - we deserve Medicare for All.

EASTON - THURSDAY, APRIL 26, 5-6PM
Talbot Co. Dept. of Parks and Recreation (Chesapeake Room), 10028 Ocean Gateway

BALTIMORE - THURSDAY, MAY 3, 4-5PM
Maryland Health Benefit Exchange, 750 E. Pratt St, 6th Floor

FREDERICK - MONDAY, MAY 7, 3-4PM
Frederick County Local Health Dept, 350 Montevue Lane

WHITE PLAINS - THURSDAY, MAY 10, 5-7PM
Charles County Local Health Department, 4545 Crain Highway

 

For more information:

hchrmaryland@gmail.com
brittany@hchrmd.org or 410-310-4589
www.hchrmd.org

“You can’t just show up for the Claire Huxtables of this world”: Facing Black Women’s Maternal Mortality

DZUNZ2WVQAAXiSf.jpg-large.jpeg

Researchers and advocates for Black women’s maternal health have been sounding alarm bells for years. Their message reached critical mass at the start of 2018, when two back-to-back events propelled this issue into the media spotlight. First, the death of 27-year-old activist Erica Garner – daughter of Eric Garner, who was murdered by the NYPD –  four months after the birth of her second child. 

Rachel Cargle of the State of the Woman newsletter remarked at the time that Erica Garner “fought hard not only against a system of racial inequality within our justice system but she bore the weight that so many in the US do and that is being a woman of color in the healthcare system.”

Commentators looked to Erica’s asthma, trauma, class background and her status as a survivor of domestic violence as causal explanations for her death. Then, less than two weeks later, a profile of Serea Williams in Vogue revealed that she nearly died after giving birth to her daughter. After experiencing a shortness of breath that she believed was caused by a pulmonary embolism, Serena had to plead with doctors and nurses for the CT scan and heparin drip that ultimately saved her life. 

Writing for Quartz, Annalisa Merelli commented that “even Serena Williams… is just another black woman when it comes to being heard in the maternity ward – and when it comes to being dismissed.” 

Maternal mortality and morbidity are on the rise in the United States, to which the World Health Organization has assigned a higher maternal mortality ratio than Kazakhstan and Libya. On top of this, Black mothers are 243 percent more likely to die within a year of giving birth than white mothers. A 2016 publication by Black Mamas Matter identified poverty, quality of care, access to care and racial discrimination as causal factors of this disparity. 

Last week, I attended a seminar hosted by the African American Policy Forum titled “From Birth Control to Death: Facing Black Women’s Maternal Mortality”. It was the final event in #HerDreamDeferred, a week of action on the status of Black women in Washington, DC. With a panel moderated by Kimberlé Crenshaw that included some of the top experts and activists from across the country, there was a lot of catching up to do.

Catholic Hospitals and Maternal Mortality

The failure of Catholic hospitals to provide adequate care for Black mothers was one of the biggest themes of the afternoon. Laurie Bertram Roberts, Executive Director of the Mississippi Reproductive Freedom Fund, started off by telling her own story. Roberts went into her local hospital with a discharge and was told she was having a miscarriage. Because of the existence of a fetal heartbeat, the hospital sent her home. She began hemorrhaging and returned to the hospital, where she received the surgery she needed to live.

Roberts was lucky, as was Tamesha Means, who went through a similar experience at a Catholic hospital in Michigan. As an Irish American and a recovering Catholic myself, I came into the seminar mindful that two days earlier, the Republic of Ireland had set a date (May 25) for a referendum on repealing a constitutional ban on abortion. The main driver towards this was the 2012 death of Savita Halappanavar, a 31-year-old dentist from India who suffered a sepsis-induced heart attack after her medical team first failed to diagnose a blood infection and then denied her abortion because of a presence of a fetal heartbeat – even though a miscarriage was inevitable. If the referendum passes, it will be celebrated as the beginning of a new era in Ireland for women’s rights. But that victory will always be tainted with its own original sin: the double disadvantage that Savita faced as a woman of color in a Catholic country. 

How is it that in the 21st century, we still see reproductive justice constricted by religion? As Roberts put it, “If you don’t have autonomy over your own body, there’s no birth justice. It can’t be separated out”. 

 Image: Brittany J. Burnam

Image: Brittany J. Burnam

Kira Shepherd is the Director of the Racial Justice Program at Columbia Law. She gave an overview of Ethical and Religious Directives (ERDs) that restrict reproductive services in Catholic hospitals. The ban on sterilization procedures stuck out, considering the disproportionate rates of sterilization, often without consent, that were experienced by Black and Brown women after the procedure was introduced in the 20thcentury. Even as recently as 2010, California prisons were illegally sterilizing female inmates

The unavailability of this procedure to women seeking care at religious hospitals adds insult to injustice, as women of color rely disproportionately on Catholic hospitals in comparison to white women. Shepherd spoke of a study in showing that while half of all women in New Jersey of reproductive age in the state are Black or Latinx, they represent an overwhelming 80% of births at Catholic hospital. That same study found that women of color accounted for 75% of births in Catholic hospitals in and 48% in non-Catholic hospitals in Maryland.

Many Catholic hospitals aren’t even advertised as such, meaning that women who enter them seeking care are often unaware of the restrictions on the type of care they can receive. According to Roberts, who had spoken about her own experience of nearly dying from her miscarriage, “I didn’t know it would be different in a Catholic hospital. I know so many women in my position who also don’t know. And then there’s being uninsured. Poor Black women internalize that this is the sort of trauma we have to take”. 

The next speaker, Dr. Joia Crear-Perry, is the President of the National Birth Equity Collaborative. She revealed that the only Medicaid providers in some states are Catholic hospitals. “They are using us for profit”, she said. Roberts later cited statistics from the Mississippi state government showing that in some majority-Black areas like Jackson, 83% of mothers were receiving C-sections. The World Health Organization recommends a maximum rate of 15%. Mortality rates for Black women in the state are still 70% higher than white women. 

Misogynoir in America’s Healthcare System

Misogynoir – a word that describes the intersecting experience of racism and sexism faced by Black women – also marks its presence in our healthcare system through a series of discriminatory and punitive policies and laws, along with the substandard level care that they often receive due to provider bias. Even Black mothers who are college educated experience a higher maternal mortality rate than women of all other races who never finished school. 

Jennie Joseph, midwife and CEO of The Birth Place, drew attention to the need for medical providers to receive antiracist training, citing a study that found a widespread belief among medical providers that Black people can endure higher thresholds of pain. “It’s about understanding the impact of your bias. Without looking at racism as part of it, we’re going in these circles where we’re not getting to solve the problem”. Joseph added that providers struggle as well, pointing to burnout, which “often overruns the good intentions that people bring to medical professions in the first place”. On top of this, providers who are Black women struggle to navigate the need to “have it all” as women of color.

The conversation turned towards how the War on Drugs has punished and incarcerated Black mothers. According to Dr. Perry, “Black women are judged more on what we’re putting into our bodies than what we’re putting into our communities”. The difference between the reporter-led witch hunt against “crack mothers” in the 1980s that was used as an excuse to escalate the War on Drugs with the more empathetic coverage of the effects of opiate abuse on white mothers today stands out.

Meanwhile, the rise of state laws that criminalize women who suffer miscarriages intersects with Black women’s poor access to birth control, abortion and other critical services to create a perfect storm. Aarin Michele Williams of National Advocates for Pregnant Women chimed in: “We’re helping people defend women who have abortions and women who have children at home. And if their home birth results in a miscarriage or stillbirth, they are prosecuted and robbed of their lives.”

Despite its in-depth evaluation of the intersecting oppressions faced by Black mothers in the United States, the panelists’ concluding mood was overwhelmingly positive and hopeful. Jennie Joseph, who runs a midwifery practice for Black mothers, said that this “is generational work we're going to have to do. We can start community-based work sooner than we can get any larger organizational to do anything besides a quick training." Roberts, who is part of the Black Mamas Matter Alliance, shared photographs of a new birthing center she was opening in Mississippi. “You can’t just show up for the Claire Huxtables of this world”, she said. “You’re either with mamas, or you’re against mamas.”

The Black Mamas Matter Alliance is preparing for #BlackMaternalHealthWeek starting next week. Click here for more information.

1497564279487.jpeg

Brittany Shannahan is the Statewide Organizer for the Healthcare is a Human Right Campaign. An educator, social scientist, and historian, Brittany has been involved in a variety of social movements in the US and the UK since 2009. 

6 Lessons from the UK Election for National Improved Medicare for All

The results of the UK general election are telling for our fight for single payer healthcare and how we’re going to win.

Britain had mass youth riots before us, the biggest anti-government resistance movement since the 60s before us, Conservative victories in 2015 and then Brexit before Trump. What happened last night says a lot about the future of politics in this country. They’re also very telling for what lies ahead in the fight for single payer healthcare and how we’re going to win. Here are six key takeaways from the 2017 UK General Election for our movement:

Call Senator Sanders: We need a Senate Companion to HR-676

At Healthcare is a Human Right Maryland, we are excited that Senator Bernie Sanders has promised a Medicare for All bill in the Senate. As an organization that has participated in single payer advocacy for many years, HCHR-MD strongly urges Senator Sanders to pursue the strongest bill possible, as companion legislation to HR-676, National Improved Medicare for All. In addition, we urge Senator Sanders to act quickly in introducing this legislation, and to not delay while the Senate debates the inadequate AHCA.

We encourage our supporters to call Senator Sanders' office using the call-in tool below, or to sign this petition.