Maryland and Massachusetts are the first states to allow taxpayers to start signing up for health care coverage on their tax returns, with more states expected to follow. The goal is to enroll as many residents as possible in low- or no-cost plans they may not be aware they qualify for.
Despite the advances made by the 2010 Affordable Care Act, the initiative aims to bring in many of the remaining Americans—more than 28 million of them—who do not have health insurance.
According to a Kaiser Family Foundation estimate of the uninsured, a fifth of those people are eligible for Medicaid, the government-run health-care program for low-income Americans.
More than a third of them may be eligible for federal tax credits to help pay for at least some of their private-plan premiums.
“As unexpected as it may seem, many people are unaware that they have insurance options,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, a state body that assists residents in enrolling.
“Out there, people are just scraping by.
They have no idea what options are available to them.”
Maryland’s first-of-its-kind bill was signed into law by Republican Governor Larry Hogan in 2019.
Maryland income tax forms have contained a box that people can click to indicate they do not have health insurance for the past two years.
The state comptroller provides the taxpayer’s income and family size data to the state’s health insurance exchange for possible enrollment in Medicaid or subsidized private insurance with the taxpayer’s permission.
This year, the Massachusetts legislature passed a similar bill, which will go into effect next year.
Other states are likely to follow suit.
Colorado and New Jersey have both enacted legislation to adopt their own easy enrollment systems via tax returns, with significant bipartisan support in both cases.
Gov. Jared Polis, a Democrat from Colorado, signed the bill into law.
Democratic Gov. Phil Murphy of New Jersey has stated his strong support for the bill, but has requested some minor technical tweaks, which the legislature is expected to approve next month.
In New Mexico, Pennsylvania, and Virginia, the idea is gaining traction, either legislatively or administratively.
Meanwhile, Maryland Democrat Chris Van Hollen presented a bill in Congress last month that would add a similar check-off box to federal tax returns.
Van Hollen touted Maryland’s performance, which, according to the Maryland Health Benefit Exchange, has enrolled approximately 7,000 residents in the last two years.
The uninsured rate in the state was 6% in 2019, the most recent year for which data is available.
According to the most recent census, 8.6% of people in the United States do not have health insurance.
President Joe Biden’s Build Back Better measure, which is currently being debated in Congress, would raise federal subsidies for health insurance and expand Medicaid eligibility to millions more people.
A check-off box on federal tax returns, according to proponents, would alert many of these taxpayers to their alternatives and encourage them to enroll in health insurance plans.
60,645 Maryland taxpayers clicked the box indicating they didn’t have health insurance in 2020, the first year of Maryland’s Easy Enrollment program.
A total of 53,146 people were found to be qualified for Medicaid or a federal tax credit by the state.
A total of 4,015 people, or 7.6%, eventually signed up for a health plan.
This year, 29,020 people ticked the box, 27,223 were judged to be eligible, and 2,962 (or 10.8%) of those who were found to be eligible enrolled.
“We’re happy with that ten percent,” Eberle remarked.
“While it may appear little, it is 10% more than we would have received otherwise.”
The majority of other taxpayers ignored the state’s approach.
Despite this, Eberle believes the data from the tax returns will help her office better focus its marketing and education activities.
Nearly a quarter of people who enrolled in health care plans through their Maryland tax return identified as Black, and 20% as Latino, according to Eberle.
More than 40% were between the ages of 18 and 34, a demographic known for having low insurance rates.
Nearly three-quarters of the new Medicaid enrollees were women.
The rest enrolled in commercial plans, with around 95% of them qualifying for federal tax credits, according to Eberle.
Kentucky identified a new technique to help raise health insurance enrollment by piggybacking on the responsibilities of a government agency.
Kentucky’s Medicaid department followed up with those who claimed for unemployment benefits to enroll them in health plans last year, when thousands of workers were laid off in the early months of the outbreak.
In an interview, Eric Friedlander, secretary of the Kentucky Cabinet for Health and Family Services, stated that outreach helped the state’s Medicaid enrollment grow by 130,000 people during the pandemic.
Friedlander termed Maryland’s Easy Enrollment program “a fantastic example” that he hopes Kentucky could follow in the future.
Maryland is also exploring into using unemployment benefit applications for health insurance enrollment, according to Eberle.
According to Audrey Morse Gasteier, chief of policy and strategy at the Massachusetts Health Connector, the state’s health insurance exchange, officials in Massachusetts, which has the lowest rate of residents without health insurance at 3%, have been frustrated by the obstacles to getting everyone into health plans.
“We’ve spent a lot of time and money on marketing, outreach, and community engagement to get individuals enrolled,” she added.
“The remaining 3% is a source of great concern for us, and we remain committed to reaching them.”
With that goal in mind, Gov. Charlie Baker’s administration pushed through a new law that will implement a program similar to Maryland’s next year.
The Maryland Health Insurance Coverage Protection Commission, a panel comprised of lawmakers, hospitals, and other providers, as well as consumer advocates, was established by the legislature to recommend ways to improve access to health care in Maryland.
According to Vinny DeMarco, a member of the commission and president of the Maryland Citizens’ Health Initiative, one of the commission’s aims was to enroll the remaining 6% of Marylanders without health insurance.
And one way to do so, he suggested, was to take advantage of people’s interactions with government bureaucracies like tax collectors.
“The Affordable Care Act’s success is fantastic,” he added, “but we still need to get the rest of the way for health care for all Marylanders and Americans.”