Empowering MD Health Care: Lawmakers Must Dismantle Insurance Barriers

TL/DR –

Maryland has faced challenges with health insurance companies implementing policies that restrict access to timely care for chronic illness patients. Maryland lawmakers have taken measures for greater transparency and accountability in insurance procedures, but issues remain, such as copay accumulator programs which force patients to pay out-of-pocket costs twice. Furthermore, low payments from insurance carriers to healthcare practitioners in Maryland are leading to shortages and delayed patient appointments, with the state’s resident-to-primary care physician (PCP) ratio being 12% lower than the national average.

Maryland Patients Struggle with Chronic Illness Management Due to Health Insurance Policies

Health insurance policies in Maryland are proving challenging for chronic illness patients, who depend on consistent access to treatments. Certain policies by health insurance providers obstruct timely care, placing further strain on patients and their families.

Maryland Lawmakers Act in Favor of Patients

Thankfully, lawmakers in Maryland have recently prioritized reforms, notably Senate Bill 791 and House Bill 932, to increase transparency and accountability within the dealings of insurance carriers and their pharmacy benefit manager (PBM) partners. Further, enforcement guidance issued by the Maryland Insurance Administration (MIA) prevents insurers and PBMs from denying patients continuation of effective medication.

The Battle Continues for Patient and Physician Rights

Despite these essential reforms, Maryland lags behind in patient and physician protections compared to many other states. The elimination of copay accumulator programs, which prevent copay assistance from contributing towards patients’ deductibles and out-of-pocket maximums, is a policy implemented by several states to reduce costs for patients. Such programs are critical for patients with unique or chronic conditions that lack generic treatment equivalents, as they cover over 99% of copay assistance.

Challenges Ahead for Maryland Healthcare

Unfortunately, Maryland still has obstacles to overcome. For instance, insurance carrier payments to physicians and other healthcare practitioners in Maryland are among the lowest nationwide. This issue affects recruitment, leading to shortages in all areas of healthcare and delayed patient appointments or procedures. Current forecasts suggest that Maryland will need 23% more primary care physicians by 2030.

Addressing Future Healthcare Needs

Going forward, Maryland must ensure adequate insurance networks and tackle broader issues such as copay accumulator programs and payment access. By addressing these issues, we can ensure that patients receive the care they need and secure a robust healthcare system for Maryland’s future.

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