Acting Maryland Insurance Commissioner Marie Grant and Michelle Everly, executive director of the Maryland Health Benefit Exchange, told the Health and Government Operations Committee on a joint briefing that federal and state actions tied to the Affordable Care Act have lowered Maryland's uninsured rate and helped keep marketplace premiums among the lowest in the nation.

"The Affordable Care Act has really helped lower our uninsured rate," Marie Grant said, noting Maryland's uninsured rate fell from about 10.2 percent in 2013 to about 6.3 percent in 2023. She reviewed state and federal consumer protections that now apply in Maryland, including essential health benefits, guaranteed issue, prohibitions on annual and lifetime limits, and limits on cost sharing for preventive services.

The briefing focused on three policy levers the presenters said have driven those results: Maryland's reinsurance program, state-level protections that mirror federal requirements, and enhanced premium tax credits created by the American Rescue Plan Act and extended through the Inflation Reduction Act. Everly described enrollment and program outcomes from the exchange, Maryland Health Connection.

Why it matters: Committee members pressed for details about how these programs affect premiums, provider participation and health outcomes. Committee members were told reinsurance and program design helped produce some of the lowest benchmark premiums in the nation and supported higher enrollment in richer plans. Both presenters warned that expiration of enhanced federal subsidies would raise costs substantially for many Marylanders.

Key details from the briefing:

- Consumer protections. Grant summarized provisions now enforced under federal and Maryland law, including the required package of essential health benefits, guaranteed issue and renewability in the individual and small-group markets, a prohibition on routine rescissions, limits on cost sharing for preventive services under HRSA guidance and the federal definition of minimum value and affordability.

- Enrollment and coverage trends. Everly said Maryland Health Connection reported record enrollment this season, citing roughly 247,016 consumers enrolled through the exchange (figure given by the exchange during the briefing). She said about 49 percent of enrollees selected gold plans, and overall roughly 72 percent of exchange enrollees were in higher-value plans (gold or silver variations that function like platinum).

- Young adult subsidy pilot. Everly described the young adult subsidy pilot (initially a two-year pilot, later extended) as a significant driver of younger enrollees: she said 36 to 37 percent of total enrollees are ages 18 to 37, with year-over-year growth among young adults in the 21 to 24 percent range. Everly said the program produced average monthly savings of about $38 for participating younger consumers and contributed to reduced morbidity assumptions used by carriers.

- Reinsurance. Everly and Grant credited Maryland's 1332 reinsurance waiver and program with large early premium declines, carrier market stability and the state's low-cost bronze, silver and gold plans. Everly said the reinsurance program was implemented in 2019, subsequently extended and is currently available through 2028.

- Federal enhanced subsidies. Everly outlined the effect of the ARPA-enhanced premium tax credits and said those provisions, continued through the Inflation Reduction Act, were a major driver of increased enrollment. She estimated that if enhanced subsidies are not extended, between about 170,000 and 190,000 Marylanders could be affected and could face large increases in monthly premiums (Everly cited estimates of roughly a 67'to 68 percent increase for affected consumers). She also said replacing the federal subsidy expansion with state funding would be expensive, citing a roughly $150,000,000 cost estimate shown during the briefing.

- Equity outcomes. Everly said Black and Hispanic enrollment on the exchange increased substantially year over year (she cited figures including a roughly 23 percent increase for Black enrollees and a 25 percent increase for Hispanic enrollees in one slide and larger increases for some young cohorts in other slides). The exchange also reported 249 DACA recipients enrolled under a new deeming policy that allows them to purchase coverage and receive tax credits.

Questions from committee members focused on how young adult enrollment affects premiums for older adults, whether improved coverage is translating to better health outcomes in Maryland, and whether low exchange premiums reflect constrained provider reimbursement. Grant and Everly said some data show improved outcomes (citing external studies referenced in the exchange's appendix and carrier accountability reports), that morbidity trends can reduce rates for the whole pool, and that the relationship between reimbursement levels and premium affordability requires further review.

No formal committee action or votes occurred during the briefing. Committee members were told a bill to continue the young adult subsidy is expected to be introduced. Presenters pointed committee members to reports and district-level monthly data the exchange updates online.

Ending: Committee Chair Jocelyn Pena Melnik thanked the presenters and scheduled the session to proceed directly into bill hearings. Presenters urged continued attention to federal subsidy timelines and to state-level program design as both enrollment and affordability trends evolve.