- Associated Press - Sunday, April 27, 2014

BALTIMORE (AP) - Maryland hadn’t had a health insurance co-op for 20 years. Then Dr. Peter Beilenson came along.

Although Beilenson - who has held a number of prominent health positions - describes himself as a staunch advocate for a single-payer health care system, he said he felt compelled to start an insurance company that broke the mold.

So, using federal funds allocated by the Affordable Care Act, he founded Evergreen Health Cooperative, which debuted this past October for open enrollment on Maryland’s glitch-ridden health exchange.

The Evergreen model is based partly on the Healthy Howard Health Plan, which launched in 2008 as an experiment to provide primary care to Howard County’s uninsured population. Beilenson, as the county’s health officer, was instrumental in crafting that program.

Beilenson recently sat down for a wide-ranging interview about health care in Maryland and the nation, changes within the insurance industry and how the flawed exchange nearly derailed his vision for Evergreen.

Q: Open enrollment just wrapped up - about 295,000 people enrolled in private insurance or Medicaid on Maryland Health Connection. To you, is that success?

A: I think it’s a half success. The expanded Medicaid coverage for these particularly vulnerable folks is a true, significant improvement. So I’d give the Medicaid expansion an A-. In terms of the private coverage and providing subsidies, I’d give it a C. The exchange was clearly inadequate. But the numbers came up toward the end. Whether they all paid their premiums is another question.

Q: What kind of impact does that have on businesses, consumers and the economy in general?

A: Assuming that a significant percentage of those who obtained new coverage were previously un- or underinsured, that will translate into much less uncompensated care at hospitals, which is immediately passed on to all Maryland consumers who have insurance. Businesses will have less absenteeism, and productivity will increase, especially in small businesses because those employees are more likely to not have had insurance.

Q: Can you briefly explain uncompensated care?

A: It is care provided to those who are uninsured. Uncompensated care costs are spread out in the rates that Maryland hospitals charge all payers: CareFirst, Evergreen, Medicare. Those rates are bumped up depending on how much uncompensated care is provided at that hospital, so the costs are passed on to everybody who has insurance.

Q: How will Maryland’s health care environment change as a result of Obamacare and this larger insured population?

A: The ACA is a very important step to increase access to affordable health coverage, but it doesn’t change the health care system very much, per se, except for some pilot initiatives like what we’re doing with Evergreen Health, where we’re not just the insurance company; we have a health care system attached to us. Things like the Patient Centered Medical Home model, salaried physicians, evidence-based practices, telemedicine. That’s real health system reform.

. I think two to three years from now, we’ll have pretty much forgotten the rocky rollout of the exchange, and over the next 10 to 15 years, we’ll be doing more to reform the way health care is delivered.

Q: How has the insurance industry changed as a result of the exchanges?

Story Continues →