THIS PROGRAM IS MADE BY MPT TO ENRICH ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

*] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

COMING UP TONIGHT HOW THE GOVERNMENT SHUT DOWN WILL AFFECT YOUR OBAMACARE RATES.

BUT WE BEGIN TALKING ABOUT YOUR HEALTH IS Dr.

ELIZABETH NICHOLS ONCOLOGIST AT THE CANCER CENTER AND THE MARYLAND PRO TON TREATMENT CENTER AND MEGAN GARSTKA, THE GREENEBAUM CANCER CENTER AND THE KAUFMAN CANCER CENTER.

AND BOTH DOCTORS AT THE FACULTY AT THE MARYLAND SCHOOL OF MED SIN THANK YOU FOR JOINING US.

>> THANK YOU FOR HAVING US.

>> YOU ARE WEARING PINK BECAUSE OF BREAST CANCER MONTH.

THERE'S GOOD NEWS IN TERMS OF ADVANCES IN EARTH DETECTION AND TREATMENT.

>> ABSOLUTELY.

WE DO KNOW THAT BREAST CANCER IS ONE OF THE MOST COMMON THINGS WE SEE DIAGNOSED IN AMERICAN WOMEN.

ONE OUT OF EIGHT, A LIFETIME RISK OF 12.PIF%.

WE CONSIDER PATIENTS HIGHER RISK FOR BREAST CANCER.

UNFORTUNATELY SOMETHING VERY, VERY COMMON AND WE HAVE A LOT OF GOOD TREATMENT OPTIONS.

>> Jeff: AND YOU SPECIALIZE IN THOSE TREATMENT OPTIONS THE SURGICAL SIDE AND THE RADIATION SIDE.

ARE THE CASES MOST OFTEN DETECTED BY MAMMOGRAMS?

>> OF COURSE, WE STILL HAVE A LOT OF PATIENTS IN OUR COUNTRY BOTH IN OUR STATE AS WELL AS NATIONWIDE WHO DON'T UNDERGO THEIR SCREENINGS AND TOES PATIENTS WE FIND IT BECAUSE THEY FELT SOMETHING WHICH MEANS IT'S MORE ADVANCED.

>> Jeff: AND THE TREATMENTS YOU BOTH PROVIDE I'M SURE YOU MUCH RATHER SEE SOMEBODY EARLY.

>> YES, FOR SURE.

>> Jeff: HOW BIG A DIFFERENCE DOES IT MAKE?

>> IT'S SIGNIFICANT IN TERMS OF TREATMENT OPTIONS.

WE LOOK THE THE SIZE OF THE LUMP IN THE BREAST AND PEOPLE'S LYMPH NODES TO SEE IF THE CANCER MOVED IN THE BODY.

LESS IS MORE IN TERMS OF TREATMENT THE EARLIER WE FIND THINGS THE MORE OPTIONS WE HAVE IN TERMS OF SURGERY AND RADIATION THERAPY, YOU KNOW, SO I THINK IN GENERAL WE ARE ALWAYS HAPPIER TO FIND IT EARLIER.

>> Jeff: TELL ME ABOUT LESS IS MORE IN TERMS OF TREATMENT.

>> GOOD POINT.

YEARS AGO THEY USED TO THINK EVERY PATIENT HAD TO HAVE A MASTECTOMY.

THEN WE FOUND WE CAN DO BREAST CONSERVATION AND REMOVE THE LUMP AND CLEAN UP THE BREAST LIKE THE RADIATION THERAPY, SOMETIMES ENDOCRINE THERAPY WORKING ON HORMONE LEVELS.

THERE ARE MORE TREATMENTS THAN YEARS AGO.

IN TERMS OF SURGERY, EVEN WITH DEALING WITH MAPPING OUTPATIENT'S LYMPH NODES WE CAN DO A LOT MORE IN TERMS OF LESS SURGERY THE MORE WE DO REMOVING LYMPH KNOWEDS, IN GENERAL WE LIKE TO SEE THE LESS IS MORE IN TERMS OF SURGICAL OPTIONS AND PREVENTATIVE OPTIONS.

>> Jeff: LET'S GET TO THE MAMMOGRAM SIDE.

WHAT ARE THE CURRENT SCREENING RECOMMENDATIONS?

>> THE CURRENT SCREENING RECOMMENDATIONS ARE THAT WOMEN BEGIN MAMMOGRAMS AT THE AGE OF 40.

AND UNDERGO A YEARLY MAMMOGRAM UNTIL 70 OR SO.

AS WE AGE IT BECOMES A CONVERSATION WITH YOUR INDIVIDUAL DOCTORS BASED ON YOUR OTHER HEALTH PROBLEMS, TOO.

AND REMEMBER IF YOU HAVE A FAMILY MEMBER WHO HAD BREAST CANCER AT A JUDGER AGE WE WILL RECOMMEND EARLIER SCREENING OR IF YOU HAVE ONE OF THE GENES THAT RUN IN YOUR FAMILY THAT CAN LEAD TO INCREASED RISK OF BREAST CANCER WE RECOMMEND EARLIER SCREENING FOR THOSE PATIENTS.

>> Jeff: ANY FIGHTS WITH SURGERIES WITH INSURANCE COMPANIES, EARLIER THAN RECOMMENDED?

>> YES, THE WAY WE LIVE IN NOWADAYS IF SOMEONE MEETS THE CRITERIA AND THERE ARE NATIONAL GUIDELINES ON SCREENING YOUR TEAM CAN FIGHT FOR THAT AND ARE ABLE TO GET THAT FOR YOU.

>> Jeff: I REMEMBER A CONVERSATION TRYING TO ACCELERATE THE AMOUNT OF TIME GETTING A WORRISOME REPORT ON A MAMMOGRAM A QUESTION WE NEED TO TAKE A LOOK AND GETTING TO THE BOTTOM OF THE SITUATION BECAUSE IT CREATES SUCH WORRY.

WHAT IS THE BEST PRACTICE THERE?

>> WELL, I THINK MOST OF THE INSTITUTIONS THAT PERFORM 34578 GRAHAMS TRY TO ACCELERATE GETTING PATIENTS THROUGH TO GET DIAGNOSTIC STUDIES IF A WOMAN GETS A CALL BACK.

NOT EVERY CALL BACK IS GOING TO BE BAD.

WE THINK THERE'S VALUE IN THE SCREENING MAMMOGRAMS AND WE ARE LOOKING FOR THINGS CAUGHT EARLY SO YOU SEE CALL BACKS.

THAT BEING SAID THERE ARE BREAST CANCER MRI'S IF WOMEN DO HAVE DENSE BREASTS WE WILL TRY TO FIGURE OUT WHAT IS GOING ON IN IMAGING, TOO.

WHAT WE ADVISE WOMEN IF THEY HAVE QUESTIONS ABOUT THEIR FAMILY HISTORY AND WHAT AGE TO START WE LOOK AT THAT AGE OF 40.

IT CAN BE CONTROVERSIAL BUT MOST SOCIETIES AGREE THAT 40 IS THE AGE TO START.

WE HAVE GREAT HIGH-RISK CLINICS THROUGHOUT THE STATE, AND SO IF THERE'S EVER ANY QUESTION IF A PATIENT SHOULD START WITH A SCREENING MRI AT AN EARLIER AGE WE ENCOURAGE TO SCHEDULE A CONSULTATION TO TALK ABOUT THAT RISK.

>> Jeff: IF YOU HAVE A QUESTION FOR THE DOCTORS ABOUT BREAST CANCER SEND US AN E-MAIL LIVE QUESTIONS AT MPT.ORG.

THE IDEA OF DENSE BREAST TISSUE AND A MAMMOGRAM IS THAT ITSELF A RISK FACTOR OR SOMETHING THAT MAKES IT HARDER TO READ AND PERFORM A MAMMOGRAM?

>> THE LATTER.

IT MAKES IT HARDER TO PERFORM AND READ THE MAMMOGRAM.

THERE HAVE BEEN ADVANCES IN MAMMOGRAM TECHNOLOGY INCLUDING 3-D WHICH ARE THE STANDARD NOW, NATIONALLY AND WIDELY AVAILABLE IN OUR AREA THAT HELP THE RADIOLOGIST TAKE MORE PICTURES AND HELP DETERMINE THAT BETTER.

MOST WOMEN HAVE SEEN ON THEIR OWN REPORT THAT IT WILL GRADE YOUR BREAST DENSITY AND IT CAN SOMETIMES LIMIT THE TEST WHICH CAUSES ANXIETY FOR PATIENTS AS WELL.

WE CAN SOMETIMES USE ADDITIONAL TESTS TO MONITOR THOSE PATIENTS.

>> >> Jeff: I THINK YOU BROUGHT UP THE GENETIC SIDE OF THIS THE GENES INVOLVED.

WHO SHOULD FIND OUT ABOUT THAT?

IF YOU KNOW THERE'S FAMILY HISTORY THEN YOU GET INTO THE GENETICS OR EVERYBODY SHOULD?

>> THAT IS A GREAT QUESTION AND IT IS A LITTLE BIT OF BOTH.

THERE ARE CLEAR GUIDELINES WHICH PATIENTS ARE CANDIDATES FOR GETTING GENETIC TESTING.

BUT AGAIN WOMEN UNDER THE AGE OF 50 WITH BREAST CANCER ARE ELIGIBLE FOR JN PARTICULAR TESTING AND TRIPLE NEGATIVE BREAST CANCERS AS WELL.

IF YOU HAVE A FAMILY HISTORY WHERE SOMEONE ELSE IN YOUR FAMILY HAS A GENETIC MUTATION YOU CAN GET TESTING LING AS WELL.

BUT THOSE GUIDELINES CHANGE EVERY YEAR IT'S SOMETHING WE HAVE TO KEEP UP-TO-DATE ON.

>> Jeff: WHAT DOES TRIPLE NEGATIVE MEAN?

>> IT IS A TYPE OF BREAST CANCER AND WE LOOK AT RECEPTORS THE FLAGS THAT THE TUMOR CELLS CAN PUT UP TO THE BODY.

MOST CANCERS RESPOND TO ESTROGEN AND THOSE ARE HARDER TO TREAT THAT WE CAN'T WORK ON YOUR HORMONES TO PREVENT THEM.

THOSE ARE TUMORS THAT COME UP MORE QUICKLY BUT WE HAVE GOOD TREATMENTS FOR THOSE, TOO.

WHEN WE TALK ABOUT QUICKLY IN BREAST CANCER MONTHS TO YEARS NOT DAYS TO WEEKS.

THIS IS SOMETHING WE'RE TALKING ABOUT SCREENING CAN PICK UP ON THE CHANGES BUT THIS IS SOMETHING WE LOOK AT HOW DO YOU PREVENTED IT IN THE FUTURE, TOO.

THAT IS WHAT A TRIPLE NEGATIVE IS.

>> Jeff: EVERYBODY WATCHING IS UNFORTUNATELY FAMILIAR WITH THE STAGING SYSTEM FOR CANCERS BUT IN BREAST CANCER YOU HEAR THE PHRASE STAGE ZERO.

IS THAT A THING?

>> BREAST CANCER IS THE ONLY CANCER THAT HAS A STAGE ZERO, CANCER CELLS WITHIN THE DUCT OF THE BREAST, DCIS.

AND SO IT IS NONINVASIVE FORM OF BREAST CANCER IT DOESN'T HAVE THABILITITY TO SPREAD BUT IT MANAGED TO AN INVASIVE BREAST CANCER.

>> Jeff: THIS IS FROM MEGHAN.

YOU CAN ANSWER IT.

CAN YOU TALK ABOUT CONTRAST ENHANCED MAMMOGRAPHY?

>> SURE THAT IS A NEWER TECHNIQUE IN TERMS OF IMAGING LIKE YOU MENTIONED.

WHAT A CONTRAST ENHANCED MAMMOGRAM IS LOOKING AT THE ENERGY USE OF THE TISSUES OF THE BREAST WITH A MAMMOGRAM IT IS A NEWER TECHNIQUE WE DO USE IT IF WE'RE TRYING TO FIND OUT IF THERE'S ENERGY USE BY THAT PARTICULAR TUMOR TO MAKE SURE IT IS NOT A TUMOR.

CONTRASTED ENHANCED MAMMOGRAMS ARE A GREAT OPTION NOT SOMETHING EVERYONE NEEDS TO DO BUT HELPFUL IN CIRCUMSTANCES.

IT IS AN OPTION WE HAVE AT DIFFERENT FACILITIES AND IT IS A GOOD ONE SOMETHING TO TALK ABOUT WITH YOUR PROVIDER TO FIND IF THAT IS THE RIGHT ONE FOR YOU.

>> Jeff: THE PROVIDER TO PATIENT CONVERSATIONS BOTH ARE DELICATE, PRECISE WORK AND SURGERY AND DIRECTING RADIATION BEAMS.

BUT IN TALKING TO YOUR PATIENTS IS ALSO REALLY IMPORTANT AND PRECISE WHAT YOU SAY AND WHAT YOU HEAR.

TELL US ABOUT THOSE DIFFICULT, CONVERSATION YOU HAVE A LOT OF TIMES THE PATIENT HAS IT ONCE.

>> YEAH.

SURGERY OFTEN COMES FIRST.

I CAN COMMENT ON THE RADIATION PERSPECTIVE.

>> IN THE WORLD OF SURGERY, WE CERTAINLY HAVE THE DIFFICULT DISCUSSIONS AND WITH BREAST CANCER SURGERY MORE WE'RE TALKING ABOUT INDIVIDUALIZED OPTIONS.

OUR ROLE IS TO MAKE SURE THAT PATIENTS KNOW THEIR CHOICES AND ARE INFORMED.

AND I LIKE TO MAKE SURE THAT MY PATIENTS ARE AWARE OF THE CHOICES WHETHER IT'S KEEPING THE BREAST, DOING A SURGERY WITH PLASTIC SURGERY TO HELP REBUILD THE BREAST.

A LOT OF WHAT WE DO IS TRYING TO BE TAILORED FOR OUR PATIENTS TO MAKE SURE WE KNOW AND TAKE INTO ACCOUNT THEIR CIRCUMSTANCES NOT JUST THE DIAGNOSIS BUT THE FUTURE.

THERE IS A LOT WE'RE DOING IN THAT RESPECT.

>> AND FROM A RADIATION PERSPECTIVE ONE OF THE BIG THINGS ABOUT RADIATION IT CAN BE A DAILY TREATMENT MONDAY THROUGH FRIDAY FOR SEVERAL WEEKS.

A LOT OF PATIENTS DON'T HAVE RESOURCES TO DO THAT OR HAVE A FAMILY MEMBER TO DRIVE THEM EVERYDAY.

IT'S UNDERSTANDING PATIENTS' SOCIAL ISSUES, TRANSPORTATION ISSUES DO THEY NEED CHILDCARE.

AND THAT HELPS US INFORM US WHICH REGIMENT WE MAY CHOOSE OR BEST FOR THE PATIENT'S CANCER.

>> Jeff: THANK YOU FROM THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM APPRECIATE YOUR TIME.

THANK YOU SO MUCH.

NOW THE FEDERAL GOVERNMENT SHUT DOWN IS IN DAY 20.

THE BIG ISSUE IS WHETHER TO EXTEND SUBSIDIES THAT MAKE OBAMACARE PREMIUMS MORE AFFORDABLE.

THE OPEN ENROLLMENT PERIOD IS ABOUT TO START WE SPOKE WITH MICHELLE EBERLY WHO RUNS MARYLAND HEALTH CONNECTION.GOV.

THANK YOU FOR JOINING US.

LET'S START WITH THE DATES FOR OPEN ENROLLMENT THIS YEAR AND HOW MANY PEOPLE YOU EXPECT TO SIGN UP?

>> YEAH.

WE ARE OPENING UP NOVEMBER 1.

OUR WEBSITE, MARYLAND HEALTH CONNECTION.GOV IS OPEN NOW FOR SHOPPING AND LOOKING AND SEE WHAT HAS CHANGED.

PUT THE OPEN ENROLLMENT DATES ARE NOVEMBER 1-JANUARY 15TH.

THE SAME AS THEY WERE LAST YEAR.

>> Jeff: NOW, HOW MANY PEOPLE OVER THE YEARS HAVE SIGNED UP FOR I WANT TO CALL THEM OBAMACARE PLANS SHORTHAND FOR THE AFFORDABLE CARE ACT, AND HAS THAT NUMBER BEEN CHANGING OVER TIME?

>> YOU KNOW, JEFF, I'M SO PROUD OF THE WORK THAT MARYLAND HAS DONE AND THE EXCHANGE HAS DONE OVER THE LAST 10 PLUS YEARS TO GET OUR ENROLLMENTS WHERE WE ARE TODAY.

WE HAVE ABOUT 247,000 MARYLANDERS ENROLLED IN COVERAGE THROUGH THE EXCHANGE.

THAT HAS INCREASED YEAR-OVER-YEAR.

WE HAD A PERIOD OF TIME WHERE WE WERE LOSING ENROLLMENTS BECAUSE PREMIUMS HAD INCREASED.

SO WORKING WITH OUR GENERAL ASSEMBLY AND THE ADMINISTRATION, WE CREATED THE REINSURANCE PROGRAM.

AND THAT LOWERED RATES ON AVERAGE BY 35% OVER THREE YEARS.

WE'VE BEEN ABLE TO KEEP THAT REDUCTION IN RATES OVER THE YEARS.

AND WE NOW CONSISTENTLY HAVE THE LOWEST BRONZE AND THE LOWEST GOLD PLAN THAT NATION.

HOWEVER THAT IS GOING TO CHANGETIES YEAR.

AND WE ARE ANTICIPATING THAT FOR THE FIRST TIME, IN 10 YEARS, WE'RE GOING TO LOOSEN ROLL.

RATHER THAN GAIN ENROLLMENT THIS YEAR.

>> Jeff: AND IT'S DEPENDENT ON THE PREMIUMS JUMPING IN COST.

IS THAT RELATED TO THE SHOWDOWN ON CAPITOL HILL?

>> IT SURE IS.

AND I WILL SAY SIX MONTHS AGO, WHEN WE WERE TALKING ABOUT HR1 OR OB3, THE ONE BIG BIG ACT EVERYONE WAS TALKING ABOUT IMPACTS TO MEDICAID WHAT ARE GOING TO BE DEAF IT STAKING AND THEY -- DEVASTATING AND THEY WON'T COME INTO PLAY UNTIL 27.

AND WE WERE RINGING ALL THE BELLS SAYING WE HAVE A BIGGER COMING UP SOON.

HR1 CONGRESS DID NOT EXTEND THE TAX CREDITS IF WE DON'T HAVE THAT RESOLVED BY THE END OF SEPTEMBER, CONSUMERS WILL GET THEIR NOTICES THAT SHOW SIGNIFICANT INCREASE IN PREMIUMS.

AND, IN FACT, IN MARYLAND, WE HAD WE ESTIMATE THAT THE AVERAGE INCREASE FOR INDIVIDUALS THAT USE TAX CREDITS THE PREMIUMS WILL GO UP BY IT 95%.

FORTUNATELY, AGAIN, SO PROUD TO BE A MARYLANDER BECAUSE WE WORKED WITH THE GENERAL ASSEMBLY LAST JANUARY AND SAID WHAT CAN WE DO TO MITIGATE THIS IMPACT AND WE FOUND A WAY TO USE OUR RERA INSURANCE FUNDING TO SHORE-UP SOME OF THAT LOSS.

THE EXTENDED TAX CREDITS IF CONGRESS DID NOT TAKE ACTION.

WE ARE FORTUNATE IN THAT FOR LOWER INCOME FAMILIES WE ARE ABLE TO 100% FILL THAT VOID.

AND FOR MIDDLE INCOME UP TO 400% OF THE FEDERAL POVERTY WHICH FOR ONE PERSON IS $62,000 WE WERE ABLE TO PROVIDE 50% OF WHAT THAT EXPANDED TAX CREDIT WOULD HAVE BEEN.

SADLY WE CAN'T DO ANYTHING FOR THE OVER 400% POPULATION AND FAMILY OF FOUR, THAT 400% IS 128,000.

ALTHOUGH IT SOUNDS LIKE A LOT FOR A FAMILY OF FOUR IN MARYLAND TRYING TO PAY YOUR MORTGAGE AND FOOD AND SUCH AND THAT INCREASE IN HEALTH COVERAGE IS GOING TO BE SUBSTANTIAL.

SO WE ARE STILL WAITING ON CONGRESS TO TAKE ACTION AND AS WE KNOW NOW THE NUMBER ONE ITEM TALKED ABOUT WITH THE FEDERAL GOVERNMENT SHUT DOWN.

OUR NOTICES HAVE GONE DOWN.

PEOPLE HAVE GOTTEN THEY SEE WHAT THE PREMIUM INCREASES ARE GOING TO BE.

WE KNOW WE'LL LOSE FOLKS THAT JUST CAN'T AFFORD IT IT'S GOING TO BE TOO EXPENSIVE AND I CAN'T STRESS ENOUGH THESE ARE MIDDLE INCOME FAMILIES, HARD-WORKING FAMILIES THAT ARE DOING THE RIGHT THING AND BUYING THEIR OWN HEALTH INSURANCE BECAUSE THEY DON'T HAVE AN EMPLOYER THAT PROVIDES IT FOR THEM AND USING THE TAX CREDITS TO MAKE IT AFFORDABLE ON A MONTHLY BASIS TO DO THE RIGHT THING FOR THEIR FAMILY.

>> Jeff: THIS IS COMPLICATED STUFF AND WE HAVE NOT TALKED ABOUT THE BRONZE AND SILVER AND GOLD AND ALL THAT STUFF.

BUT DO I UNDERSTAND IT RIGHT THAT OBAMACARE HAD SOME DEGREE OF BUILT IN SUBJECT YOU ISDY THAT LOW INCOME LEVELS THEN THE ENHANCED SUBSIDY FROM THE BIDEN ADMINISTRATION AND MARYLAND HAS ITS OWN SUBSIDY SYSTEM?

>> THAT'S ABSOLUTELY CORRECT.

SO WE KNOW PEOPLE WANT HEALTH INSURANCE, RIGHT?

WE KNOW FAMILIES WANT TO GET PREVENTATIVE CARE, WANT TO STAY HEALTHY WANT TO BE HEALTHY BECAUSE WHEN YOU DONE HE AHAVE YOUR HEALTH AS YOU KNOW, NOTHING ELSE MATTERS.

YOU CAN'T GO TO WORK YOU CAN'T EARN A LIVING YOU CAN'T TAKE CARE OF YOUR FAMILY.

PEOPLE WANT HEALTH INSURANCE WHAT WE FOUND IN THE EARLY DAYS OF THE AFFORDABLE CARE ACT WHEN RATES STARTEDDED TO SIGNIFICANTLY GO UP, WE LOST ENROLLMENTS.

WHEN THE STATE PUT IN PLACE THE REINSURANCE PROGRAM AS A MECHANISM TO LOWER RATES FOR ALL WE SAW GROWTH.

WHEN DURING COVID, WE HAD THE ENHANCED TAX CREDITS WHICH MEANT THAT THE PERCENTAGE OF YOUR TAXES THAT YOU COULD USE TO PAY FOR YOUR INSURANCE WENT UP.

AND WHEN WE SAW THAT HAPPEN WE HAD EXPLOSIVE GROWTH IN ENROLLMENTS.

IT IS NOT A MATTER OF PEEL NOT WANTING HEALTH INSURANCE IT IS A MATTER OF BEING ABLE TO AFFORD HEALTH INSURANCE.

AND I LIKE TO ALWAYS SAY THAT IF I HAD TO PAY THE PERCENTAGE THAT MY EMPLOYER CONTRIBUTES TO MY HEALTH INSURANCE, I PROBABLY WOULD HAVE A CHALLENGE WITH HAT.

SO WE TAKE THAT FOR GRANTED ALL OF THOSE OF US THAT GET EMPLOYER SPONSORED COVERAGE BUT FOR FOLKS THAT WORK FOR SOMEBODY THAT DON'T OFFER IT AND NEW BUSINESSES AND GET HEALTH COVERAGE AND USE THEIR MONEY TO START A BUSINESS.

>> Jeff: AND DOWNGRADING SOMEBODY'S COVERAGE GOING FROM A DWOLD TO A -- GOLD TO A BRONZE IS NOT GOING TO MAKE ENOUGH DIFFERENCE I'M GUESSING?

>> THAT IS WHY WE'RE ENCOURAGING PEOPLE TO LOOK AT PLANS.

WE ARE HERE TO HELP.

WE HAVE OUR NAVIGATORS AND LICENSED AUTHORIZED BROKERS THAT CAN WALK THROUGH THAT SOMETIMES IT LOOKS LIKE THE PREMIUMS LOWER SO THAT IS WHAT I WILL DO, IS GET THE PLAN WITH THE LOWER PREMIUM BUT THERE MAYBE MORE OUT OF POCKET COSTS YOU MIGHT HAVE A HIGHER COPAY.

SO THE DEDUCTIBLES, PEOPLE GET SCARED BY THE AMOUNT OF THE DEDUCTIBLES BUT WE HAVE A LOT OF PREDEDUCTIBLE SERVICES, WELLNESS ALL THE WELLNESS IS COVERED PREDEDUCTIBLE DON'T LOOK AT THAT AND SAY I HAVE A HIGH DEDUCTIBLE BECAUSE THERE IS A LOT OF COVERAGE IN OUR PLANS ESPECIALLY FOR DIABETES THAT IS PREDEDUCTIBLE AND LOW OR NO COST.

>> Jeff: WHAT HELP IS AVAILABLE TO HELP CONSUMERS DIG THROUGH SOME VERY, VERY COMPLICATED DECISIONS HERE?

>> THEY ARE COMPLICATED DECISIONS AND EVEN THOSE OF US THAT ARE IN THE INDUSTRY, IT IS COMPLICATED.

SO WE HAVE OUR FIRST OUR CALL CENTER IS AVAILABLE.

AND WE HAVE A WAY OF ACCESS UP TO 200 LANGUAGES.

SO THEY ARE AVAILABLE IF YOU ARE COMFORTABLE WORKING THROUGH THE PHONE AND A COMPUTER.

WE HAVE OUR NAVIGATOR PROGRAM, WHICH IS OVER ABOUT 125 CONSUMERS ASSISTANCE WORKERS THAT WILL MEET WITH YOU IN PERSON AND MANY ARE MUTUALTY LINGUAL.

AND WE HAVE OUR GREATEST RESOURCE IS OUR BROKER COMMUNITY.

WE HAVE ABOUT 2,000 LICENSED AUTHORIZED BROKERS THAT ARE AVAILABLE AND MANY OF THEM ARE HAVE MANY OF THEM HAVE A PRIMARY LANGUAGE THAT IS NOT ENGLISH.

SO WE HAVE FOLKS THAT ARE HERE TO HELP.

OUR BROKERS I CANNOT SAY IT ENOUGH THAT IS THEIR BUSINESS THEY CAN LOOK AT WHAT WOULD MAKE SENSE FOR YOU AND THOSE ARE ALL FREE RESOURCES DOESN'T COST A THING.

IF YOU HAVE A MOBILE APP WE ENCOURAGE YOU TO ENROLL MHC ON THE MOBILE APP AND THERE IS A FEATURE THAT YOU CAN SAY GET HELP AND IT WILL SHOW YOU CLOSEST TO WHERE IT HAS A GPS INDICATOR CLOSEST TO WHERE YOU ARE.

WHAT HELP YOU CAN GET.

REALLY, WANT TO MAKE SURE ESPECIALLY THIS YEAR BECAUSE THIS YEAR IS GOING TO BE MORE CONFUSING THAN EVER.

>> Jeff: I SHOULD EMPHASIZE THE CONFUSION WE ARE TALKING ABOUT HAS NOTHING TO DO WITH MEDICARE OR BUSINESS PLANS OR MEDICAID.

THIS IS JUST THE AFFORDABLE CARE ACT OBAMACARE PLANS IS THAT CORRECT?

AND THE MEDICAID ISSUE THAT YOU BROUGHT UP IS FORTUNATELY A YEAR AWAY?

>> WELL, THAT'S CORRECT.

THERE ARE A COUPLE PIECES THAT WILL BE EFFECTIVE IMMEDIATELY.

AND MARYLAND HEALTH CONNECTION WE DO ENROLL ALL WHAT WE REFER TO AS A CATEGORY OF MEDICAID AND IT'S OVER A MILLION PEOPLE THAT COME THROUGH THAT.

THERE ARE THINGS SADLY WE HAD TO TERMINATE COVERAGE FROM DIFFERENT ACTION CHILDHOOD ARRIVALS AT THE END OF SEPTEMBER BECAUSE THEY WERE NO LONGER IN A LAWFULLY PRESENT CATEGORY, NO LONGER DEEMED LAWFULLY PRESENT.

WE ALSO EFFECTIVE JANUARY 1, 2026, THERE IS ABOUT 17,000 ENROLLEES WE HAVE THAT ARE UNDER 150% OF FEDERAL POFORT LEVEL AND THAT FOR AN INDIVIDUAL IS A LITTLE OVER 23,000.

THEY USED TO BE ABLE TO UTILIZE TAX CREDITS.

AND THEN THEY WILL NO LONGER BE ABLE TO UTILIZE TAX CREDITS THAT IS ANOTHER POPULATION WE'RE GOING TO HAVE TO -- WE RENEWED THEM AND WOULD LOVE TO KEEP THEM IN HEALTH COVERAGE BUT THEY CANNOT USE TAX CREDITS.

THOSE ARE SOME OF THE CHALLENGES WE'RE FACING THIS YEAR.

AND OUR MESSAGE TO EVERYONE IS DON'T GO IT ALONE WE'RE HERE.

WE'RE HERE TO HELP GET YOU TO RESOURCES WHETHER IT'S THROUGH A HEALTH PLAN COVERAGE OR GETTING YOU OTHER RESOURCES THAT WE CAN HELP WITH.

CONNECT YOU WITH OTHER RESOURCES.

IS IT WILL BE A CHALLENGING YEAR AND THE BIGGEST CHALLENGE WILL COME AND I HAVE THAT TALKED ABOUT THIS YET IF CONGRESS TAKES ACTION.

IF THEY TAKE ACTION BETWEEN NOW AND NOVEMBER 1, IT WILL BE A LITTLE DIFFERENT BECAUSE WE MIGHT DELAY OPEN ENROLLMENT TO MAKE CHANGES IF THEY WAIT UNTIL THE END OF THE YEAR AND DECIDE TO EXTEND THE TAX CREDITS, WE WILL MOVE MOUNTAINS TO GET MORE AFFORDABLE PLANNINGS TO OUR CONSUMERS.

BUT IT MAY MEAN, CLOSING DOWN FOR A LITTLE BIT AND DOING SYSTEM CHANGES.

SO IT WILL BE ANOTHER LEVEL OF COMMUNICATION.

BUT REALLY THIS YEAR IT WILL BE IMPORTANT FOR OUR CONSUMERS WHEN YOU GET YOUR NOTICE, DON'T JUST LET IT SIT.

STAY IN TOUCH WITH US.

LET US KNOW WHAT YOUR SITUATION IS, BECAUSE IT MAY CHANGE YOU MAY SEE YOU WILL PAY A LOT TODAY AND IF WE GET THE EXPANDED TAX CREDIT IT MAY GO RIGHT AWAY.

>> Jeff: MICHELLE EBERLY AND HER 250E78 RUNNING MARYLAND HEALTH CONNECTION.GOV.

THANK YOU SO MUCH.

AND THAT IS "DIRECT CONNECTION" WE'RE BACK FRIDAY WITH "STATE CIRCLE" THE LATEST ON MARYLAND POLITICS JOIN US FRIDAY EVENING AT 7:00 P.M.

YOU CAN SEE PAST EDITIONS OF OUR PROGRAMS AT VIDEO.MPT.TV AND THE FREE PBS APP.

FOR ALL OF US AT MPT THANK YOU FOR WATCHING "DIRECT CONNECTION" AND HAVE A GOOD NIGHT.

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