Both before and especially after President Trump and his congressional allies ended federal enforcement of the ACA’s individual mandate, several states established their own enforcement systems. Maryland’s lawmakers are proposing an innovative “down payment plan” that uses a more enrollment-oriented approach to requiring people with affordable access to health coverage to obtain insurance. Instead of imposing tax penalties on the uninsured, the Maryland proposal helps the uninsured enroll into coverage whenever possible. As uninsured residents file state tax returns, they can avoid an insurance responsibility payment by agreeing to get health insurance and keep it through the end of the year. They can apply for financial assistance and immediately begin the enrollment process by simply checking a box on their tax return. That step sends information to the exchange, which reaches out and helps uninsured consumers sign up for coverage. With roughly 130,000 Maryland uninsured who have access to zero-premium coverage through Medicaid and the state’s exchange, this approach promises to substantially reduce the number of uninsured while greatly improving the individual market’s risk pool, resulting in lower premiums. To read the full explanation of the proposal, with answers to frequently asked questions, download the pdf.