A gubernatorial commission has recommended a law requiring virtually all of the state's employers to provide health insurance to their workers or to pay a tax -- part of a sweeping package aimed at bringing health coverage to Maryland's 570,000 medically uninsured residents.
The proposal, so complex that the commission doesn't recommend its adoption until 1996, would require all firms employing two or more people to provide coverage or pay fees into a pool that would benefit Marylanders who remain without insurance. Eligible workers would be those who have worked at least 20 hours per week for four months.
New businesses with fewer than 50 employees would be the lone exceptions to the requirement -- called "play or pay" because it would require companies to play a role in their workers' health coverage or to cough up a new tax. Once they were in business for two years, however, new businesses, too, would come under the requirements.
The recommendation was a major feature in a package -- three years in the making -- released for public consumption yesterday by the Governor's Commission on Health Care Policy and Financing, led by attorney Eugene Feinblatt.
If adopted, the package would radically alter the face of health care in Maryland, ensuring that many Marylanders who forgo medical care because they lack insurance receive such basic services as immunizations and prenatal care.
"The governor just got the report and he's considering it," said Bruce Martin, an adviser to Gov. William Donald Schaefer on health-care issues. "This is something that would require legislative action -- and what we are really talking about is what we will do in future legislative years."
One of the proposals -- dubbed "Maryland KidCare" -- would provide outpatient medical coverage to all uninsured children of low-income families. The program carries an estimated $14.2 million price tag, although the commission said a substantial part of the total cost could be reallocated from existing programs serving children. It would enroll about 56,000 children. "Play or pay" seems headed for years of intense scrutiny, especially by business interests that have opted out of employee health insurance because they have found the costs too onerous.
Under the proposal, the employer would have to pay 75 percent of the health insurance premium and the worker 25 percent. There would be no state subsidies.
On its face, the Maryland proposal is similar to a universal health insurance law passed three years ago in Massachusetts -- a program that has yet to be implemented, in part because of the huge cost it exacts from business.
The Feinblatt commission, however, noted that its proposal was crafted with greater sensitivity to the business community.
The insurance would provide a sparer benefits package, and would cover the employees but not their dependents.