Md. plan would cover its uninsured

Business, industry object to $1 billion proposal by coalition

September 07, 2001|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Leaders of a statewide coalition of labor, religious and civic groups are proposing an ambitious health plan costing up to $1 billion that would provide coverage for the state's 650,000 uninsured residents.

The strategy, already under attack by business interests, would require employers to provide insurance or pay a tax, expand a government health program for children and create a buying pool so the elderly could get their medicine cheaper.

Dr. Peter L. Beilenson, Baltimore's health commissioner, is leading the group, Health Care for All. The coalition is to release a 70-page document today detailing its preliminary plan.

Beilenson said the group wants input on the proposal and intends to make it an issue in state elections next year and in the General Assembly in 2003.

"It's unconscionable that the richest country on the face of the Earth doesn't guarantee coverage for health care. It's clearly not going to happen at the national level, so it's got to happen at the state level," Beilenson said, noting that most of the uninsured are in working families.

Over the past decade, as the numbers of uninsured Americans grew by nearly 10 million, states have struggled to bridge the gap. Some efforts, in places such as Tennessee and Washington state, were overhauled or abandoned. After the Clinton health plan failed, most states have taken only incremental steps.

Beilenson believes something more comprehensive must be done. But his coalition will have to deal with powerful political forces and prove it can meet the $1 billion annual cost. Current spending on health care in Maryland amounts to $20 billion a year, about equal to the state budget.

Del. Michael E. Busch, chairman of the House Economic Matters Committee, which deals with health issues, said the General Assembly has been working on these issues for years, and there are no easy answers.

"We're more than happy to entertain any proposal they have," the Anne Arundel Democrat said, "but trying to make this an issue that is driven by the electorate rather than by a defined process doesn't seem quite equitable or fair to me."

The coalition's plan was developed after months of public forums; meetings with hospitals, doctors and insurers; and analysis by some of the country's top health policy experts. By last count, 2,175 organizations in the state - including the AFL-CIO, the Maryland State Teachers Association, the Baptist Ministers' Conference, the Baltimore Jewish Council and the Maryland Academy of Family Physicians - had endorsed comprehensive reform that would guarantee all Marylanders quality health care.

The initial phase of the proposed plan would deal with the state's roughly 650,000 uninsured people. The Maryland Children's Health Program, a joint federal-state effort, would be expanded to include about 43,000 uninsured children now ineligible. For the estimated 200,000 elderly who have Medicare but no prescription drug coverage, the coalition wants to create a buyers' pool that could negotiate discounts up to 35 percent.

"We're proposing to build on the successes of Maryland," said Vincent DeMarco, the coalition's executive director. "We want to take it to the next step."

The biggest change would be the creation of a new entity, the Maryland Health Care Trust, to run a state-of-the-art insurance plan for uninsured adults. This quasi-governmental, non-for-profit body would be headed by a board appointed by the governor, with legislative consent.

Under the plan, enrollees would pay $10 co-pays for doctor visits, plus a premium based on their income. Patients would need a primary care doctor and referrals, but they could choose their own physicians.

Along with these benefits, though, the public would have to swallow what are essentially mandates: companies that don't provide health insurance would have to kick in 1 percent of their payroll; and in the second phase of the plan, any resident not eligible for public assistance would have to buy health coverage.

The rest of the money for the trust would come from a variety of sources: a 70 cents-per-pack increase in the cigarette tax, matching federal dollars and administrative savings. The coalition also proposes redirecting the millions of dollars already used to pay for primary care and hospital bills for the uninsured.

Experts who closely follow similar proposals nationwide called the Maryland scheme ambitious and well-crafted. They noted that the Maryland group responded to the public distaste for a Canadian-style, single-payer system by coming up with a different approach.

"They have done more work on this to make this politically palatable than many of the other proposals around the country," said Bob Blendon, a Harvard health policy professor and expert on public opinion and health care. "But I think they're ahead of the curve."

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