Maryland's top health administrator said yesterday that he is developing a proposal to ensure that all state residents have at least a basic package of health care benefits.
Nelson J. Sabatini, secretary of the Department of Health and Mental Hygiene, said the concept of universal health coverage has the endorsement of Gov. Robert L. Ehrlich Jr., although the governor has not endorsed a particular plan.
"The governor's very supportive," Sabatini said, adding he discussed the issue with Ehrlich two to three weeks ago. "I talked to him about it and said we need to pursue it, and he said, `Go ahead.'"
Sabatini is scheduled to deliver a speech on the subject tomorrow morning at a gathering of business leaders at the Center Club in Baltimore. In an interview yesterday, he said he has formulated only "general thoughts and ideas" on the subject so far, although he envisions that any plan would be administered through private insurers.
Ehrlich spokesman Greg Massoni said the governor has not seen Sabatini's proposal but noted that it likely would prove difficult to implement within the state's current economic climate.
It comes at a time when the governor, trying to avoid future deficits, is planning to cut as much as $500 million more from the state budget that goes into effect beginning July 1.
"I don't know where we'd find the dollars for that," Massoni said. "Certainly, if it is something that the governor buys into, we would find the dollars."
Sabatini described a system under which health care for the working poor, who currently don't have coverage, could be subsidized through tax credits. It would also be designed to somehow provide coverage to those who are not working, a move that would require a waiver of federal Medicaid rules.
The idea appears to share at least one characteristic with a proposal by the Maryland Citizens Health Initiative (MCHI), a group headed by Baltimore City Health Commissioner Dr. Peter L. Beilenson.
Like that plan, Sabatini's idea would use existing health insurers. MCHI estimates that 80 percent of Maryland residents would continue to be covered by private insurers.
But while MCHI's proposal would pay for the $637 million plan partly through a 50-cent increase in the tobacco tax and partly by taxing payrolls of businesses that don't offer health coverage, Sabatini's idea would rely on income tax credits to subsidize coverage for the working poor. It isn't clear how the state would replace the tax revenue lost through those credits.
"I feel very strongly that universal health care is essential and important, and we've got to find a way to get there," he said. The question, he added, is "What's the best way to do it within the current framework of market-driven insurance [and] how it will be delivered."
Sabatini said he supports universal access to a basic package of benefits, including coverage of hospitalization and physician care. But he said Maryland would clearly have to look hard at some of its existing mandates for private insurers, such as 48-hour hospital stays for new mothers.
Sabatini said his ideas are based in part on conversations with former House Speaker Casper R. Taylor Jr. and with Robert Moffit, director of the Center for Health Policy at the Heritage Foundation, a conservative Washington think tank.
Taylor developed the idea of using tax credits to help offset the cost of insurance for the working poor and vetted the idea before the last election with Moffit and David Kendall of the Progressive Policy Institute, an arm of the Democratic Leadership Council.
After his defeat in the election, Taylor began helping Sabatini develop a similar proposal, most recently meeting with the secretary in Sabatini's office last week.
`A state model'
Taylor said the idea could pay for itself because expanding the number of insured people decreases the number whose care is paid for by others.
"Our hope is that if we can create a state model, it would catapult it onto the federal stage," Taylor said.
Universal health care, once a partisan Democratic policy issue, is becoming less so, Sabatini and Moffit said. Because insured people already subsidize the uninsured through premiums that help pay hospitals for charity care, savings from a general reform of the health care system could be put into subsidizing care for the uninsured.
"There's a growing consensus in the academic and policy community on this," Moffit said. "We're not fighting with each other all the time."
Beilenson also said Sabatini has talked with him about the issue. "We agree - not he and I - but our organization and he and many others, to work somewhat in the existing framework," Beilenson said.
Sun staff writer Ivan Penn contributed to this article.