Health coverage for uninsured is focus

Ehrlich, advocacy group, legislator have plans

October 29, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

Advocates of plans to extend health coverage to the state's estimated 690,000 uninsured are beginning to stake out positions in the run-up to the legislative session in Annapolis this winter.

The chairman of the House Health and Government Operations Committee plans to release today a new plan to extend health services to the uninsured.

Yesterday, the Maryland Citizens Health Initiative, a pro-health coverage group, released a study that it said showed its universal health coverage plan would be good for business.

Gov. Robert L. Ehrlich Jr.'s administration is developing its version.

Del. John Adams Hurson, a Montgomery County Democrat who chairs the House health committee, seeks to expand Medicaid coverage to the working poor through employer contributions and federal matching funds, similar to a system in Maine. It also would seek to build on "safety net" clinic services and to link people with primary care doctors, avoiding more expensive emergency room visits, he said.

Hurson said he would expect his plan to be phased in over several years, beginning with the creation of a Community Health Resources Commission that could help health centers qualify for federal funds and try to devise a system for paying medical specialists who treat the uninsured.

Such a system might use an existing fund to pay for hospital stays for those without insurance coverage, he said.

Under Hurson's plan, a tax on premiums of health maintenance organizations would finance insurance for the uninsured. The governor vetoed a similar HMO tax in the spring after the legislature approved the measure over strong objections from business groups.

"That's obviously a hurdle I've got to overcome," Hurson said.

The Citizens Health Initiative proposes an increase in the cigarette tax and a payroll tax to help cover the uninsured. Employers who provide coverage for their workers would gain tax credits under the plan, so those that don't cover their workers would bear most of the cost.

The group's study, released at a news conference in Baltimore, estimated that the payroll tax could cost 4,400 to 10,300 minimum-wage jobs but could add 7,000 to 11,000 jobs for health care workers. The group commissioned the study by the Lewin Group, a Virginia health consulting company, in hopes of deflecting business criticism.

Vincent DeMarco, executive director of the initiative, said his group would press for adoption of its plan next year, rather than pursuing a series of reforms over several years.

"We've been working on this for five years, and the people of Maryland are ready," he said. The plan was introduced last session but died in legislative committee.

Senate Majority Leader Nathaniel J. McFadden, a Baltimore Democrat who intends to introduce the measure in the Senate, said yesterday that escalating costs are helping build momentum for reform. "In the final analysis, if people really examine the plans that are out there, they will see that ours is the most equitable," he said.

Another speaker at yesterday's news conference, C. William Struever, chief executive of the real estate development company Struever Bros. Eccles & Rouse, said he favors universal coverage. His firm is sometimes at a cost disadvantage when bidding against competitors who don't provide coverage for their employees, he said.

The news conference was held outside at Struever's Tide Point development.

The governor's plan would use tax credits to subsidize employers who provide coverage to the "working poor."

State Health Secretary Nelson J. Sabatini said he is working on a plan including ways of limiting malpractice costs, "disciplined use of the system" such as limiting unnecessary emergency room care and "reasonable expectations about what you can provide" in benefits.

However, Sabatini said that given the state's budget problems and "an economy that seems to be gaining some steam but is still somewhat weak," a comprehensive administration plan is more likely to be offered in the 2005 session. He said the administration will continue to look for incremental expansions in coverage in the short term. In one such expansion, announced last week, the state will apply for a federal support to provide primary care to 17,000 low-income adults.

All three plans will be described at a "health summit" next month sponsored by the state legislative leadership and the Ehrlich administration.

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