Health coverage options in works

Proposals to help state's uninsured offered ahead of legislative session

January 01, 2007|By M. William Salganik | M. William Salganik,Sun reporter

When lawmakers convene this month, Maryland could see the biggest change in care for the uninsured in the three decades since the state crafted a system that pays for uncompensated hospital care.

With the number of uninsured large - 780,000 in the latest Census Bureau estimates and growing - momentum to find solutions is building, especially after last year's bruising fight over the so-called Wal-Mart bill. The bill, aimed at forcing the giant retailer to spend at least 8 percent of its Maryland payroll on health insurance, was passed over the governor's veto, only to be blocked by a federal court.

That left advocates looking for other ways to expand coverage, and business groups - bitterly opposed to an employer requirement - looking for more palatable ways to help the uninsured.

Ideas and plans are coming from all angles.

The chairman of the House of Delegates health committee is drafting a bill. The Maryland Health Care Commission, a state regulatory panel, is floating policy options. The Maryland Health Care for All Coalition, an advocacy group, is pushing an initiative. A joint legislative task force is completing a report. The Greater Baltimore Committee, a business leadership group, is putting forward a proposal.

The proposals share key elements - expansion of the Medicaid program to more low-income adults, changes to make health premiums more affordable for small businesses, and a mandate that at least high-income individuals buy insurance. More than a third of Maryland's uninsured have family incomes above $43,000.

"We're thrilled a consensus has developed that coverage must be expanded," said Vincent DeMarco, president of Maryland Citizens Health Initiative, a group that has been working for five years on various permutations of coverage expansion plans. "Something's going to happen in the next session."

While sharing common elements, the various proposals differ on details that could be deal-breakers.

Financing - expanding coverage could cost $200 million to $250 million a year - also remains an obstacle as state leaders face looming budget shortfalls and consider a yearlong revamping of Maryland's revenue system. Most supporters of broader insurance coverage, however, want to find the money this year by a $1-a-pack increase in tobacco taxes.

Also, some might counsel delay, to see if new Democratic majorities in Congress produce a federal solution, although that doesn't seem likely at this point.

"Washington does not move fast. They're incapable of doing anything in one year," said Del. Peter A. Hammen, a Baltimore Democrat who is chairman of the House Health and Government Operations Committee. "There are a lot of problems we can solve [at the state level], and we should be about the business of doing that."

Hammen said he has been meeting in recent months with an informal group of health policy experts and has begun drafting legislation and talking with key players.

Adding momentum to efforts in Maryland is Massachusetts' ground-breaking plan to cover most of its uninsured. Under a law passed last year, that state has already signed up about 30,000 people below the poverty line and will begin selling sliding-scale policies to the near-poor this week. The Massachusetts plan managed to assemble elements that won the support of labor and business, Democrats and Republicans.

"It kind of showed that something was possible," said Enrique Martinez-Vidal, acting director of the state health coverage initiatives program at AcademyHealth, a Washington research organization. Vermont has since followed with a bill, and coverage expansions are being discussed in California, New Jersey, Rhode Island, Wisconsin and Oregon, according to Martinez-Vidal.

Part of the lesson of Massachusetts, Hammen said, is that it might be easier to pass an ambitious plan - with different components that appeal to different constituencies - than small, incremental changes.

"The different pieces work together, and people see the bigger picture," Hammen said.

In most of the plans, the major pieces are the same:

Medicaid expansion: Most favor this as a first step because the federal government matches state dollars one-for-one. Currently, the state program covers children from families with incomes up to three times the federal poverty level, but adults up to only about 40 percent of poverty - less than $4,000 a year in annual income for an individual, $6,640 for a single parent with three children.

That ranks Maryland 40th of 50 states in level of coverage for parents, according to the Kaiser Family Foundation. "We do a decent job at insuring children," said Hammen. "We have a very dismal record of covering adults."

Help for small employers: About 60 percent of Maryland's uninsured work, according to the Maryland Health Care Commission. But while almost all large employers offer coverage, only about 40 percent of companies with 50 or fewer workers do, the commission reports.

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