Health care priorities

January 02, 2007

An estimated 788,000 Maryland residents lack health insurance of any kind, and it's time the state got serious about addressing the issue. Not just for humanitarian reasons (although that argument is compelling), but because the lack of coverage is simply too costly for most of the other residents of the state, who pay higher insurance premiums to cover the uninsured's emergency room care. It's a horribly inefficient system, and the spiraling cost of health care is, in turn, only fostering more uninsured each year.

Expanding Medicaid coverage is clearly part of the solution. But it would be a costly effort. Right now, it's extremely difficult for a poor adult in Maryland to qualify for government-subsidized health care. In a family of three, a parent must earn less than $6,474 annually to qualify. To raise that standard to the poverty level (an annual income of $16,600) would add tens of thousands of people to the Medicaid system, which would cost the state about $40 million a year.

But there is growing momentum for a plan that would not only finance this Medicaid expansion but enhance health care in a variety of other ways, too. This includes closing the state's growing Medicaid deficit, restoring health care services to legal immigrant children, providing tax credits to small businesses that offer health care coverage to their employees, markedly expanding access to drug treatment, and fully funding state programs that discourage the use of tobacco.

All this, proponents say, would be possible if Maryland raised the tax on cigarettes from $1 to $2 per pack.

That's a big tax increase. It would raise at least $150 million a year - and rank Maryland fourth in the nation for tobacco taxes. But the more costly cigarettes become, the better off for everyone, particularly smokers. Studies show that people are less likely to buy cigarettes as the price rises. That's particularly true for teens. And the adverse health effects of smoking account for about one in five deaths in the United States - more than HIV, automobile accidents, murders, suicides, and drug or alcohol use combined.

This would, of course, cause hardship for some. It is a brutally regressive tax. Poor people addicted to smoking may find themselves choosing between food and cigarettes (something many already do). And that's why it's important that the money not simply be dumped into the state's general fund but specifically go to health care for those who can't afford it.

This is not a perfect proposal. The future of Medicaid can't hinge on a punitive tax that - if it works as intended - will eventually produce less, not more, revenue. The size of the tax increase, the Medicaid eligibility standard, what ancillary programs are financed - all deserve to be debated. It might also be tied to a Massachusetts-like mandate to require the purchase of private health insurance by those who can afford it.

But the so-called Healthy Maryland Initiative backed by a coalition of health care advocates could prove to be an important step toward reducing the number of uninsured. The legislation ought to be among the top priorities for the incoming governor and General Assembly.

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