After hours of testimony yesterday on ways to expand health coverage in Maryland, a key committee will turn its efforts to combining various proposals into a comprehensive piece of legislation that would likely pass the House of Delegates.
"We'll continue to work within the committee, sectioning the bills into pieces," said Del. Peter A. Hammen, chairman of the House Health and Government Operations Committee and sponsor of one of eight bills the panel reviewed at yesterday's hearing.
"We'll be looking globally at all the different issues, and we'll get to the point where we just have one bill."
A consensus bill would include elements from several proposals, but is likely to resemble the bill sponsored by Hammen.
His proposal includes an expansion of Medicaid to cover more poor adults, subsidies to moderate-income people and to small businesses to make coverage affordable, expansion of the current State Children's Health Insurance Program (SCHIP), and a requirement that higher-income individuals buy insurance or pay a tax penalty.
The Hammen bill is projected to cover 236,000 of the state's estimated 780,000 uninsured, at an annual cost of $392 million in state funds.
"It's pretty clear the House is going to pass a substantial health care expansion backed by a tobacco tax," Vincent DeMarco, president of Maryland Citizens Health Initiative, a group working to cover more of the uninsured, said after listening to the testimony.
So far, however, leaders of the state Senate and the administration of Gov. Martin O'Malley have opposed a tobacco tax increase this year. If the parties can't come together on a proposed doubling of the tax to $2 a pack, it is unclear how the state could finance expanded coverage.
The $2 tax is projected to raise more than $200 million in the first year. Hammen also hopes to help pay for his program through savings in other state programs that treat the uninsured, particularly some of the $800 million now spent on uncompensated hospital care.
"The administration shares the goals and recognizes the problems," Joseph C. Bryce, the governor's chief legislative aide, testified. But, Bryce continued, with the state uncertain how it will deal with a projected deficit next year, "We have concerns about embarking on any new spending initiative."
House Speaker Michael E. Busch made a rare appearance as a witness to testify in favor of the Hammen legislation and increasing the tobacco tax. Expanding health coverage is "a laudable goal that we ought to try to accomplish in this session," he told the committee.
Other than the question of the tobacco tax - opposed by several witnesses - the hearing produced little disagreement over the need to reduce the number of uninsured.
Some 90 witnesses signed up to testify, virtually all of them favoring some form of expansion.
Tobi Dradczyk, 40, of Walkersville in Frederick County, described her plight for committee members.
"My husband works hard and we pay taxes, but no matter how hard he works, health coverage is unaffordable." She said she was diagnosed with gestational diabetes during her last pregnancy, and received treatment under a program for expectant mothers, but now, "I don't have care. I don't go to the doctors."
She said her husband, Kevin, an apartment maintenance supervisor, gets health coverage through his job, but it doesn't include the family. Their four children are covered by the State Children's Health Insurance Program. But with a family income of about $36,000, she said, they couldn't afford premiums to insure her.
Under a bill sponsored by Hammen, she and other moderate-income Marylanders would be eligible for subsidies to reduce the premium cost, which she said she would welcome. "We're absolutely willing to pay our share," she said.
Most of the other bills use some of the same elements as the Hammen package.
Even the lawmakers who introduced them said they weren't looking to compete with the chairman's bill, and looked forward to working to blend elements of the various proposals.
The most radical of the proposals would scrap private insurance in favor of a single-payer system, a state-run insurance program that would cover all Marylanders.
"There are more and more people uninsured every year, despite these incremental changes," Dr. Richard L. Humphrey, an associate professor at the Johns Hopkins School of Medicine, who testified in support of the single-payer plan. He said money that now goes into the private insurance system would be enough to finance coverage for everyone.
Insurance expansion bills
A House Health and Government Operation (HGO) Committee yesterday held a hearing on eight bills to expand health coverage. Some would make limited changes; here are the four most comprehensive proposals:
Maryland Health Care Access Act.