Gov. Martin O'Malley wants to make more people eligible for health care through the Medicaid program, a move that could cost the state millions at a time when it is facing a projected $1.5 billion budget shortfall.
Maryland makes it difficult for an adult to qualify for Medicaid. A working parent in a family of three has to earn less than $6,288 a year, about half the pay of a full-time worker earning the minimum wage. In Pennsylvania, the limit is $33,200.
"You have to be very, very poor indeed to be on Medicaid in this state," O'Malley said in a recent interview, saying he would like to expand the program.
Since the late 1990s, Maryland has tried to include more children in Medicaid through the Children's Health Insurance Program, and the state now covers them in households earning up to 300 percent of the federal poverty level, $51,500 for a family of three. But the parents of those children are rarely eligible for Medicaid, and adults without children can't get into the program unless they are blind or disabled.
With states such as Massachusetts and Vermont enacting universal health care plans, an attempt to cover more adults became one of the marquee issues of this year's General Assembly session. A coalition of health care advocates pushed a $1-a-pack increase in the tobacco tax through the House of Delegates as part of a proposal to offer coverage to an additional 100,000 people. The proposal died in the Senate.
O'Malley has not offered a specific plan for expanding Medicaid, but he lent his support to the concept while he is grappling to find solutions for the projected budget shortfall. The prospect that he might seek Medicaid changes at the same time thrills advocates for government-subsidized health care.
"It's great news for the people of Maryland," said Vincent DeMarco, president of the Maryland Citizens Health Initiative, one of the chief advocates of increasing the tobacco tax to benefit health care. "Thousands of Marylanders can't get the health care they need, and everyone pays through the hospitalization of the uninsured."
Critics say it makes no sense to expand one of the biggest reasons for the state's precarious financial position, particularly given more innovative health care expansion plans that have been tried in other states, ones that offer consumers more choice than Medicaid does.
Even without expanding the program, Maryland will spend about $2.5 billion, more than 15 percent of its general fund, on Medicaid this year. Spending on the program is expected to increase 6.9 percent a year, twice as fast as the projected growth in state revenue.
"It's expensive, and there's also the question of the quality of care people receive under the Medicaid program," said Sen. E.J. Pipkin, an Eastern Shore Republican who has proposed market-oriented health care reforms.
"The goal should be that people make their own decisions about their own health care rather than having the government make decisions for them."
People who want to expand Medicaid say it ought to serve people such as Curtis Brown, a 55-year-old West Baltimore man whose tendinitis forced him to give up a career as a welder. He also has high blood pressure, diabetes, stomach problems and dental problems.
Another state program covers some basic primary care, but Brown said it is not nearly enough. It doesn't cover most of his medications, and when he has had to go to the hospital, it hasn't covered him at all, leaving him with tens of thousands of dollars in medical debt.
"Sometimes I feel good, and sometimes I can barely walk, so if I got a job, it would probably have to be sitting down or something like that," Brown said. "I did get some medication one time to help the tendinitis, but the program doesn't cover your whole [cost], and I just don't be having the money for that. ... I think all my problems could be probably at least manageable through better medical."
Medicaid has been an attractive program for states to expand because they split its cost with the federal government. Relatively affluent states, including Maryland, pay half of the cost of their Medicaid programs, and poorer states pay less.
The greatest expansion in recent years has been in the coverage of infants, children and pregnant women through the Children's Health Insurance Program, which states have expanded so much that it has become more costly than originally expected, making its reauthorization the subject of intense debate in Congress.
Coverage for children
Maryland is one of the leading states in covering children through the CHIP program.
Nearly all states in the Northeast - including Delaware and Pennsylvania - have also expanded Medicaid eligibility for adults. The maximum income for working parents in a family of three to qualify is $17,680 in Delaware and $33,200 in Pennsylvania under a combination of state and federal programs. Maryland's $6,288 limit is similar to those in Virginia and West Virginia, which are $5,124 and $5,992, respectively.