A Healthy Start

Our View: Medicaid Expansion Has Helped 44,000, But More Must Be Done

July 01, 2009

At a time when some cash-strapped states are contemplating reducing Medicaid coverage, Maryland has boldly moved in the opposite direction. Today marks the first anniversary of a program that has brought taxpayer-financed medical assistance to more than 44,000 low-income parents, the vast majority of whom lacked health care before.

That's nearly 20,000 more people than advocates had expected to enroll by now, and it's one of the more significant accomplishments of Gov. Martin O'Malley's term in office. Previously, Maryland was among the stingiest states in the nation in terms of providing medical care for poor adults, and now it's closer to the national average.

Why underwrite health care for the poor? The most obvious justification is to ensure that everyone has access to decent and affordable medical care. But that's far from the only reason.

Another critical one is to simply save money for the rest of us. Regular check-ups at a doctor's office or clinic are a lot less expensive than trips to a hospital emergency room, which is exactly what happens when medical problems are ignored and allowed to worsen into full-blown health crises. Who pays for that? Such uncompensated care is built into hospital rates charged to the insured and financed by employers and workers.

No matter how President Barack Obama and Congress choose to reform health care in this country, expanded Medicaid coverage is likely to play a crucial role. The expansion in Maryland - approved by the state legislature two years ago - is intended to continue so that all working people earning up to 116 percent of the federal poverty guideline can receive benefits, and not merely those with minor children.

But the recession has caused that element of the plan to be deferred. Even when the economy recovers, the program will require a source of funding to avoid further (and perhaps even permanent) delay.

One possibility is to raise the state tax on alcohol, which is now among the lowest in the nation. Advocates say a tax increase that amounts to about 10 cents per drink would raise $200 million annually. That, along with the savings from less uncompensated care, could foot the bill - but a tax increase of most any kind has a frozen daiquiri's chance in Hades of passing in 2010, an election year.

So while health care advocates can rejoice at the success of their efforts so far, the job is far from complete. An estimated 750,000 Marylanders lacked health insurance as of last year. With this new program, that number would still be more than 700,000, even without taking into account the number who may have lost employer-based insurance because of the recession. Enrolling 44,000 amounts to a good start, but there's still a long way to go.

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