Care Coverage

Maryland's first-in-the-nation law to compel Wal-Mart to spend more on employee health care suffered another setback yesterday, providing fresh incentive for legislative leaders in Annapolis to explore ways to boost insurance coverage that do not involve the retailing giant. The U.S. Court of Appeals for the 4th Circuit upheld a lower court finding that struck down Maryland's legislation. A divided three-judge panel ruled that the state's Fair Share Health Care Act was incompatible with federal rules that promote uniform treatment of employees.

The Maryland Senate approved legislation yesterday that would expand government-funded programs to provide medical coverage to more of the state's 800,000 uninsured, boosting the measure's chances just months after a similar proposal died in that chamber. The Senate voted 30-17 to pass the bill, which was championed by Gov. Martin O'Malley, and the House of Delegates is expected to act on heath care legislation in the coming days. Both versions would allow more adults to be eligible for Medicaid, the state-federal health insurance program for the poor, and extend insurance premium subsidies to small businesses and their employees.

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.

THE ERA of the Health Maintenance Organization is coming to an end. No doubt many Americans will cheer, just as they did when the Helen Hunt character in the 1997 film "As Good as It Gets" forcefully denounces the HMO industry.But if HMO coverage is bad, no coverage is worse. And a government takeover of all health care, still the enduring dream of many, would be the worst outcome of all.According to a recent study by the William M. Mercer consulting company, the percentage of workers enrolled in health maintenance organizations and point-of-service plans fell in 1998, after rising steadily for years.

WASHINGTON -- The battle over managed care reform began in earnest yesterday when House Republican leaders unveiled a far-reaching proposal to provide new rights for patients, ensure access to specialists and lower the cost of health care.The proposal was driven by a popular outcry against managed care that threatens to make it the hottest issue of this congressional election year.Pushed by their rank-and-file, GOP leaders reversed course from opposing any federal legislation to embracing a surprisingly broad proposal that could change the face of the U.S. health care industry.

Having succeeded in extending health care coverage to millions of children, the White House and some members of Congress are now turning attention to another group of uninsured Americans -- the 3 million who are 55 to 64 years old.The people in this age group, called the "near elderly," are too young for Medicare, the insurance program for those 65 and over, and not poor enough for Medicaid, the program for the indigent and disabled. Many have chronic illnesses such as diabetes, high blood pressure, ulcers and bladder and kidney conditions that require extensive and costly care.

THOSE OF US who came of age before the Seventies remember pulling our car into a service station and having an attendant fill the tank with gasoline, check the oil and clean the windshield.Many of us rebelled when self-service pumps were first introduced. Two decades later, however, we fill our tanks, check our oil, clean our windshields and even process our credit card transactions ourselves with nary an attendant in sight.Remember the first time you used the automatic teller machine at your bank?

All Americans should have the right to health coverage, and it is everyone's moral responsibility to guarantee that right, a leader of a national religious coalition told a group of parishioners in Savage last week."

WASHINGTON -- At a time when most of the momentum around health care reform seems to be directed toward slowing down and trimming back the costs of the new insurance program, a consensus is quietly building for one expensive new benefit.Home health care coverage for the elderly and disabled, which only recently seemed like a luxury Congress could not afford, is now given a reasonable chance of being included in some form in the version of the health care bill that comes up for a final vote this fall.

Reform means universal coverageDuring a three-year intensive study, League of Women Voters members examined the delivery and financing of health care in the United States.They found a system in crisis: 37 million Americans without health insurance; one of every four Americans expected to be without coverage at some point over the next two years; 20 million more Americans with inadequate coverage; and skyrocketing health-care costs, rising at twice the rate of inflation.Americans are spending $1 out of every $7 we earn on health care.

Health care advocates said Monday that they had met their goal of adding 10,000 Baltimore residents to Medicaid rolls since the state expanded coverage and lowered eligibility requirements last year. Vincent DeMarco, president of the Maryland Citizens' Health Initiative, said that statewide, 50,000 adults have benefited from the new state health care expansion since it took effect in July of last year, and that 50,000 more children who were eligible for insurance but not yet covered have been enrolled since 2007 because of the O'Malley administration's outreach program and efforts by health care advocates.

On Labor Day, workers are struggling As we celebrate Labor Day, we must also recognize that a large segment of Baltimore's workforce is struggling to provide for themselves and their families. One in five workers in Baltimore is employed in health care. But health care workers make up a large percentage of Baltimore's uninsured working poor. They earn some of the lowest wages for urban health care workers in the country, and many struggle to pay for health care coverage for themselves and their families, or just go without.

Our national experience with the Medicare program can provide guidance to the choices our legislators must make regarding health care reform. If one favors more or less government in health care, positive and negative lessons emerge from the nearly 50-year Medicare experience of providing universal health care coverage for all those age 65 and older. Medicare eliminated the fragmented, episodic and often dehumanizing care that many retired seniors were forced to seek through emergency departments or charitable sources because they no longer had coverage from an employer.

As presidents of three Maryland black chambers of commerce, our goals include promoting economic stability while eradicating barriers to growth within Maryland's black- and minority-owned business community. But it is difficult to promote economic stability while insurance costs are skyrocketing. The Maryland Health Care for All! plan ( www.healthcareforall.com) offers a solution that is both fair and practical. Two-thirds of Maryland workers enjoy company-sponsored health insurance, but our members are being forced to cut back on these benefits.

Hospitals often wind up with stacks of unpaid bills because of the lack of universal health insurance coverage in this country. And certainly, no one likes to receive a letter or call from a bill collector or go to court over a hospital charge. Yet hospitals can only survive if bills get paid. That was one of several key points missing from The Baltimore Sun's series "In Their Debt" (Dec. 21-23). At the same time, hospitals aren't anxious to litigate. Few disputes make it to court: less than 0.5 percent of all hospital bills.

Expanding Medicaid still fiscally responsible With budgets on the chopping block, one area the state should not cut is health care coverage ("'Devastating' state revenue report may mean cuts in public safety, education," Dec. 17). Here's why: As Maryland expands Medicaid coverage including preventive care, data from other states are showing that expanding health insurance can lead to costs savings down the road. Massachusetts adopted an ambitious program in 2006 that provides incentives for business and individuals to expand health insurance coverage.

Market cannot cure what ails health care As a practicing physician for almost 40 years, I read with sheer incredulity the column "Cut health costs through market innovation" (Commentary, Oct. 7). The column advocates "using innovation to make health care cheaper and more accessible." But the basic reasons U.S. health care costs continue to rise each year at an alarming rate are the fact that we have an aging population and the continuing introduction of new, high-tech procedures and medications.

Soldiers' stories tell a brutal tale Thanks for publishing the column "Winter soldiers" by Madeleine Mysko (Opinion Commentary, March 19). As we enter the sixth year of the war in Iraq, it is important that newspapers such as The Sun let the public hear the horrifying words of those who have returned from the front lines, the winter soldiers. I appreciated how Ms. Mysko, a former second lieutenant in the U.S. Army Nurse Corps, wove her story from the Vietnam era with the testimony of a veteran of the Iraq war, Jason Hurd of the U.S. Army, who spoke along with other veterans, their parents and friends last weekend in Silver Spring.

All this election year talk about health care seems to be about extending it to people who don't have it: children and the working poor. But I wish a candidate would talk about people who have health care, but feel it slipping away like a greased watermelon. Like me. When my husband and I started in this working game, our companies each covered both of us. What the primary coverage didn't pay for, the secondary coverage did. I think I may have turned a profit on the birth of my first child.

The people of Maryland should be very proud of their leaders for making 2007 the year of public health in Maryland, which despite its wealth has traditionally been among the worst states at providing health insurance for poor adults. The General Assembly this year passed four new laws, which will: Require all workplaces and public places to be smoke-free. Increase the state tobacco tax by $1 per pack. Allow young adults to stay on their parents' insurance plans. Provide health care coverage for many lower-income adults.