Md. universal health care plan wins backing from black chambers of commerce
Baltimore Business Journal - by Julekha Dash Staff
Wednesday, May 27, 2009

Three black chambers of commerce have endorsed a universal health care plan that had been criticized by business groups for placing too heavy a financial burden on companies.

The Greater Baltimore Black Chamber of Commerce, the Prince George’s Black Chamber of Commerce, and the Black Chamber of Commerce of Anne Arundel County Inc. said Wednesday they support the Health Care for All Plan. The plan is spearheaded by Vincent DeMarco, president of the Maryland Citizens’ Health Initiative.

DeMarco’s universal health care proposal includes a 2 percent payroll tax on businesses — a provision that several business groups, including the Maryland Chamber of Commerce, have come out against.

But the three chambers said the health plan will be good for business.

“Small businesses cannot remain competitive when employers are unable to provide the health care benefits that are necessary to attract and retain talented employees,” leaders of the three organizations said in a joint statement.

The chambers said that the 2 percent payroll tax increase will be offset by lower health insurance premiums.

The support for the plan comes as state and national business leaders and politicians debate how to cover the 46 million Americans who lack health insurance. In Maryland, there are more than 800,000 individuals who lack health insurance.

Advocates claim success for Medicaid outreach
10,000 city residents added to rolls under new state rules

By Joe Burris | joseph.burris@baltsun.com

October 27, 2009

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. The state initially projected that the Medicaid rolls would increase by about 25,000 residents when coverage was expanded.

In July 2008, Maryland extended Medicaid eligibility to adults who have children and whose household income is 116 percent of poverty, or $20,500 for two parents with one child. Previously, the cutoff for parents was 40 percent of the poverty level, so the same family would have had to make less than $7,000 per year to be eligible.

Melanie Townsend Diggs, who spoke at a news conference Monday, enrolled in July of last year, nine months before the birth of her daughter, Eden. The coverage enabled her to get the health care she needed during the pregnancy.

DeMarco said the program expansion has improved the state's coverage of adults. "Last year Maryland went from 44th in the country to 21st in health care coverage for adults," he said.

The recent expansion is a byproduct of Gov. Martin O'Malley's Working Families and Small Business Health Care Coverage Act of 2007. It was funded in part by the state's $1-a-pack cigarette tax increase.

Analysts originally estimated that the expansion would cost $94.6 million in federal and state money yearly, but the amount was subsequently raised to $144.6 million. Tricia Roddy, director of Medicaid planning for the state health department, said officials are analyzing whether the estimate will go higher. Funding the expansion, she said, came from a number of sources.

DeMarco said his group is proposing an additional 75-cent increase in the cigarette tax and a 10-cents-per-drink increase in the alcohol tax to fund more of the program. He said that the next step is to ensure that the coverage is expanded to childless adults.

But state Sen. David R. Brinkley, a Frederick County Republican, said that if cigarettes and alcohol are taxed too much, "people go somewhere else to buy it. Case in point: Virginia and West Virginia. We are losing revenue in that regard."

John G. Folkemer, a deputy secretary for the state Department of Health and Mental Hygiene, said that the small-business component of the act began last October, and since then more than 200 small businesses have signed up to participate with more than 1,000 employees enrolled with their families.

Mayor Sheila Dixon said she made it a point to inform residents throughout the city that health care coverage is available.

"Being healthy makes a huge difference in so many aspects of people's lives," Dixon said.

www.baltimoresun.com/health/health-care/bal-md.hs.medicaid27oct27,0,1765097.story

Copyright © 2009, The Baltimore Sun

Vincent DeMarco, president of the Maryland Citizens' Health Initiative, attributed the decline almost entirely to the legislature's decision during a 2007 special session to raise the tobacco tax from $1 to $2 per pack.

From a revenue perspective, the higher tax more than offset the drop-off in sales. In the year after the increase took effect, tobacco tax collections on cigarettes increased from $273.8 million to $418.0 million.

That's less than state fiscal analysts had anticipated, but the money helped fund an expansion of subsidized health care to more than 47,000 newly insured Maryland adults.

"This was a big success," DeMarco said. This shows that the dollar tax increase did exactly what public health advocates predicted."

In July 2008, The Washington Post reported that cigarette sales dropped by nearly 25 percent during the first six months that the tax increase was in effect. At the time, there was a good deal of speculation that smokers were picking up extra packs in lower-tax jurisdictions, including Virginia, Delaware, Pennsylvania and the District.

Data on that theory are inconclusive. DeMarco said that purchases across state lines probably have not been widespread, given that cigarette sales dropped in Delaware and the District during that period and that the District raised its tax to $2 in October. Modest upticks in sales have occurred in Virginia, where the cigarette tax is 30 cents per pack, and Pennsylvania, but nothing approaching the magnitude of Maryland's decrease.

Data shared by DeMarco's group run through last year. In the early months of this year, sales in Maryland were back up slightly, according to numbers kept by the comptroller. That was probably in anticipation of a federal tobacco tax increase of 61 cents that took effect April 1, analysts say. Since then, Maryland sales have started dropping off again.

DeMarco's group is pushing the General Assembly to raise Maryland's tax again, by 75 cents, to further expand health care in the state. With election season around the corner, that seems like a long shot for the coming session.

Advocates for medical change in Maryland get endorsed by Wicomico Democratic Club

By Deborah Gates
Staff Writer

SALISBURY -- Advocates for health care reform in Maryland picked up an endorsement from the Wicomico Democratic Club while on the Lower Shore this week to win support for a proposal that would impose cigarette and business payroll taxes to finance expanded affordable health insurance coverage for state citizens.

A $1 per pack tax increase a year ago raised an additional $144 million to cover health care costs for close to 50,000 more uninsured Maryland residents. Now, Health Care for All -- a health reform advocacy group -- wants the per-pack cigarette tax increased again, this time by 75 cents -- a source for an additional $60 million to fund coverage for more uninsured Maryland residents, including 100,000 or more with children, said Vincent DeMarco, president of Maryland Citizens' Health Initiative, a division of Health Care for All. A 2 percent employer payroll tax on wages under a FICA cap would, over five years, contribute $13.2 billion toward state health care coverage, DeMarco said.

The proposed state plan would move forward regardless of the outcome of controversial national health care reform bills steeped in debate in Washington, DeMarco also said. State measures would either fill gaps in an approved federal plan, or worse, kick in with low-cost, quality insurance coverage if the federal bill failed, he said.

The Health Care for All plan, among other things, would:

Create an insurance pool by merging individual and small-group markets and provide premium subsidies for low-income residents.
Provide catastrophic reinsurance benefits that would cover 75 percent of health costs over $35,000 for those currently uninsured and those with private insurance.
"We have to make health care affordable to everyone, especially to small businesses and individuals," DeMarco told an audience of about 20 people at a gathering this week of the county Democratic Club. “A federal bill will help a lot of people, but not all. We want to finish the job. Whatever they do at the federal level, there will be measures (also) at the state level.”

Attending the meeting was Delegate Norman Conway, D-38B-Wicomico; Wicomico County Executive Richard Pollitt; County Council member David MacLeod and Salisbury Mayor Jim Ireton.

Ireton, citing the hundreds of civil rights, labor, religious and business groups endorsing the Health Care for All plan, called the Wicomico Democratic party’s endorsement, “a natural step.”

Faced with unpalatable program cuts, legislators see alcohol, tobacco as possible revenue sources

by Sean R. Sedam | Staff Writer

Legislators are not ruling out increases in so-called sin taxes on alcohol and tobacco to prop up programs that have suffered during the state's ongoing budget crunch.

Such taxes have been at the heart of attempts in recent years to fund services for the developmentally disabled and to expand health care coverage for the needy.

Now, with services for the disabled sustaining $24 million in cuts, as part of the $735 million in budget reductions by the state Board of Public Works this summer, and with health care advocates looking to restart a stymied expansion of Medicaid, legislators say they are not ruling out raising taxes on alcohol and tobacco.

Cognizant of the 2010 elections, legislative leaders have said no to new taxes. And rank-and-file members agree that taxes are unpalatable.

"However, that being said, there may be a few targeted revenue increase measures that we may be able to take," said Sen. Mike G. Lenett (D-Dist. 19) of Silver Spring.

"One might be the alcohol tax," he said. Earlier this month, Lenett sent a letter asking Gov. Martin O'Malley (D) to, "reconsider the latest cuts and restore funding to protect adults and children with developmental disabilities and resist any further such cuts."

With the Board of Revenue Estimates on Thursday revising tax revenue forecasts for fiscal 2010 downward by $683 million, more cuts are all but assured; with or without new revenue.

The impact of such cuts was evident at the Board of Public Works on Wednesday, where the planned February closing of the Upper Shore Community Mental Health Center took center stage. The closing of the Chestertown center, as part of the $454 million in budget cuts made last month, was expected to save the state about $8.4 million annually and include 90 job losses.

Lawmakers who represent the area said the planned shuttering of the center has generated concern that there is not enough private capacity in the rural region to transfer uninsured patients from state-run facilities.

Advocates for mental health and people with developmental disabilities have been vocal since the Board of Public Works slashed by 2 percent aid to community service providers, many of whom were already cash-strapped after years of inadequate funding.

This year, Sen. Richard S. Madaleno Jr. (D-Dist. 18) of Kensington and Del. William A. Bronrott (D-Dist. 16) of Bethesda sponsored a bill that would have used a 5-cent-per-drink alcohol tax to generate an estimated $80 million a year for services for people with developmental disabilities and drug and alcohol addictions.

The bill failed to receive committee votes in either chamber. Madaleno expects an "uphill battle" when he introduces the bill again in 2010. Given the bleak fiscal outlook, a sin tax "might be more palatable to some of my colleagues who are prone to support them," he said.

But he doesn't expect to get the support of anti-tax conservatives. “To those who want to run on a mindless anti-tax platform, one tax is just as evil as the next,” Madaleno said

That has not deterred health care advocates from continuing to push alcohol and tobacco tax increases as a way to expand Medicaid coverage.

Maryland increased its cigarette tax by $1 per pack as part of an expansion passed during the 2007 special legislative session.

The increase led to 74 million fewer cigarette packs being sold in Maryland in 2008, according to the Maryland Citizens' Health Initiative. The Medicaid expansion that the tax revenue funded resulted in 47,000 more Marylanders gaining health care coverage.

"The successes indicate we should continue to use alcohol and tobacco taxes for public health goals," said Vincent DeMarco, president of the Maryland Citizens’ Health Initiative.

DeMarco's group plans to again push legislation that would expand health care, in part through a 75-cent-per-pack increase to the cigarette tax and substantial hikes to taxes on beer, wine and distilled spirits that have not risen in 37 years.

Advocates say the dual benefit is that the increases would raise awareness of the health consequences of alcohol and tobacco consumption and would lead to fewer people drinking and smoking, all while raising revenue for health care.

Critics say the tax model leads to decreased revenues for health care as sales decline, and that the taxes unfairly target individual products.

Indeed, the Board of Revenue Estimates on Thursday reduced its estimated tobacco tax revenue by $18 million. BRE Director David Roose attributed the downward revision to higher state and federal taxes on cigarettes, as well as the long-term trend of people kicking the habit.

As revenue goes down, lawmakers will look for other products to tax, said Nick Manis, whose lobbying firm represents both Reynolds American Inc. and the 24-member Maryland Beer Wholesalers Association.

Services for the developmentally disabled should not be paid for through increased alcohol taxes, Manis maintained.

"It should be funded by the general fund" he said.

Staff Writer Alan Brody and Bobby McMahon of the Capital News Service contributed to this report.

So even though the full-time sales clerk from Baltimore could get health insurance from his employer, RadioShack, Stokes figures he can find far better ways to spend his cash.

Health problems "aren't coming up yet, so it's not much of a priority," he said.

In the debate over health care reform, Stokes and his peers are known as "invincibles," strong and healthy young adults who have no experience with wallet-crippling illness and feel they have no need for coverage.

They're also the most likely to be affected by the reform effort that President Barack Obama insisted in Wednesday's prime-time address to Congress is crucial to the future of the economy.

Adults ages 18 to 34 comprise more than half of the nation's uninsured. Under the various plans before Congress, they would be required to get health insurance or face penalties if they refuse.

While young adults supported Obama in huge numbers during last year's election, they have been relatively quiet about his quest for health reform despite the stakes involved. Noisy town hall meetings last month drew older crowds. Polls show that young adults are ambivalent about the need for reform and are generally paying less attention than their parents and grandparents. It is unclear whether Obama's address swayed many of them.

"Many folks in their 20s are pretty apathetic about health care in general, because they think, 'I'm not going to get sick,' " said Matthew Celentano, deputy director of the nonprofit Maryland Health Care for All.

That's dangerous, he said, because more than half of bankruptcies are health care- related. "You have a 23-year-old who gets in a car crash and is suddenly looking at $500,000 in medical bills. It happens all the time, but they don't think in those terms. They're really a forgotten sector."

The disconnect worried Jovany Andrade enough that he helped organize a health care forum at the University of Maryland, Baltimore last week. The 30-year-old pharmacy and public health student recalled his own indifference to health issues during his undergraduate years.

"I think we're going to look back in 10 years and realize this was a historic time," he said.

Insurance companies are hungry to sign up invincibles: Premiums of young people who don't need much care mean money that can be spent on those who do.

While some analysts say mandated insurance would place financial burdens on the young and healthy, others say they would be helped by proposals to subsidize those with lower incomes and to allow them to be covered longer under their parents' health plans.

Stokes, for one, would not be upset if Obama's plan mandated that he buy health insurance. He knows he needs to grow up a bit and take responsibility for himself - and being insured would be a step in that direction.

"I've known that's something I need to take seriously, so I'm glad he's enforcing it," Stokes said. "I wouldn't mind."

However, many young adults say they have gone uninsured or minimally insured out of necessity, not choice. Many entry-level jobs do not offer insurance, and private plans are expensive. Presented with a choice between crippling their budgets and betting that they will remain healthy, young adults reluctantly go without insurance.

More than one in four adults between ages 18 and 34 were without health insurance in 2008, according to a census report released Thursday. They account for 55.1 percent of uninsured Americans, and the percentage is growing, up from 53.8 percent a year earlier.

When Chaundra Scott graduated from college, her mother's insurance dropped her and she could not afford COBRA coverage. The Hanover native found a social work job, but it offered no health benefits. So for three years, she went uninsured.

Scott suffers from asthma and eczema and said that while uninsured, she had to go to the emergency room four or five times a year for treatment.

"The debt piled up from me not paying my bills," she said.

Scott looked into private insurance but found that many carriers would not accept her because of her chronic conditions. Others were prohibitively expensive.

"It was a very difficult time," she said.

Scott, 27, is now a student at the University of Maryland School of Social Work and has health insurance. But her credit rating is still hurt by the debt she accumulated while uninsured. She favors mandated health coverage because she does not want others to share her experiences.

"I like the idea of everyone having insurance," she said.

Her classmate Sonali Nijhawan isn't so sure. It would be nice if everyone had good health insurance, Nijhawan said, but mandates give her pause.

For years, Nijhawan carried low-cost insurance in case of catastrophe but was reluctant to use it because of high co-payments. She did not see a local doctor when she hurt her shoulder or when she was banged up after being hit by a car. She relied instead on telephone advice from her uncle, a physician.

Now that she has insurance, Nijhawan, 26, goes for checkups every six months and calls her doctor when she feels sick. She laughed when thinking about the risks she took while carrying minimal insurance.

"Whatever. I don't need it. I won't get sick," she said of her mentality in those years. "My parents, they were the ones who were very anxious about it."

Nate Mook is just 27, but his growing online technology publication, BetaNews, already has 10 employees around the country. Last year, the Baltimorean tried to get group health insurance for his small business, figuring that it was the right thing to do for his mostly young workers, only to learn how difficult and expensive the undertaking would be.

When he first tried, the wife of an employee was pregnant - a pre-existing condition that would have made everyone's premiums soar. When Mook tried again, he had a 63-year-old employee whose age would have skewed premiums. In the end, he paid his employees a little extra to buy their own insurance.

Now, many of his employees are just like he is: young, healthy and underinsured. Mook pays about $150 a month for his high-deductible policy, which covers one dental visit a year and has other limited benefits. He tries not to think about what would happen if he got sick.

He supports Obama's call for everyone - especially those in his age group - to get insurance. "We don't let people drive on the road without car insurance," Mook said. "Obviously, it's your personal health and it's up to the individual, but if it's a low-cost option ... having a little bit of an upfront requirement for cost will improve the system for everyone."

Evidence from national opinion surveys is mixed on the degree to which younger Americans are embracing Obama's biggest domestic initiative, which the president is attempting to jump-start this week.

A Gallup poll completed this month showed respondents ages 18 to 34 evenly split when asked whether they wanted their representative to vote for "a health care reform bill," offering less support than Americans ages 35 to 54 who might also be among those likely to feel squeezed by health care costs

Another national poll, completed about the same time by the Pew Research Center, found that those younger than 30 were more likely than other Americans to favor "the health care proposals being discussed in Congress."

Young adults (younger than 30) were also more likely than other Americans to say that both they and the country would be better off if the Democratic proposal became law, the Pew poll found.

The survey also found that young adults were less likely to be following the health care debate closely. Only about 1 in 3 adults younger than age 30 said they had heard a lot about health care, compared with a clear majority of those older than 30, according to the Pew poll, completed in late August.

Suzanne Gilbert, 25, a Celentano colleague at Maryland Health Care for All, said she has friends who have put off having babies because they cannot afford health insurance. Another uninsured friend recently paid $5,000 after having an appendix removed. Despite such examples, she said the health care debate leaves many young adults confused.

"You're used to your parents taking care of it and you don't really know how it impacts you," Gilbert said. "Then you realize how hard it is to find an affordable option. We're used to just Googling something and having the answer be right there for us. But you can't Google this."

By Childs Walker, Stephane Desmon, and Paul West

Baltimore Sun, September 11, 2009 

Cigaratte Sales Remain Down in Maryland

A leading health-care advocacy group in Maryland is preparing to tout numbers showing a sustained drop-off in cigarette sales since the state doubled its tobacco tax in January 2008.

In Maryland, 201.8 million packs of cigarettes were sold during 2008, down from 275.7 million in 2007 and 273.4 million in 2006, according to data gathered from the Maryland Comptroller's Office.

Vincent DeMarco, president of the Maryland Citizens' Health Initiative, attributed the decline almost entirely to the legislature's decision during a 2007 special session to raise the tobacco tax from $1 to $2 per pack.

From a revenue perspective, the higher tax more than offset the drop-off in sales -- in the year after the increase took effect, tobacco tax collections on cigarettes increased from $273.8 million to $418.0 million.

That's less than state fiscal analysts had anticipated, but the money helped fund an expansion of subsidized health care to more than 47,000 newly insured adults in Maryland.

"This was a big success," DeMarco said. "This shows that the dollar tax increase did exactly what public health advocates predicted."

In July 2008, The Post reported that cigarette sales dropped by nearly 25 percent during the first six months the tax increase was in effect. At the time, there was a good deal of speculation that smokers were picking up extra packs in lower-tax jurisdictions, including Virginia, Delaware, Pennsylvania and the District.

The data on that is inconclusive. DeMarco argued that purchases across state lines likely have not been widespread, given that cigarette sales have dropped in both Delware and the District during the same period, and that the District raised its tax to $2 in October. There have been modest upticks in sales in both Virginia (where the tax rate is only 30 cents) and Pennsylvania, but nothing approaching the magnitude of Maryland's decrease.

Data shared by DeMarco's group runs through 2008. In the early months of 2009, sales in Maryland were back up slightly, according to numbers kept by the Comptroller. That likely was in anticipation of a federal tobacco tax increase of 61 cents that took effect April 1, analysts say. Since then, Maryland sales have started dropping off again.

DeMarco's group is pushing the General Assembly to raise Maryland's tax another 75 cents to further expand health care in the state. With election season around the corner, that seems like a long shot for the coming session.

Washington Post.com By John Wagner |  September 9, 2009; 10:45 AM ET

2:18 PM EDT, June 30, 2009

Here's a preview of an editorial we're working on. Let us know what you think, either by using the comment tool below or by sending an e-mail to talkback@baltimoresun.com We'll print the best comments alongside the editorial.

At a time when some cash-strapped states are contemplating reducing their Medicaid coverage, Maryland has boldly moved in the opposite direction. Today marks the one-year anniversary of a program that has brought taxpayer-financed medical assistance to 40,000 previously uninsured low-income parents.

That's about 15,000 more people than advocates had expected to enroll one years ago and it's one of the more significant accomplishments of Gov. Martin O'Malley 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 all Marylanders have access to decent and affordable medical care. But as compassionate and laudatory a purpose as that might be, it'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 their employees.

No matter how President Obama and Congress choose to reform health 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 ? and now that number may be closer to 700,000. That amounts to a good start.

Copyright © 2009, The Baltimore Sun