Proposed fixes are both large, small

By Kristen Wyatt
Associated Press Writer

Frustration with health care -- and the growing number of Marylanders who can't afford any -- is getting attention from state lawmakers. Dozens of health-related measures are up for consideration at this year's General Assembly session, from minor tweaks to sweeping plans to boost the number of people covered by health insurance.

Maryland has between 750,000 and 800,000 residents with no health insurance, according to state estimates. That's about 14 percent of the population, and reducing that number is a priority for lawmakers and health workers.

Without insurance, many people avoid routine but pricey medical work and seek doctors only when they're very sick. That means bigger bills to be paid by the insured, who shoulder the cost of emergency care for the poor through higher premiums.

Several plans floating around the state legislature would tackle that problem by putting more people on Medicaid, which helps pay for health care for the poor and disabled. Adults in Maryland are eligible if they make less than 39 percent of the federal poverty level. That means a single adult making $4,000 a year can't qualify. Some lawmakers believe the first step to improving health care coverage is to boost the Medicaid benchmark to at least 100 percent of federal poverty guidelines, or $10,210 a year for a single adult.

The current Medicaid guidelines are a major reason the uninsured problem is growing in Maryland, said Delegate Peter Hammen, D-Baltimore, who is one of the chief backers of a health care reform plan.

"Four years ago, we had 600,000 uninsured. Today, we have nearly 800,000. The more we delay, the more uninsured we will have," Hammen said.

But it wouldn't be cheap to add people to Medicaid. Already, the state will spend about $4.7 billion this year on Medicaid. Adding more people to the tab could spike Medicaid costs at a time when state government doesn't have any cash to spare; deficits are projected in future years if spending doesn't fall.

State lawmakers tried last year to juice the Medicaid pot by passing into law -- over a veto by the Republican governor -- a plan to force Wal-Mart Stores Inc. to improve health care for its workers, a plan lawmakers hoped would reduce Medicaid rolls. But two federal courts have ruled that law illegal; currently, there are no plans to revive the Wal-Mart bill.

Hammen's plan is to start a $1-a-pack cigarette tax hike to pay for his plan to boost Medicaid eligibility to 116 percent of the federal poverty level. He doesn't have details yet, but he believes the tax could pay for the Medicaid expansion. But such a tax has been considered before without success.

Smaller plans

Other lawmakers have less ambitious plans, ideas they say could improve health care but wouldn't be as pricey as expanding Medicaid or starting universal insurance coverage.

Democratic Gov. Martin O'Malley -- who has said he doesn't want any new taxes this year -- has proposed small changes in health insurance. His legislative agenda includes a new rule requiring health insurers to cover adult dependents up to age 25, an idea aimed at reducing the number of young adults who don't have health insurance.

O'Malley also has suggested a task force to study whether Medicaid should be expanded. And he proposed an insurance exchange to help small business afford to offer insurance; it's unclear how many people this would help.

Those plans are in addition to many smaller, targeted ideas aimed at improving Maryland's health. Lawmakers are considering plans to require physical education classes in public schools and income tax credits for long-term care, among others.

In O'Malley's first State of the State address last week, he hinted that sweeping reform may not be the only tactic, saying, "health care is a battle of a thousand partial victories."

Top issue

A statewide poll released last week indicated that all the attention on health care is a sound idea for politicians. A telephone survey of 809 registered voters showed that one in five named "health care costs/access" as the most important issue facing Maryland. That narrowly topped the perennial top issue, education. The survey had a margin of error of plus or minus 3.5 percent.

Joe DeMattos, state director of the Maryland AARP, said lawmakers are being forced into action because public worries about health care are so high. His group advocates the tobacco tax hike and universal insurance. He wasn't sure whether lawmakers would be able to pass a sweeping reform this year, but he said it's imperative they try to address the problem

"It's too soon to say whether comprehensive or targeted health care reform will pass this year, but it's not too soon to say the cost of inaction is incredibly high," DeMattos said.

Doctors agree. MedChi, the Maryland State Medical Society, is also pushing for the tobacco tax to pay for health care.

"We are in support of any reasonable effort to expand access to health care," said the group's executive director, Dr. Martin Wasserman. The group also would like to see lawmakers work on what Wasserman called an "impending crisis" of a doctor shortage in Maryland.