2:18 PM EDT, June 30, 2009

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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