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Text: Working to win quality, affordable health care for all Marylanders

Health Care for All! Plan Specifics

The Health Care for All! Coalition has been working since 2000 to expand access to quality affordable health care for all Marylanders. What follows below was a recommended course of action to achieve that goal developed in partnership with our coalition partners in communities across the state and experts based at the Johns Hopkins Bloomberg School of Public Health. This plan was released in 2008.

The passage of the Patient Protection and Affordable Care Act in March 2010, greatly advanced many specific policy initiatives recommended by our state-specific plan including further expansion of Medicaid and the creation of an Maryland Health Insurance Pool, or what is now known as the Maryland Health Connection.

Other aspects of this plan that emphasize the importance of high-value and low-cost care for consumers remain at the forefront of our work. For more information on this specific work, check out our page on health system transformation.


Full Technical Proposal (Slideshow)

Plan Outline

The first section of this proposal describes reforms to the financing and organization of health insurance coverage in the state, including a mandate that all residents obtain coverage. We propose to:

  • Create the “Maryland Health Insurance Pool” to make insurance affordable by both merging the individual and small group markets and providing premium subsidies for lower-income residents;
  • Provide a “Catastrophic Reinsurance” benefit that covers at least 75% of high annual health spending over $35,000 for all currently uninsured and privately insured residents; and
  • Expand Medicaid eligibility for non-parents up to 200% of the federal poverty line and parents up to 300% of poverty in a better coordinated “Healthy Maryland” program.


The second section describes reforms to the delivery of health care in the state of Maryland meant to improve quality and cost efficiency. We propose to:

  • Create the “Maryland Institute for Clinical Value” which will implement a “value based” insurance design that emphasizes the provision of care with well-established cost-effectiveness;
  • Support projects, in large part based on electronic health records, that will improve the coordination and effectiveness of care for persons with chronic conditions; and
  • Emphasize culturally appropriate prevention and health promotion to improve overall public health and reduce health disparities.



third section 

describes the financing of this proposal. We propose new revenue sources to fund all additional spending so that there is no use of the state’s general funds. We estimate that the plan would have:
  • Total costs to the state of about $15.5 billion over five years from FY 2010 to FY2014, comprised of about $4.3 billion for low-income subsidies and other costs in the Maryland Health Insurance Pool, about $7.6 billion for the Catastrophic Reinsurance program, about $3.1 billion for the Healthy Maryland Medicaid expansion, $166.0 million for the Maryland Institute for Clinical Value, and $407.5 million for prevention and promotion activities; and
  • Total revenues of about $15.5 billion over five years, comprised of about $13.2 billion from a 2.0% employer payroll tax on wages under the FICA cap, about $1.0 billion from an increase in the alcohol tax, $516.4 million from increased taxes on cigarettes and other tobacco products, $150 million from the tobacco settlement bonus payments, and $590.7 million re-allocated from the state high risk pool.