Md. Pushes Expansive Medical Coverage

By Lisa Rein
Washington Post Staff Writer
Wednesday, January 31, 2007

Maryland lawmakers are drawing up ambitious proposals to provide medical insurance to hundreds of thousands of residents without coverage, stepping into the national debate over who should pay the soaring costs of health care.

Gov. Martin O'Malley (D) will call for expanded coverage of the state's 780,000 uninsured -- one in seven residents -- in his State of the State address today, aides said, highlighting a proposal that would bring more of the poorest residents into public programs and require private insurers to allow young adults to remain on their parents' plans until age 25.

General Assembly leaders are offering more ambitious plans that would add a $1 tax on cigarettes to pay for covering tens of thousands of low-income workers and offer subsidies to small businesses that provide coverage. Many workers who can afford insurance but choose not to pay for it would have to buy it or face penalties.

"Maryland holds out much promise," said Ron Pollack, executive director of Families USA, an advocacy group pushing for affordable, universal health care. The state "may well jump to near the head of the line."

Maryland would join Massachusetts, California, Vermont and a handful of other states that are mapping a path toward universal coverage in the absence of action by Congress or the Bush administration. Instead of the dramatic national overhaul contemplated more than a decade ago, the states are working within the health system, tapping businesses, hospitals, insurers and workers to pay for expanded health care.

The medical repercussions of a lack of health insurance are prodding many states to act.

"Generally, the uninsured get about half the care that the insured get," said Arthur Garson Jr., dean of the University of Virginia's medical school, who has been an outspoken participant in the state and national discussions. And the ultimate consequence? "The uninsured have a 20 percent higher mortality rate than the insured."

Massachusetts is putting in place a plan that would cover 515,000 people. Maryland's approach is more limited: The most ambitious proposal -- a bill to be filed this week by Del. Peter A. Hammen (D-Baltimore), the health committee chairman -- would affect about a third of the state's uninsured but leave a half-million people without coverage.

O'Malley and lawmakers say they are balancing the political will to expand health coverage with the looming state budget shortfall they will tackle next year.

"The administration is interested in working with Delegate Hammen to make health care more accessible in Maryland," Joseph C. Bryce, O'Malley's senior policy and legislative adviser, said yesterday. "But we have some concerns about how some provisions in the bill would be funded."

The governor opposes a tobacco tax increase, and even if lawmakers approve it, there is some sentiment to use the revenue to cover other needs. And despite the momentum in the Democrat-controlled legislature, initiatives of this magnitude often take more than a single session to sell.

Hammen, with strong backing from House Speaker Michael E. Busch (D-Anne Arundel), is crafting a plan that would dramatically expand Medicaid coverage to many low-wage workers who now are eligible only if their income is 40 percent of the federal poverty level, which is set at $10,210 for an individual or $20,650 for a family of four.

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