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Massachusetts health care — wonky, with a healthy dose of reality

The New Health Reform Wave IV: Maryland

The New Health Reform Wave IV: Maryland

May 19, 2006

From the Daily Record, Maryland's business and legal newspaper:

Sure, the health care plan recently passed in Massachusetts aims to insure every state resident and was hailed as groundbreaking. But it won’t change Vinnie DeMarco’s plan to insure all Marylanders. DeMarco, the president of the Maryland Citizens’ Health Initiative, said he applauds the Massachusetts plan as progressive, but his organization will continue to push its own health care for all plan that aims to provide health insurance for all of Maryland’s uncovered. Many Maryland policymakers likely will look at the Massachusetts plan to determine if it might work here.

But in reality, the Massachusetts plan leaves a number of important questions unanswered. Observers will not know how the plan works until Massachusetts regulators hammer out the fine details, and until then, lawmakers and advocates in Maryland seem content to continue down the path they’ve already begun. DeMarco’s group is perhaps best known as the force behind the Fair Share Health Care Fund Act, or the Wal-Mart bill, that passed in 2005. The measure requires Maryland companies with 10,000 or more employees to spend a certain amount on worker health insurance, or pay the difference to a state Medicaid fund. The measure, which is currently stalled amid court challenges, received national attention and inspired lawmakers in a number of other states to push similar proposals. Some considered the bill to be pioneering — while others considered it devastating — but it was only one piece of a larger, comprehensive plan developed by DeMarco’s group.

“Our overall proposal is a better way to go because we don’t put key decisions to regulators. Massachusetts did some great things, but they did not do health care for all,” DeMarco said.
The Massachusetts plan creates subsidies for low-income people to purchase health insurance. But the amount of the subsidy, available to individuals with incomes up to 300 percent of the poverty level, will be on a sliding scale. The plan did not determine the scale. The plan also established penalties for individuals above a certain income level that do not purchase health insurance if there is an affordable plan available, though it failed to determine exactly who would be subject to the penalty and how much it would cost. It also failed to define “affordable.”
Under the plan, employers that do not offer fair coverage would have to pay a per-employee fee to the state, though the legislation did not determine what level of coverage employers must provide.

DeMarco and other advocates are currently pushing another piece of the pie. Known as the Healthy Maryland Initiative, the newest proposal would increase the cigarette tax by $1 and use the proceeds to fund expanded health care access for the uninsured. Though the proposal failed during this year’s General Assembly session, DeMarco said he believes it will have more momentum next year. Of course, the comprehensive plan is on the table each year, but more as a reminder of where DeMarco and other advocates hope to end up.

Del. James W. Hubbard, a Prince George’s County Democrat, has sponsored the Public-Private Partnership for Health Coverage of All Marylanders, this year’s HB 1510, for several years.
“That’s why the full bill is in, to remind everybody what the theory behind this is,” Hubbard said. “The Wal-Mart piece was part of that bill. The tobacco tax is part of that bill. We use the big bill as the big picture. Sometimes you have to crawl before you can walk.” Hubbard co-chairs the Joint Legislative Task Force on Universal Access to Quality and Affordable Health Care, which should report its findings in time to make recommendations for the 2007 legislative session, he said. The task force, he said, will look at the tobacco tax and other proposed measures as well as the Massachusetts plan when determining how to go about providing uninsured Marylanders with coverage.

One of the ideas likely to be brought before the task force resembles the Massachusetts provision requiring individuals above a certain income level to purchase health insurance.
Del. Donald B. Elliott, a Republican representing Carroll and Frederick counties, has sponsored that provision twice now. The bill, introduced as HB 1121 this year, would impose a $1,000 tax surcharge on individuals who earn more than 500 percent of the federal poverty guideline but do not have health coverage. The proceeds would subsidize health insurance for lower-income people. “We’ll work on it this summer again, and we’ll review the Massachusetts bill. And then we’ll come in next year with guns-a-blazin’,” Elliott said. Purchasing health insurance, if it is affordable, is the responsible thing to do, Elliott said.

But another lawmaker who has attempted to push forward-thinking health insurance policies said Maryland might not be ready for some of the provisions approved in Massachusetts.
Sen. E.J. Pipkin, an Upper Shore Republican, said a provision like the one endorsed by Elliott is “like step No. 8 in an eight-step process.” Pipkin said policymakers would first have to take away any excuses people might have for not buying insurance. He applauded parts of the Massachusetts plan that did just that. For instance, the Massachusetts measure allows for the creation of a new minimum coverage plan for young adults, since they often choose not to purchase health insurance because they believe they will not need it. Still, even if lawmakers wanted to adapt the Massachusetts plan for Maryland, some health care policy experts warn Maryland and Massachusetts differ greatly. About 14 percent of Marylanders have no coverage while about 11 percent of Massachusetts residents are uninsured.