Health Bill Clears Md. House
March 16, 2007
Lisa Rein and John Wagner, Washington Post Staff Writers
But Medicaid Expansion Faces Senate Hurdles
The House of Delegates approved Maryland's biggest expansion of subsidized health care in years yesterday, voting overwhelmingly to extend Medicaid coverage to 200,000 low-income residents by doubling the state's tobacco tax.
But the plan's prospects look dim in the Senate, where leaders are adamant that raising a tax to pay for a costly program would be irresponsible when the state is facing a massive budget shortfall next year.
The ambitious move by the House reflects a growing political will in Annapolis to address a soaring population of uninsured residents, an issue many states face. But even with delegates' emotional pleas on the House floor for Maryland to help its poorest residents, the state's precarious finances may preclude the Democratic-dominated legislature from approving major health-care changes this year.
House leaders called the plan -- which would slash the number of uninsured in the state by about a third -- a morally defensible way to generate revenue from an unhealthy habit. And they said everyone in the state would benefit, by paying less in insurance premiums to cover the emergency-room visits of those without coverage.
"Yes, it is expensive," the bill's House sponsor, Health Committee Chairman Peter A. Hammen (D-Baltimore) told a hushed House floor before the 102-37 vote. "But if we wait another year, we can expect the rolls of the uninsured to grow by another 50,000 people."
He pointed to the stingy coverage under Medicaid that Maryland offers to poor adults, limiting benefits to those with salaries less than half the federal poverty rate. "A state as wealthy as ours should be ashamed of ourselves."
The Children and Working Families Heathcare Act is a top priority of House Speaker Michael E. Busch (D-Anne Arundel). The bill includes $50 million over five years to bail out the financially strapped Prince George's Hospital Center, which is more than $100 million in debt.
But on a day when House lawmakers also gave final approval to a $30 billion state budget, Senate leaders repeated their opposition to raising the tobacco tax by $1 a pack to $2 before the General Assembly tackles a deficit that could exceed $1.3 billion in the next fiscal year.
"Everyone agrees we have issues in health care," Senate President Thomas V. Mike Miller Jr. (D-Calvert) said after the House vote. "But it's fiscally irresponsible to embark on a new program."
He predicted that the Senate will pass some form of health-care legislation before the legislative session ends next month, but something far less ambitious that does not rely on the tobacco tax.
House leaders stood their ground, though, holding a news conference with health advocates that capped a week of State House rallies, lobbying and a statewide radio ad sponsored by union leaders and the Maryland Citizens' Health Initiative, the advocacy group pushing the bill.
"The support in the Senate [to pass the bill] is there," Busch said, surrounded by health advocates and more than a dozen lawmakers. "It's just a matter of whether they have the political will to deal with this. . . . If we wait four more years to pass this, we'll have a million people without health insurance."
The spending plan the House approved 134 to 5 does not reflect the estimated $500 million the health-care bill would cost, using a variety of sources besides the new tax on cigarettes.
Under the health care bill, the cigarette tax would generate $207 million the first year, then gradually decline as fewer people smoke. Hundreds of millions of dollars more would be leveraged from the federal government to enroll new adults and children in Medicaid, a federal and state program.
Surpluses in state funds that offer insurance to high-risk residents and subsidize malpractice insurance for doctors also would be tapped. Eventually, a $700 million fund that now pays the hospital costs of the uninsured would be diverted to pay for the new plan, as fewer patients without coverage flood emergency rooms.
Gov. Martin O'Malley (D) has embraced a more modest plan that would expand insurance for low-income children and, like the House plan, require private insurers to allow young adults to remain on their parents' plans until age 25. But for now, the governor opposes a tobacco tax increase.
"The governor does agree with the goals of this legislation," spokesman Rick Abbruzzese said. "The question is how quickly we can move forward with it, given the significant structural deficit the state faces."
Republicans who opposed the measure said that although the goal is laudable, the program is irresponsible.
"This bill should come before us next year, once the budget issues have been solved," Del. Steven R. Schuh (R-Anne Arundel) said.
But supporters said passing the bill was a moral responsibility. Del. Heather R. Mizeur (D-Montgomery) compared the income ceiling for a single adult with the per diem received by lawmakers during the 90-day session. She noted that a person at 116 percent of the federal poverty level earns less than $12,000 "for 365 days, while we get $14,190 for 90 days."
The budget for the fiscal year that starts July 1 leaves the governor's proposal largely intact. The plan contains a record increase in spending on Maryland's public schools, allows universities to hold the line on tuition in the fall and boosts state funding on stem cell research.
Several Republicans, including some who voted in favor of the budget bill yesterday, argued that lawmakers should have done more this session to prepare for the looming shortfall. Democrats argued that it was reasonable to allow O'Malley, who has been in office two months, more time to find savings that will reduce the needs for future tax increases.
The Senate's version of the budget is scheduled for floor debate next week.
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