ANNAPOLIS – Community-based health care is the key to a new plan introduced by three Maryland lawmakers Thursday, who want to close the gap between Medicaid recipients and the privately insured.
Currently, the state Medicaid program insures people who fall below 46 percent of the federal poverty level, but nearly 700,000 uninsured don’t fit this qualification.
The Community Health Care Safety Net Act of 2004 will expand Medicaid and increase use of community clinics to tackle the health care access issue.
One of several heath care coverage proposals in the General Assembly, the plan is sponsored by Delegate John A. Hurson, D-Montgomery, Sen. Paula C. Hollinger, D-Baltimore County, and Sen. Thomas M. Middleton, D-Charles.
The sponsors make up an important block of influence in the Legislature that could bolster the bill’s chances – each is a chairperson of health or finance-related committees.
For those just above the current Medicaid cutoff, but still under the poverty level ($18,400 for a family of four), legislators propose an expansion of the state Medicaid system, at a cost of $51 million. The move will insure an additional 54,000 Marylanders.
Lawmakers hope to eliminate a 2 percent tax break on premiums given to health maintenance organizations and managed care organizations, which would add $64 million to health care. Funds for Medicaid are matched by the federal government.
Plowing the money back into the health care system, Hurson said, could reduce the rates for all premiums.
The tax exemption has been contentious, and a bill against it was vetoed by Gov. Robert L. Ehrlich last session. The governor met with Hurson Thursday afternoon and “has vowed to keep an open mind” to find ways to reduce the number of uninsured, Ehrlich’s spokeswoman said.
The second tier of uninsured earn up to 300 percent of the poverty level, and generally still have a hard time affording health care.
For this group, the plan reverts back to pre-Medicaid days and relies on the social safety net, by bolstering school-based clinics and federally qualified health centers. The clinics would offer services on a sliding-scale based on the patient’s ability to pay.
The state’s clinics accommodate about 130,000 people, and that number could increase by up to 400,000 under the plan.
By providing places for affordable primary care, up to 40 percent of emergency room visits could be avoided, said Steven Galen, chief executive officer of the Primary Health Care Coalition.
“These kinds of visits don’t benefit anyone in the long run,” he said.
Hollinger said the plan could reduce hospitalization and also addresses the crisis in malpractice insurance.
“I think it’s important to attract physicians to work in the federal centers, and to know they are covered by the federal government for their malpractice insurance,” she said.
A separately filed bill for a tobacco tax of 50 cents per carton will contribute $100 million to the plan, money that will increase Medicaid payments to doctors.
These funds would be federally matched, bringing the funding for the health coverage initiative to around $300 million.
Tax incentives will encourage the third tier of uninsured – those who make more than 300 percent of the poverty level – to self-insure.
Hurson predicted that the General Assembly will meld several proposals to come up with a solution.
A rival proposal, the Maryland Health Care Initiative’s “Health Care for All” plan, puts a tax on businesses that don’t provide health care insurance for employees.
“If we had a perfect world, we’d put everyone under 300 percent of the poverty level in Medicaid and our MCOs (managed care organizations),” said Hurson. “We don’t have the money. While we’re waiting for Nirvana to occur, we have to find a place for people to get health care.”