Maryland governor aims to boost insurance access

Medicaid reforms and tax incentives are included in the plan.

By Joel B. Finkelstein, amednews staff. Dec. 8, 2003.

Washington -- Maryland Gov. Robert L. Ehrlich Jr. has proposed an initiative to help uninsured residents obtain health coverage.

While many states contemplated universal health coverage plans this year, only in California and Massachusetts did lawmakers pass broad-ranging expansion laws that will go into effect over the next few years.

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According to current estimates, Maryland has 690,000 uninsured residents, just under 13% of the state's population. Nationally, the uninsured represent 15% of the population.

Ehrlich has proposed a multifaceted strategy to expand coverage and improve the affordability of health insurance. The state Legislature could take the proposal up in next year's session.

The Maryland Dept. of Health and Mental Hygiene recently has filed for a Medicaid waiver that would allow the program to cover primary care services for 17,000 Marylanders who are already receiving pharmacy assistance from the state.

Other administrative and legislative activity could include medical liability changes, such as alternative dispute mechanisms and medical-error reduction initiatives. Ehrlich also proposed reducing health system waste, fraud and abuse; strengthening the safety net of federally qualified health centers; and encouraging affordable small-group health insurance products.

13%, or 690,000, of Maryland residents are uninsured.

The administration would pursue short- and long-term changes to Medicaid to stem the program's spending growth. The high cost of long-term care would be an important target.

Ehrlich proposed an individual tax deduction aimed at enticing those who can already afford health insurance, but have not purchased it, to buy coverage. Future measures could include refundable tax credits, to be implemented if and when the state can afford to do so, and purchasing pools for employers and individuals.

Aside from the organizational changes that the health department is already undertaking, many of these proposals are highly conceptual at this point, said T. Michael Preston, executive director of MedChi, the Maryland State Medical Society. "It's clear that the [administration is] wrestling with the considerable problem of the uninsured, and particularly the growth of the uninsured," he said.

The proposal lacks details, said John Holahan, PhD, a senior fellow at the Urban Institute. "Everybody wants to reform Medicaid, but how do you do it?" he asked.