A day after the historic vote in Congress to overhaul the nation's health care system, local patients and their advocates cheered the legislation and say they're already looking ahead to the expansion of coverage to 600,000 uninsured Marylanders.
While some benefits kick in right away, the provisions that will enable most low and moderate income people to get insurance won't become available until 2014. That has left the states to decide if they will add people to the rolls early or if they will seek to opt out of the federal requirements. Maryland has worked to expand coverage in recent years, but it's not yet clear how far the cash-strapped state is willing to go ahead of federal timelines.
Of those uninsured and underinsured in Maryland, some, such as Megan McCurdy, a 24-year-old single working mother, say they hope the aid comes immediately.
"If people get sick they ought to be able to see a doctor," she said. "My doctor has been CVS."
McCurdy, who lives in Burtonsville, said her job as a contractor for the U.S. Food and Drug Administration doesn't offer benefits. Her 4-year-old daughter is enrolled in a state program for care, but since being dropped from her father's insurance 18 months ago when he went on disability, McCurdy has been unable to find affordable coverage.
During that time, she's developed migraine headaches, blurred vision and an eye infection. After a trip to the emergency room yesterday, she left with a $135 prescription and a payment plan for the hundreds of dollars the visit cost. She also left with an inconclusive diagnosis and no way to pay for more tests.
With health care reform, she's hoping she will now qualify for coverage in the state's high-risk pool for those with pre-existing conditions or that she can get coverage through her mother's health insurance. The federal legislation allows for children up to 26 to remain on their parents' policies.
She's hoping she won't have to wait until 2014 when the states are required to set up health care exchanges where the uninsured can shop, most with federal subsidies.
"I put off going to the eye doctor, and now I have added costs," she said. "The doctor told me I could go blind and I'm only 24 years old."
Since 2007, Maryland has moved to cover more low-income people, adding thousands of kids and their parents to the Medicaid rolls. Amid budget troubles, others have been left waiting for help, particularly those without children. Still more have watched their premiums skyrocket.
Gov. Martin O'Malley said Maryland expects a "net benefit" from the federal reform, with the state saving about $1 billion over the next 10 years. He called Sunday's vote "courageous and important." Still, Maryland Secretary of Health and Mental Hygiene John Colmers said that O'Malley and the legislature will have to decide how much farther to go in expanding coverage early.
"We'll be taking a look at everything," he said.
O'Malley, who will join Obama at the bill signing, announced that a task force, led by Colmers and Lt. Gov. Anthony Brown, will analyze the national legislation and make recommendations about its implementation.
For a city like Baltimore, struggling with high rates of uninsured, the legislation's impact would be "huge," said Kathleen Westcoat, president of Baltimore HealthCare Access, a quasi-public agency which helps link low income people with Medicaid.
"This is an amazing and tremendous step forward," she said.
Of the 600,000 Marylanders who will be covered under the federal legislation, about half would quality for Medicaid coverage, and half for subsidies to purchase insurance, according to an analysis by the nonprofit.
To add more people to the rolls, the pro-reform Maryland Citizens' Health Initiative has advocated for increasing the alcohol tax, a political non-starter for years.
Vincent DeMarco, president of the group, said if the state would pass a new dime-a-drink tax next year, coverage could be extended to 100,000 childless adults, in addition to tens of thousands of children and their parents who have been added since 2007 through a tobacco tax.
The rest of the uninsured would get coverage in 2014 when the exchanges are created and federal subsidies kick in, he said.
DeMarco said that those with insurance will also benefit. They now pay a "hidden tax" in their premiums to pay for the uninsured who still use the health care system. When everyone's covered, the insured won't pay for the uninsured. Further, competition from exchanges create by each state should help bring down costs for everyone, he said.
"We recognize this isn't the end of the end, but this will make insurance more affordable," he said. "In Maryland, we'll build on this."
Rawle Andrews Jr., state director of AARP in Maryland, said that other provisions will benefit its senior members. The federal legislation will begin to close the so-called doughnut-hole, a gap in Medicare drug coverage. And while baseline benefits will be protected, providers will have to certify the care they offer so patients will be subjected to fewer tests performed solely because they bring in more revenue. That should save tens of millions, if not billions of dollars, Andrews said.
Medicare and Medicaid, federal programs for seniors and the poor, will consider more in-home care rather than nursing home care. And the federal legislation will limit the amount that insurers can charge seniors over younger people.
That is a meaningful provision for Gloria Brennan, 66, who uses Medicare but would like to buy supplemental insurance on a state exchange. She said extra coverage now is unaffordable.
Brennan, a medical make-up artist and skin care consultant who lives in Owings Mills, has battled insurers for years. She was dropped in the 1990 after going to see a specialist even though she was not diagnosed with an illness.
However, soon after she was diagnosed with rheumatoid arthritis, a painful joint disorder. She thought she had secured new insurance but it didn't actually offer any benefits. And when she finally did sign onto a new policy, the insurer refused to cover anything related to her illness.
She was able to enroll in a study at Johns Hopkins Hospital, which paid for a new drug, which worked for Brennan. The study continues to pay for her medicine today, although a year ago, the 66-year-old qualified for Medicare.
With health care reform, she hopes to buy supplemental insurance on an exchange to pay for the percentage of care the federal program doesn't cover. If the legislation holds done the cost for seniors, as promised, that may be possible, she said.
"How can anyone say Americans don't want this? I don't know who they are talking about," she said. "Everyone has something to gain, even people with coverage. I know it's not perfect, but I was watching the debate and I was clapping away."
Also pleased was Jay Wolvovsky, president and CEO of Baltimore Medical System. The group supports six Baltimore City and county clinics and believes expanding insurance to low-income people could double the nearly 50,000 patients who come through the doors over a decade.
Such health centers, seen as a safety net for those who can't afford coverage, have struggled for years to meet the demands of a growing uninsured population, particularly of late as job losses leave many without insurance.
But adding more people to the rolls will mean the need for more practitioners to serve them and Wolvovsky estimated the system will need double the estimated 50 providers it has now.
While many patients are happy with the bill, the state's medical society is not. The nation will have to confront a severe shortage of family doctors, said Gene Ransom III, chief executive officer of MedChi.
Ransom said his members are most frustrated with the bill's failure to confront an expected 21 percent decrease in Medicare reimbursement rates for doctors and tackle tort reform.While the American Medical Association threw its support behind the legislation, MedChi did not.
"There are some good things in the bill, but we said we could not support it if it did not address these two things," he said. "Our concern is that physicians are simply not going to be able to take Medicare patients if they are going to face a 21 percent rate reduction. And this will put a lot of seniors in a bad situation."
Maryland hospitals, meanwhile, are supportive of the bill, even if it produces deep rate cuts. The nation's hospitals agreed to $155 billion in cuts over 10 years to help pay for insuring millions of Americans. Those cuts will put pressure on Maryland's rate setting system, said Carmela Coyle, president of the Maryland Hospital Association. Still, said Coyle, the bill presents a "tremendous opportunity."
"If we can really get people access to care where they need it and when it's most appropriate, we can save money overall, instead of catching people downstream when their conditions are the most extreme and most expensive," she said. "Not only can it potentially lower costs, it's the right thing to do."
Still, the potential costs have outraged many Americans. Dave Schwartz, Maryland director of Americans for Prosperity, spent Saturday in Washington protesting the measure, along with, he estimates, about 1,000 Marylanders.
AFP has already sent out thank you notes to the two Maryland congressmen who voted against it and issued warnings to the six who voted for it, saying that AFP "will be devoting a heck of a lot of time to educating citizens on how they voted for a bad bill."
"Health care has brought in so many people who are now turning their attention to things like spending at the local level, taxes, the state budget," Schwartz said. "And I think health care is going to continue to motivate our activists."
Staff writer Julie Bykowicz contibuted to this article.