When it comes to finding an answer to the nation's health-care problem, Maryland is indeed "America in miniature." The same three-prolonged debate taking place in Congress is also being argued in Annapolis' State House. And like their counterparts in Washington, Maryland legislators are far from reaching a consensus.
Still, the three days of public hearings in the House Economic Matters Committee last week proved an eye-opener for a number of lawmakers and made it clear that only one of the three plans discussed has any chance of advancing in this legislative session.
The enormous price tag of the Canadian-style "single payer" plan remains its major impediment. This proposal, which would provide universal health-care coverage with a state board setting an annual budget for all health-care spending in Maryland, has only a few advocates. Nor is there much enthusiasm building for the "play or pay" program in which employers would provide basic health insurance coverage or be taxed heavily to pay for a state-run insurance package. A drawback to this approach is that it wouldn't lower health-care costs, only shift the payment burden.
These plans mirror proposals floated by Democratic presidential candidates. Democratic leaders in Congress are pushing a "play or pay" scheme of their own. The Bush administration, meanwhile, has put forth a $100 billion plan of tax credits and vouchers to help the poor and middle class buy health insurance. This approach is similar in many respects to the one plan in the General Assembly with wide backing: a "consumer's choice" option that would give every Marylander a tax credit or voucher to obtain health insurance.
But state legislators have just started the debate. They are unlikely to iron out all the complex issues relating to a new health-insurance approach before they adjourn in early April. A series of evening "working sessions" in the House committee begins tonight and is aimed at hammering out specifics on how to structure a new health-care plan, especially the state and federal tax implications. Even if the House embraces a tax-credit/voucher bill, it may not get far in the state Senate, which has failed to debate the issue in any depth.
Much depends on discussions with federal officials over obtaining a waiver so the state can set up a voucher program for Medicaid recipients, and the willingness of the Bush administration to support a demonstration health-insurance plan in Maryland. Public dissatisfaction with the health-insurance situation remains strong. It is this discontent that is propelling state and federal lawmakers to examine possible solutions, though passage of legislation this year remains a long shot not only on Capitol Hill, but in Annapolis, too.