Despite being among America's wealthiest states, Maryland posted one of the highest increases of uninsured people last year.
Nearly 160,000 Marylanders joined the rolls of those without health insurance in 1998, bringing the number of uninsured residents to 837,000, or one-sixth of the population. Statistics show more than half of these people work. A quarter of them are children.
Decrying these numbers, a coalition of more than 30 groups launched a grass-roots, statewide campaign yesterday to fix the problem. Their solution: Give every Marylander access to comprehensive, quality health care.
"It's time for a sea change," declared Dr. Peter L. Beilenson, Baltimore City health commissioner. "Clearly, the private-sector approach is not working."
The percentage of the state population with no insurance rose from 13.4 percent in 1997 to 16.6 percent in 1998, according to new figures from the U.S. Census Bureau. Compared with 1989, the number of uninsured in the state has roughly doubled.
Brenda Zook, 26, knows the problem all too well. After changing jobs, the Baltimore woman has gone without health coverage for 17 months, getting by with the help of free clinics and a roommate who was a nurse. But all the while, she worried that she could be stuck with thousands of dollars of medical bills if she got sick or had an accident.
"I count my blessings that nothing has happened so far," said Zook, who spoke yesterday for the Maryland Citizens' Health Initiative Education Fund. "But I'm basically playing Russian roulette with my health."
Nationally, one-third of people 18 to 24 didn't have health insurance in 1998. Overall, an estimated 44.3 million Americans, or 16.3 percent of the population, are uninsured. This is an increase of about 1 million people from the previous year, but the percentage is about the same.
Maryland was No. 3 among 16 states in which the ranks of the uninsured grew significantly, with a 3.2 percent rise. The state with the biggest percentage growth was Wisconsin, at 3.8 percent, followed by Nevada, at 3.7 percent.
Analysts suggested causes for Maryland's increase: double-digit cost increases for health insurance premiums, welfare reform, more part-time workers.
Fran Doherty, vice president of government affairs for CareFirst BlueCross BlueShield, which covers 1.5 million state residents, said Maryland has historically mandated more benefits and administrative services -- making premiums more expensive.
"The sheer numbers of those benefits applied to all insured contracts -- that may have something to do with it," she said.
Others, considering several state efforts to help the uninsured, were puzzled.
"What is it? Why are we seeing more and more uninsured at a period when you would intuitively expect it to be the opposite?" asked Nancy Fiedler, spokeswoman for the Maryland Hospital Association.
Some cautioned that the most recent increase might not be as sharp as it appears because the U.S. Census Bureau uses a relatively small sample of people to conduct its study. John Colmers, executive director of the Maryland Health Care Commission, said his agency is releasing its own analysis this week.
For the past three years, the commission shows, the numbers of uninsured people have been "relatively flat," Colmers said.
Maryland has made efforts to provide health coverage. Under a state rate system, hospitals are compensated for medical care for those who cannot afford to pay. The state has also enrolled 58,000 low-income children in the Clinton administration's insurance program since July.
Dr. Georges C. Benjamin, the state health secretary, said he was surprised and concerned about the increase of uninsured people, but said he was comfortable that Maryland has done its part. "Certainly there is still a role for the federal government to further enhance its efforts to cover more kids," he said.
In 1998, the governor and state legislature set up an independent, nonprofit commission to get preventive and primary health care to the state's uninsured and underinsured. The Maryland Health Care Foundation raises private money for clinics and outreach programs. So far, it has distributed more than $1 million to 14 projects statewide.
Small businesses can pool their employees to get better insurance rates, and 48 percent of these employers were offering workers these plans in 1998, up from 40 percent in 1995, Colmers said. But that still leaves more than half of small businesses in the state not offering health insurance to workers.
Jeff Singer, CEO of Health Care for the Homeless, said he can sympathize. His clinic's health care premiums rose by 17 percent in the past year alone. He said the clinic could have chosen a cheaper plan but didn't want to disrupt long-standing relationships staffers have with physicians.
Hospitals across the state have reported a steady increase from 1996 through 1998 in the percentage of care for people who cannot pay, Fiedler said. The Shepherd's Clinic, a nonprofit city clinic providing primary care to uninsured adults and children, is seeing an average of five new patients a day, which is unusual, said Ruth Clemens, its administrative director.
'Such a relief'
One patient, Carolyn Nicholson, 54, hasn't had health insurance since she left a government job in 1988. Since then, she has held short-term jobs, or jobs without health insurance. She struggles with arthritis, diabetes and hypertension. She landed in the emergency room twice.
Her most recent visit was for an ear infection that had progressed to the point that it causes vertigo. Now she has a $355 bill she can't pay. But the clinic hired her as office administrator, and as of Friday, she has health insurance.
"It's such a relief. At least you can go to the doctor," said Nicholson, who appeared at yesterday's news conference. "We have to make a change."
One by one, representatives of churches, unions, nurses and patient advocacy groups signed what they called the "Declaration of Health Care Independence."
The group aims to get 2,000 organizations signed on by the end of 2000, ultimately pushing for a statewide system in which one agency, governed by health care professionals and consumers, would finance and administer health care for everyone.
These state programs are available to uninsured Marylanders:
CHIP, for poor children who don't qualify for medical assistance: 800-456-8900.
Primary Care Program, for low-income disabled adults with chronic conditions: 888-754-0095.
AIDS Insurance Assistance Program, for AIDS patients too ill to work: 410-767-1780.
Pharmacy Assistance Program, for low-income people with chronic medication needs: 800-492-1974.
Public Mental Health System: 800-888-1965
Source: Department of Health and Mental Hygiene