A House of Delegates panel approved a scaled-back bill yesterday to extend medical coverage to more than 100,000 uninsured Maryland residents, or less than half the number originally proposed by its sponsors.
But opposition to the bill's main funding source -- a doubling of the tobacco tax to $2 a pack -- remains strong in the state Senate, casting doubt on passage this year.
The bill would drastically expand Medicaid, the government health insurance program for the poor, so that every child in Maryland could be eligible.
But legislators abandoned plans to give small-business subsidies to provide insurance to workers, and they eliminated a provision that would have required that higher-income individuals and families buy insurance or pay a fee.
Del. Peter A. Hammen, a Baltimore Democrat and the bill's chief sponsor, said it would provide a "proper safety net" for the poor and could lay a foundation for greater access to health care in the future. The House Health and Government Operations Committee, which Hammen chairs, approved the bill, 17-5.
"I wish we could have done more," Hammen said. "However, what I wanted to do was to make sure we had a reform package that was not only meaningful but sustainable."
The bill would cost an estimated $200 million in state funds, or half the outlay in the original proposal. The total price, which includes federal funding, is about $500 million a year. Hammen said the committee was unable to get as much money as hoped through the so-called uncompensated care fund, which reimburses hospitals in the state for treating the uninsured.
The tobacco tax increase must be approved by the House Ways and Means Committee, and legislative leaders say the bill likely has the votes for passage in the full chamber. House Speaker Michael E. Busch backs the legislation and has pledged to cut the number of uninsured -- nearly 800,000 residents -- in half over four years.
In the Senate, President Thomas V. Mike Miller and others say a bill tied to the tobacco tax is dead on arrival.
Sen. Thomas M. Middleton, chairman of the Finance Committee and a Charles County Democrat, commended the House committee for its work and said the bill could serve as a blueprint for action next year when legislators debate funding for all programs and how to fill a projected $1.3 billion shortfall.
"My hope is that next year when we have to sit down and figure out what funding we have for programs, we'll look at providing funding for health care," Middleton said. "We cannot leave that undone."
The House bill would triple the maximum allowable income for Medicaid coverage for adults to about $12,000 a year for an individual. It also would extend Medicaid to children from families with incomes up to four times the federal poverty level, or $82,800 for families of four, while allowing families above that income level to buy into Medicaid at cost.
The number of people who eventually get insurance through the legislation could rise above the current estimate through higher enrollment rates.
The bill also would require that private insurers allow adults up to age 25 to stay on their parents' plan.
The bill no longer provides funding for substance abuse treatment or smoking cessation programs, though it now includes $50 million over five years to help the financially strapped Prince George's Hospital Center.
Del. Patrick L. McDonough, a Baltimore County Republican who voted against the House bill, said he not only objected to the tobacco tax but he also was against the bailout of the hospital, which he said has not presented a coherent plan for recovery.