The phones have started ringing in the stately offices of Maryland Senate President Thomas V. Mike Miller, and the deluge of calls is not expected to let up until the General Assembly session ends in less than two weeks.
The retiree organization AARP has set up a phone bank and plans to call 10,000 members who can then be patched directly to Miller's office to demand action on legislation that would extend medical coverage to uninsured residents.
Miller opposes a bill, easily passed by the House of Delegates, that would fund expanded government health care through a $1-a-pack increase in the tobacco tax.
No politician relishes calls from angry constituents, let alone calls from thousands of them who are coordinated and ready to talk legislative details. That is the kind of pressure that health care advocates are trying to bring to bear in Annapolis as prospects dim for the House bill, the most expansive of health care proposals pending in the legislature.
"We've got to do something about the uninsured and bring health care to our Maryland neighbors," said Joseph DeMattos, director of AARP Maryland. "We're saying, 'We can't wait another year.'"
The campaign reflects the view of several health advocacy groups that with a new Democratic governor in office and the House leadership behind the proposal, now is the time to push for expanded health care coverage.
Their efforts have been caught up in a disagreement between House and Senate leaders over tax increases as the state faces a projected $1.5 billion budget shortfall for the fiscal year that will begin in July 2008.
Looming over the debate are the Democratic leaders' differences over whether to legalize slot machines to raise revenue. Miller backs the idea, and House Speaker Michael E. Busch is adamantly opposed.
Miller, who can effectively control what bills are brought to the Senate floor, has said emphatically that his chamber will not pass the House health-care bill this session. He argues that the legislation is fiscally irresponsible and that revenue from any tobacco tax increase should be used to close the budget gap.
Busch counters that a meaningful expansion in access to affordable health care is not possible without a dedicated revenue source. "You're not going to have any comprehensive health care remedy unless you have funding of the magnitude of what we're talking about in the House," he said.
If the standoff between the chambers - and particularly between Miller and Busch - continues, lawmakers acknowledge that the legislature this year may not address how to cover any of the nearly 800,000 Maryland residents who lack insurance.
That marks a sharp shift since the beginning of the session, when Gov. Martin O'Malley trumpeted the need to help the uninsured. He doesn't support using the tobacco tax for health care and has said budget realities might dictate how quickly the state can address the problem.
No 'good vibes'
"It is highly possible that nothing of substance will get done this year," said Del. Peter A. Hammen, a Baltimore Democrat and lead sponsor of the House bill. "I don't want to give up. I don't want to be a naysayer. But I'm just not getting good vibes from Senate leadership."
Meanwhile, proponents have homed in on all state senators.
National organizations such as Campaign for Tobacco Free Kids and Planned Parenthood are urging members to e-mail or call their senators. Local groups such as the Maryland Women's Coalition for Health Care Reform are visiting doctors' offices to enlist supporters. And the Towson University College Democrats are canvassing neighborhoods in key districts.
Comptroller Peter Franchot has been contacting senators and directing staffers to focus on lobbying for health-care legislation for the remainder of the legislative session.
Phone and e-mail drives have proved successful before. Some legislators said they were influenced by contacts from constituents before passage of a statewide smoking ban in bars and restaurants this week. Advocacy groups also point out that their members are often more likely to vote. In fact, AARP says one-fourth of all votes cast in Maryland are from members.
Such efforts can backfire. Sen. Katherine A. Klausmeier, a Baltimore County Democrat, said she has received "tons of calls" but that sometimes callers are referred en masse and don't understand the issues. Asked whether recent efforts to push health-care legislation will make a difference, she said, "It's hard to say. It's like a logjam right now. There's a consensus around not raising taxes."
Lobbyists who had opposed the House bill have moved on to other issues.
Bruce C. Bereano, who represents the Maryland Association of Tobacco & Candy Distributors, fought the tobacco tax increase but stopped lobbying a few weeks ago when a conflict arose because the bill was amended to direct funding to the struggling Prince George's Hospital Center, another of his clients. Besides, he said, his efforts are no longer needed.
"The bill is bleeding to death so badly that I don't need to load my gun," Bereano said.
Advocates say polling shows overwhelming support for health care reform. They also point out that all residents end up paying for the problem because hospitals in the state charge higher rates to cover the cost of treating the uninsured, which totals about $800 million a year. That pushes private insurance rates higher, adding an estimated $1,000 to the annual premium for the average family plan.
The House bill would extend medical coverage to more than 100,000 residents, mostly by raising the income level at which an individual or family qualifies for Medicaid, the government health insurance program for the poor. It also would require private insurers and the health plan for state employees to allow adults up to age 25 to stay on their parents' plan.
Narrower Senate bill
The Senate approved a far narrower health-care bill, a proposal of O'Malley's that was trimmed by the Senate Finance Committee. That $3.5 million plan would allow all families not covered by Medicaid to buy into the program by paying the full premium for their children, while requiring insurers to cover children up to age 25.
Busch said the Senate bill doesn't do enough. "It is like putting an extra lifeboat on the Titanic," he said. "A few people would get help, but the vast majority of people are going to go down with the ship."
The Senate Finance Committee held a hearing on the House bill yesterday, and the House Health and Government Operations heard testimony on the Senate bill.
Committee chairmen have acknowledged that they probably won't vote on the other chamber's proposal, which would be the death knell for both bills.
That hasn't dampened hope among activists.
"Until the legislative clock strikes midnight, it is not over," said Dr. Martin P. Wasserman, executive director of MedChi, a professional society for doctors, who has been dropping in on Senate Finance Committee members. "We believe they ought to be held accountable."
PROS AND CONS
The General Assembly is considering a bill to expand medical coverage for uninsured residents by doubling the tobacco tax to $2 per pack of cigarettes. Here are some pros and cons of the proposal backed by the House of Delegates: Pros:
Extends access to health care to more than 100,000 people.
Discourages teen smoking.
Lessens burden of uninsured on hospitals, which charge higher rates for their treatment. Cons:
Ties health care to tax that declines as fewer people smoke.
Expands government programs when the state is facing a $1.5 billion projected budget shortfall next year, and limits revenue options for closing the gap.