The Maryland Senate approved legislation yesterday that would expand government-funded programs to provide medical coverage to more of the state's 800,000 uninsured, boosting the measure's chances just months after a similar proposal died in that chamber.
The Senate voted 30-17 to pass the bill, which was championed by Gov. Martin O'Malley, and the House of Delegates is expected to act on heath care legislation in the coming days. Both versions would allow more adults to be eligible for Medicaid, the state-federal health insurance program for the poor, and extend insurance premium subsidies to small businesses and their employees.
When fully implemented, the health care expansion would cost more than $600 million, including federal matching funds and $250 million in added state revenue. Coverage could ramp up over time so that eventually more than 100,000 residents would get insurance.
But to what extent, and how quickly, the programs are implemented depends on funding. The General Assembly was convened to tackle a projected $1.7 billion deficit for the next fiscal year, and a raft of measures are being debated to close the gap, including higher taxes, spending cuts and the legalization of slot machines through a voter referendum.
"As hard as it is to vote for a tax because I know its effects, I can't think of a more worthy expansion," said Sen. Thomas M. Middleton, chairman of the Senate Finance Committee. "It's a moral obligation."
While the health care bill would be paid for through a variety of mechanisms, some of the expansion would need to be curtailed if funding doesn't materialize. In particular, the extension of Medicaid benefits to tens of thousands of childless adults would not happen unless voters approve slot machines in November 2008, which could bring as much as $700 million a year to the state.
The vote on the health bill in the Senate came shortly after the chamber had approved by a one-vote margin a $1.4 billion tax plan that would raise the sales, tobacco and corporate tax rates. Republicans objected to the timing of spending on health care in the midst of a fiscal crisis. Expanding health care coverage has been a top priority of House leaders.
"If the last bill was a tax increase on steroids, this is a bill that's on Quaaludes," said Sen. E.J. Pipkin, an Eastern Shore Republican.
The health care vote in the Senate marks a reversal from the regular session earlier this year when Senate President Thomas V. Mike Miller refused to allow a similar health care bill passed by the House to come to a vote. He objected to that bill being tied to the tobacco tax, because it's a declining revenue source. This time he said he would not stand in the bill's way.
Under the Medicaid expansion, all adults earning up to 116 percent of the federal poverty level, or about $20,000 for a family of three, would be eligible. While Maryland covers children in families earning up to three times the poverty level, the state has a much lower threshold for covering adults - 40 percent - and ranks in the bottom third of all states in terms of coverage.
The change would eventually bring an estimated 20,000 parents who don't have insurance into Medicaid, while also drawing thousands of additional children into the program. Adults who don't have children would gain some health services under another state program over several years until they get full Medicaid benefits. Eventually, more than 50,000 childless adults could be pulled into Medicaid.
The subsidies would help an estimated 15,000 workers get insurance. Under the program, the state would provide subsidies of up to $1,000 a year to small businesses that don't currently offer insurance as well as $1,000 to each participating employee. The subsidies are contingent on the businesses offering a wellness program, such as a smoking cessation class.
Sun political reporters blog the latest from Annapolis at baltimoresun.com/sessionblog