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After ducking the nation's health care crisis for many years, Congress finally stands on the verge of passing comprehensive health reform. Each of several bills on the table would build on our existing public-private system to bring us much closer to making comprehensive, high-quality health care available to all Americans.

Maryland is the wealthiest state in the nation. Yet almost one in five residents is uninsured or underinsured, and many more are just one medical bill from bankruptcy or foreclosure. It's a crisis that hits women and rural Marylanders especially hard.

The federal government has designated Kent County a severe shortage area for health professionals. Caroline and Dorchester counties have among the highest rates of premature death from heart disease, cancer and stroke in the state.

Where do Marylanders in need turn for health care? Sadly, their safety net is a weakened public health system. Local health departments have seen their state funding for core services slashed by nearly half in recent months. Even the budget for the state's Wellmobile has been cut in half; its mobile clinic will now help thousands fewer Marylanders each year. These cuts are forcing local clinics to reduce or eliminate such vital services as immunizations for children, family planning services and cancer screenings. In the months to come, Gov. Martin O'Malley must find the funds to restore some of these services. But in the longer term, comprehensive federal health reform offers the only real solution to the crisis. By making more people eligible for Medicaid and providing subsidies to help low- and middle-income Marylanders pay for health insurance, the reform bills would finally put a real dent in the number of uninsured.

The bills also offer immediate help to our troubled public health system. The House bill includes a $34 billion Public Health Investment Fund and authorizes a $12 billion federal investment in community health centers over the next five years. It would also establish a program of primary-care residencies in community health care centers and a new grant program to support community-based wellness services.

In Maryland's 1st Congressional District, the reform bill would bring health insurance to about 31,000 currently uninsured residents and could provide credits to help 126,000 households pay for insurance. A careful analysis by the House Committee on Energy and Commerce shows that the bill would also improve Medicare for the district's 119,000 beneficiaries, prevent about 1,100 area families from going bankrupt as a result of huge medical bills, bring $52 million in added revenue to area hospitals and make almost 18,000 small businesses in the district eligible for tax credits to help pay the cost of insuring their employees.

For those reasons and more, we hope Rep. Frank Kratovil will recognize the urgent needs of his constituents and join other congressional Democrats from Maryland in strongly backing health care reform legislation.

Health care reform is a particularly pressing concern for Maryland's women. While women are very often caregivers for our children, the sick and the elderly, our system frequently makes it difficult and more expensive for women themselves to get the care they need.

Because women are more likely than men to work in low-paying or part-time jobs or to spend long periods out of the labor force for family and child care, they often can't get employer-based health coverage. And when women have to buy health insurance, they often pay more than men do. Forty states, including Maryland, allow insurers to charge women more than men of the same age and health status for health insurance, sometimes as much as 140 percent more. Federal health reform would prevent insurers from using gender as an excuse to charge women more.

The reform bills would also prevent health insurers from discriminating or denying coverage based on pre-existing conditions, health status and other characteristics. But the government would not end up running the health system, as many critics have unfairly charged. Instead, it would protect the public interest by better regulating what health insurers can do, just as the federal government now regulates what banks, drugmakers and other corporations can do.

The Congressional Budget Office has found that the leading reform bills would bring the benefits and security of health insurance to 29 million more Americans over the next several years even as they help control rising health care costs.

Access to comprehensive health care is a basic human right. The moment has come to make that right a reality for millions more citizens.

Anne S. Kasper ( is chairwoman and Leni Preston (le is first vice chairwoman of the Maryland Women's Coalition for Health Care Reform.

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