- The Washington Times - Monday, August 4, 2003

ANNAPOLIS — The state’s health secretary says Maryland residents will pay for much of the $84.4 million in health care budget cuts announced by Gov. Robert L. Ehrlich Jr. through higher insurance rates.

Secretary of Health and Mental Hygiene Nelson J. Sabatini is also warning that the state likely will cut its health care services in future years as costs continue to escalate faster than revenue.

He said the state’s ability to provide basic health coverage for uninsured families would depend on controlling existing programs. Mr. Sabatini has said he wants to provide basic coverage for an estimated 580,000 uninsured state residents.

Mr. Ehrlich blamed the legislature for $208 million in health care and other cuts made by the state Board of Public Works on Wednesday. He said his proposal to gain additional revenues from slot-machine gambling would have paid the bills.

About half the cuts in the health care budget come from state spending on Medicaid, the program that provides medical coverage for low-income people, mostly children and seniors in nursing homes.

Mr. Sabatini said about half of the health care cuts overall could be replaced by shifting the cost to the federal government. But he said the largest of the cuts would prompt a cost-shifting to insured Marylanders.

The state will limit on the number of hospital days it will cover in the Medicaid program, a move expected to save $20 million in state Medicaid spending. Mr. Sabatini said that will not mean patients will be pushed out of hospitals, but that the hospitals will be forced to give more uncompensated care, which leads to higher rates.

“While the taxpayers won’t formally pay for it, they’ll pay for it in a different way, through higher [health insurance] premiums. It’s just not as visible as it would be if it were in the budget,” said Kenneth E. Thorpe, chairman of the health policy and management department at Emory University and a consultant to Johns Hopkins Hospital.

“I call it a sick tax,” in that those who are hospitalized pay for the uninsured and for shortfalls in Medicaid reimbursement, said Stuart H. Altman, professor of state and national health policy at Brandeis University and a consultant to the Maryland Hospital Association.

While Maryland has a direct system of passing on the costs to hospitals, “most of the other states do it in a less-formal way, but it’s happening all over the country,” he said. “It’s one of the main reasons health insurance costs are going up so fast.”

Beyond the cost-shifting, “there’s a need for services that’s not going to be met, there’s no question about that,” Mr. Sabatini said. While the cuts do not drop people from programs, they limit new enrollments in some health care programs.

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