Maryland will try, try again on health reform

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ANNAPOLIS — Maryland lawmakers say they are determined to try again on a health care reform package that would boost the number of people with health insurance, put more workers in wellness programs and reduce premiums for people with insurance.

However, lawmakers acknowledge there may be little money to do the things they would like. The state faces a projected deficit of about $1.5 billion next fiscal year, and any pricey changes to the health care system likely will have to come with their own new taxes.

Undeterred, lawmakers from the House and Senate wrapped up a summer of hearings on health care yesterday with more talk about low-cost ways to boost health coverage.

Topics on the table include incentives to get doctors and community health centers to stay open late — so sick people won't have to resort to expensive emergency rooms after hours — and measures to encourage businesses to improve worker health by paying for weight-loss programs and gym memberships.

Delegate Dan K. Morhaim, an emergency room physician and co-chairman of the legislative commission, said the state should look at low-cost ways to save money on health care.

For example, health insurers pay $20,000 when a person breaks a hip, but they won't spend $250 or so to visit an elderly person's home and install slip guards and hand rails in the bathroom, which could prevent dangerous falls, said Mr. Morhaim, Baltimore County Democrat.

"There's a lot of money being spent [on health care], but we're not really spending it in the most effective way," Mr. Morhaim said.

Not all fixes would come cheap, though.

A big priority for lawmakers on health care — an expansion of Medicaid to help reduce the 750,000 or so Marylanders with no health insurance — likely would cost millions of dollars. Already the state spends about $5 billion a year on Medicaid, out of a total budget of about $30 billion, so a large expansion of the Medicaid population is an expensive proposal.

Lawmakers on the health care study say they will meet this fall to write proposals due by January on what to do about health care. Last year, the House passed a $1-a-pack increase in the tobacco tax to pay for a Medicaid expansion, but the Senate balked.

Sen. Robert J. Garagiola, chairman of the Joint Committee on Health Care Delivery & Financing, said another proposal on Medicaid expansion is certain next term.

"It's critical that we expand Medicaid," said Mr. Garagiola, Montgomery County Democrat. "That clearly has to be part of it."

An advocacy group that has long pushed for a Medicaid expansion plans a press conference next week to renew its call for a higher tobacco tax and a revival of the Medicaid expansion.

"There's a growing consensus that the Medicaid system in Maryland has got to be expanded," said Vincent DeMarco, head of the Maryland Citizens' Health Initiative, which backs the tobacco-tax idea.

Sen. Catherine E. Pugh, Baltimore Democrat, said lawmakers would not work on just Medicaid but also overall wellness. She mentioned legislation to increase physical education in schools and encourage more late-night doctors.

"I don't think we're just talking about money here," Miss Pugh said.