EDITORIAL: The Health Care Front

By The Baltimore Sun

Apr. 23--An advantage, if there is one, of Maryland's foot-dragging on health care reform is that it can learn from the example of bolder states leading the way on ensuring that their citizens have medical insurance.

At the head of the pack is Massachusetts, which has just unveiled an income-based scale of premiums and subsidies for a comprehensive insurance package available to state residents, who will all be required to carry some form of coverage.

After observing what is bound to be a bit of a turbulent shakedown cruise, Maryland can copy what works, avoid what doesn't and perhaps follow a swifter path to something near universal coverage.

With the ranks of uninsured Marylanders nearing 800,000, state officials can't justify waiting much longer. They missed an excellent opportunity to get started on a health insurance program during the recent General Assembly session because of a larger stalemate over tax increases and slots. Delay beyond next year would be inexcusable.

About a dozen states are building on the Massachusetts model, most notably California, which was second in the nation to adopt the principle that health insurance is not only a right but a responsibility -- like car insurance -- because society as a whole picks up the tab for the uninsured.

The Bay State is demonstrating how such a mandate can be implemented. Single individuals earning up to $15,315 a year and families with annual incomes of $25,755 or less would get free health insurance. Singles earning up to $50,000 a year would get the same coverage for monthly premiums of $300, while families bringing home $110,000 annually would pay $720 a month in premiums. A sliding scale would range in between, with state subsidies easing costs for those at lower incomes.

It's an expensive program, estimated to cost more than the $200 million annually the state had planned. And Massachusetts is starting at a base of more generous Medicaid coverage for the very poor than Maryland provides.

The cost may be offset in part by fees on employers who fail to provide their workers with coverage and on individuals who have insurance available to them but don't buy it. How all that works out, though, is still unknown.

Maryland's House of Delegates approved a far less ambitious program this year that would have extended Medicaid coverage to about one-third of those lacking insurance. Financing for that plan, which died in the Senate, would have come through a $1-per-pack increase in the state cigarette tax, a politically palatable but uncertain revenue source.

Over the rest of the year, enough should be able to be gleaned from the experience in Massachusetts, California and elsewhere for Gov. Martin O'Malley to put together a reform proposal that becomes the new model for the nation.

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Copyright (c) 2007, The Baltimore Sun

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