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December 2, 2003

A Health Care Primer

Richard B. Weldon Jr.

I have heard healthcare described as the "800 pound Gorilla" of the upcoming General Assembly session.

Over 690,000 Maryland residents lack health insurance. These folks still require medical services; they either have to pay for the services when rendered or depend on someone else to pay for them.

690,000 people! That's a staggering number, even for the most jaded among us. When I first heard that statistic, my heart was wrenched. I imagined several hundred thousand people facing the most difficult decision possible; whether to pay rent or obtain needed medical services.

As is the case in almost every public policy discussion, there is considerably more behind the fašade. In this case, the details tell a very different story.

Of the 690,000 without health insurance, 38% make over $55,000 per year. Of that number, another 15% make at least $100,000 per year. 29% percent of adults without health insurance actually work for the government or for a major employer with over 100 employees.

I can make a case for some form of government assisted health insurance program for people who simply cannot afford it. In fact, I can show you how we all end up paying significantly more when these people visit Frederick Memorial Hospital Emergency Room for their primary care.

No one I know can make a cogent argument for Maryland taxpayers to foot the bill for people who choose not to pay for some form of health insurance.

My committee, the Health & Government Operations Committee, will be debating and discussing several plans designed to provide health insurance for the uninsured.

All four of the proposed plans will be accompanied by a hefty bill (I mean payment, not legislation). The strange thing is that the General Assembly is facing a $700 million dollar deficit, yet we'll be discussing a multi-multi-million dollar health insurance initiative.

Two of the proposals are phased in over several years. One of these will come from the Ehrlich Administration, authored by Nelson Sabatini, the Secretary of Health and Mental Hygiene. Secretary Sabatini feels very strongly about this issue, and his proposal reflects the issues he believes will have the most significant impact.

The centerpiece of his plan is malpractice reform. Every expert in the healthcare field I've spoken to agrees that Maryland is facing a crisis in malpractice insurance. Doctors cannot afford the premiums, and large non-economic damage awards are choking the system.

In fact, the only special interest in dispute on this fact is the trial lawyers. Surprised?

In addition to the Sabatini Plan, two others deserve a mention. The Maryland Health Care Initiative (formerly called Health Care for All) is defined as a "pay or play" plan for employers. They will have to offer an affordable insurance plan or face a new state tax to underwrite the cost of health services to the uninsured. Small businesses in my district are already complaining about mandates. I wonder how this helps?

Obviously, business groups across Maryland object to this approach. The most common objection is that we will be creating another disincentive to owning and operating a business in Maryland.

Religious groups, human service non-profits, and organized labor are in support of this initiative. The major voice behind this plan is Dr. Peter Bielenson, the health commissioner of the City of Baltimore, long a proponent of income redistribution throughout Maryland to pay for public health priorities in Charm City.

The other plan on the table is the Primary Health Care Network Initiative, introduced by the chair of my committee, Delegate John Hurson (D., Montgomery). Chairman Hurson has designed a plan centered on the expansion of the existing network of Federally Qualified Health Center (FQHC), currently located in a few of our rural jurisdictions.

His plan calls for our existing hospitals to pay an additional tax into the Uncompensated Care Fund. Clearly, hospitals (including our own FMH) are not too excited about this idea. One thing to keep in mind is that Maryland hospitals are already very heavily regulated, and adding an additional tax burden doesn't help at all.

I envision a blending of the various approaches into some hybrid solution. I also expect that any solution will be spread over a few years, given that a one-year implementation breaks the bank.

I have written a non-partisan, plain English synopsis of this issue. You can contact me at for a copy. I don't pretend to be the expert on this, but I've sat through countless hours of testimony and presentations, so hopefully I've picked up a thing or two.

Your thoughts and ideas would be helpful, so don't hesitate to weigh in!

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