An estimated 16 percent of Maryland residents do not have health insurance. That translates to more than 800,000 people who must pay out-of-pocket for trips to the doctor. Many in that figure rely solely on the rest of us to pay for their care, driving up total health care costs and insurance premiums in the same way uninsured drivers force the rest of us to pay more for car insurance.
That?s why all Marylanders should celebrate news that the state?s Health Care Commission is crafting a legislative proposal to structurally change the system to make private insurance available to everyone.
The draft of a plan it will present to the General Assembly, released last week, outlined a number of options the legislature could adopt, including requiring Marylanders to purchase insurance through an exchange program much like the one chosen by Massachusetts earlier this year. It also draws upon legislation introduced by state senator E.J. Pipkin, a Republican from the Eastern Shore. If an exchange proposal is passed, it means insurance would not be tied to employment, although employers would continue to contribute to the cost. The proposal would not apply to large employers.
The benefits of this idea include the fact that individuals, not employers, choose coverage and it would be portable, a key feature for today?s mobile workforce. One of the main problems of today?s employer-based system is that small businesses ? who generate the most jobs in the state ? cannot afford to offer coverage because the risk of someone getting sick is spread among so few people. In an exchange, risk will be spread out among all of the participants.
Only about 40 percent of small employers offer health insurance to workers in Maryland. And since 1999, the number has dropped 13 percent. The details of how an exchange would work, including how much the state should subsidize low income workers, penalties for those who do not participate and how premiums should be set, have not been decided. A final cost estimate has not been completed either.
Dr. Rex Cowdry, the executive director of the commission, said he favors an exchange, but realizes “this will be an expensive task.” He said the goal is to complete a draft recommendation by December.
So far the plan seems like a great start. It?s a lot better than what state legislators have offered the public so far. They rejected last year finding a solution to the problem, preferring to slap one company, Wal-Mart, with fines if the company did not spend enough on their employees? health care. That would have helped 10,000 people at most with a host of unintended consequences ? like deterring business from the state. Thankfully, a federal court struck down the law.
Governor-elect Martin O?Malley?s incoming team should study the proposal and work with the commission to achieve maximum legislative support. Republican Gov. Mitt Romney worked with the state?s Democratic legislature to pass the Massachusetts plan for the good of the people of the state. Helping to make health care affordable and portable with maximum plan flexibility certainly fits with O?Malley?s goal to work for the “common good” and “Maryland?s working families.”
Passing an exchange-based health care law would make Maryland the second state in the nation to do so and a model for others to follow. Legislators must make crafting it their top priority when they return in January.
