Lawmakers renew effort for ealth coverage

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ANNAPOLIS -- Maryland lawmakers began work yesterday on another effort to expand health coverage -- but they were warned by several specialists that the task will be both difficult and expensive.

A panel of lawmakers held the first of three meetings to regroup after failing last legislative session to agree on a plan to chip away at the estimated 750,000 residents without health insurance. A health care proposal made earlier this year sputtered amid concerns it would cost too much -- but in yesterday's briefing, speakers agreed that the job won't get cheaper.

"What's our goal? Is our goal near-universal coverage? If so, I think we have to realize that's an expensive goal to reach," warned Dr. Rex Cowdry, executive director of the Maryland Health Care Commission, a state agency.

Health care has proved one of the thorniest issues for Maryland politicians to deal with in recent years. The Democratic-controlled legislature made national headlines last year when it enacted a bill requiring Wal-Mart Stores Inc. to come up with more money for employee health care. But that attempt fizzled when two federal courts ruled that the measure -- an attempt to mitigate rising Medicaid costs -- violated federal laws about employee benefits.

This year, lawmakers tried a new tack -- expanding Medicaid coverage by doubling the state tobacco tax, to $2 a pack. That attempt passed the House but failed in the Senate over concerns about starting an expensive new program while the state is experiencing fiscal problems.

Sen. Rob Garagiola yesterday said he favored a special session to address the state's projected deficit of at least $1.4 billion, with some money being set aside for health care.

Mr. Garagiola, Montgomery Democrat, said a health care overhaul was unlikely without new taxes, and that all the tax work should be done at once. Mr. Garagiola is concerned that if money isn't set aside for health care during budget discussions, the state won't be able to afford to offer health insurance assistance to more people.

"We've got to first get our fiscal house in order," he said. Later, the senator said, "My feeling is, we've got one bite of the apple for new revenue."

John Colmers, secretary of the Maryland's Department of Health and Mental Hygiene, said the agency is already planning $50 million in cuts in coming weeks, and he called on lawmakers to craft an "affordable and sustainable" solution to the health care problem.

Lawmakers were briefed on projected expenses for certain improvements, along with examples from other states trying to expand access to health care. They learned that roughly 10 percent of the health insurance premiums paid in Maryland go for paying health costs for people without insurance. Lawmakers also heard suggestions about where to get the money to pay for health care improvements, especially the tobacco tax idea.

After the hearings, lawmakers said their work is just beginning.

"Short of a single-payer universal system, there is no quick fix," said Delegate Dan Morhaim, Baltimore County Democrat, who is also a physician.