1. Maryland’s Approach to Coverage Expansion 2004 Presentation by the Honorable John Adams Hurson Chairman, Health & Government Operations Committee Maryland House of Delegates President-elect, National Conference of State Legislatures (NCSL) June 28, 2004

2. Environment for Expansion Fiscal constraints Very low Medicaid eligibility; 41 st in country –45% FPL for adults –200% CHIP –Managed Care, mental health carve out Exploding ER’s Small business pool; high risk pool

3. Public Health Model Revisited Public health expansion is better than insurance –Insurance premiums increased by double-digits –Small group market under stress Strong public health center model working –FQHC’s-56 sites in Maryland –Hospital-based outpatient centers in Baltimore –Strong, vibrant, diverse non-profit health care providers –Targeted benefits

4. “Community Health Care Access and Safety Net Act of 2004” (HB 1271) New Community Health Resources Commission Capital assistance –Governor’s proposal; expanded by legislature –Rehabilitation clinics, Information Technology (IT), 340B drug purchase –Not impacted by operating budget crisis Operating assistance –$10 million in flexible grants; assist in payments to specialists Expansion of Medicaid to parents of CHIP children; discussion of benefit packages

5. Network of Community Care New Commission would set standards and refer qualifying individuals to proximate resource Integrates community resources through IT Hospital integration through community benefit grants and ER reverse referral Primary and Preventive Care integrated with acute care in hospital all-payor uncompensated care program

6. Advocates and Opponents Community Clinics (FQHCs) and non-profits: strong support Advocates for poor: support Hospitals: neutral to opposed Insurers: opposed to neutral Unions and “universalist”: opposed Governor: opposed, based on HMO tax

7. Outcome…”Fight another day!” Passed House by veto-proof margin, by vote of 86-54 Failed on final night of session in State Senate, by vote of 22-24 Governor’s opposition was significant Advocates were overreaching and unrealistic Budget concerns were growing Return in 2005 session with re-worked legislative product