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; 41st 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