MCHP Expansion: Shifting Money Away From The Needy

By Marc Kilmer
Published on Wednesday, March 07, 2007
Among a variety of proposals being considered in the General Assembly regarding health insurance is a plan to provide state coverage for all children who live in families that make up to 400 percent of the federal poverty level—or$82,500 for a family of four in 2007.[1] While other proposals (such as raising the cigarette tax to fund a variety of health programs) are facing opposition, the expansion of state health coverage for children has received widespread support from Governor Martin O’Malley and a bipartisan group of legislators. Unfortunately, expanding such coverage would burden an already strained state children’s health insurance program, making it more difficult for the program to fulfill its original purpose of protecting the children of needy families. [1] Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148.

Health insurance mandates won't help uninsured

Originally published in the Baltimore Examiner

By Marc Kilmer
Published on Wednesday, January 31, 2007
BALTIMORE - With the opening of a new session of the General Assembly, we can be assured of action that will address the issue of those who lack health insurance in Maryland. One proposal that has fans from all sides of the political spectrum mandates health insurance for everyone in the state. Unfortunately, this popular proposal is a poor cure for our state’s health insurance ills. The path for this type of plan has already been blazed in Massachusetts, where former Gov. Mitt Romney pushed though a health insurance plan that imposes a number of mandates on individuals and businesses as well as provides subsidies for those who cannot afford insurance. It was popular with both Democrats and Republicans and is now being implemented. Massachusetts plans to use the funds otherwise going to pay the bills of the uninsured to provide these individuals with financial assistance and access to insurance. This will be accomplished by individual mandate, where uninsured residents will lose personal exemptions on their state tax returns; by employer mandate and risk of a fine; and subsidies for residents whose income is below 300 percent of the federal poverty level.

Mandating Health Insurance: Would The Massachusetts Plan Work For Maryland?

By Marc Kilmer
Published on Tuesday, January 16, 2007
Recent surveys indicate roughly 16 percent of Maryland’s population has no health insurance. Only 22 states have a greater percentage of their population who lack insurance.[1] This has led to the call for new public policies to extend insurance coverage to the uninsured. Some elected officials have looked to Massachusetts as a model for how Maryland should deal with this issue. In 2006, Massachusetts Governor Mitt Romney pushed through a plan mandating that all residents of Massachusetts have health insurance. The idea animating this bill is to require everyone to have health insurance, and then to use the funds otherwise going to pay the bills of the uninsured to provide these individuals with financial assistance and access to insurance. The plan proposes to accomplish this through the following means: Individual Mandate: State residents are required to have health insurance or face the loss of their personal exemption on state taxes. Employer Mandate: Employers are mandated to provide health insurance for all of their employees or pay a fine. Connector: The state will set up a system to help residents find insurance through a “Connector” that will help the uninsured find insurance policies. This will theoretically lower prices by pooling the uninsured to give them group rates. Subsidies for Low-Income Residents: Subsidies will be provided by the government for residents whose income is below 300 percent of the federal poverty level. [1]Council for Affordable Health Insurance, “ State Health Insurance Index 2006: A 50-State Comparison of the Nation’s Health Insurance Market,” October 26, 2006. The data referenced here was found in the methodology paper that accompanied this report.  

Smoking bans are dangerous to a free society's health

Originially published in the Baltimore Sun

By Thomas A. Firey
Published on Wednesday, December 06, 2006
Early next year, the Baltimore City Council and the Maryland General Assembly will likely vote on legislation to ban smoking in all bars and restaurants. If passed, these laws would end the nuisance and clothes-fouling stench of tobacco smoke in public places and reduce the health risks of secondhand smoke. And yet, the city and state would be wrong to pass them. Proponents justify a ban by arguing that secondhand smoke is a health risk. But all sorts of human activities are risky - from contact sports to rock climbing, from skiing to swimming, from riding a bike to having sex. Yet many people swim, bike and play football because they take pleasure in doing so, and that's their choice. In a liberal society, people are free to make their own risk and lifestyle choices - including whether to smoke. Ban supporters respond that smokers inflict harm on other people, including bar and restaurant employees and other patrons. But again, all sorts of activities impose risks on others, and again, those people bear those risks willingly. Rock climbers endanger rescue workers, pool owners endanger lifeguards and patrons, fishing boat captains endanger their crews, and so on. We grant people the choice to be rangers or lifeguards or commercial fishermen. Why shouldn't we allow people to choose to patronize or work in smoking bars and restaurants?

Reforming Medicaid by making users share its costs

Originally published in the Examiner

By Marc Kilmer
Published on Wednesday, November 15, 2006
WASHINGTON - During the campaign season, little attention was focused on the largest item of the state budget — Medicaid. This program has grown dramatically the past six years and promises to grow even more the next decade. Unfortunately, our elected officials are offering few ideas as to how to control the program’s growth. Instead of avoiding the issue, they need to be considering how to fundamentally restructure Medicaid in Maryland. One step in the right direction would be to introduce cost-sharing requirements for some Medicaid users. Currently, there is little or no cost for Medicaid users in Maryland. Since health care is essentially free to them, some Medicaid beneficiaries tend to overuse the system, which drives up costs for the taxpayers who are funding the program and unnecessarily burdens Maryland’s health care system.

Cost-Sharing to Reduce Medicaid Costs in Maryland

By Marc Kilmer
Published on Tuesday, October 31, 2006
In February of 2005, the Deficit Reduction Act (DRA) was signed into law by President Bush. Among the many features included in the bill were provisions allowing states to take steps to reduce Medicaid spending. Unlike some other states, Maryland has not yet utilized these opportunities to help control its rising Medicaid expenditures.   One of the most significant provisions in the DRA is the allowance of limited cost-sharing for Medicaid beneficiaries. States that choose these cost-sharing options will recoup some of the costs for providing Medicaid services. More importantly, these states will also reduce utilization of services. Some may view this reduction as a negative consequence of cost-sharing, but evidence indicates that the reduction in services is not accompanied by a reduction in a person’s health quality. Instead, the reduction in services will reduce over-utilization.

Importing prescription drugs is not the solution

Originally published in the Baltimore Examiner

By Alison Lake
Published on Thursday, July 27, 2006
Baltimore Mayor Martin O’Malley announced recently in his gubernatorial campaign that he will consider buying prescription drugs from Canada and abroad as a way to reduce health care costs for Marylanders. But that policy can potentially harm both consumers and the economics of drug creation and sale in the United States. Those unsolicited and poorly worded offers for Cialis and Viagra in our e-mail inboxes say it all. Drug re-importation is one situation where the invisible hand will not solve the problem. The key prefix is the “re-” in reimportation. The United States develops, creates and produces the bulk of the world’s drugs. Foreign governments legally purchase drugs from American companies at discount prices and then set their own prices at home (translation: price controls). Were Maryland to allow drug re-importation, American firms would continue to assume the worldwide burden of drug research and development but at a profit margin that did not take those efforts into account.

Relieving overcrowded ERs in Baltimore-area hospitals

Originally published in the Baltimore Examiner

By Alison Lake
Published on Thursday, June 22, 2006
BALTIMORE - About five years ago, Baltimore’s emergency rooms started overflowing. The city’s emergency rooms are not alone. In 2003, the General Accounting Office reported that ERs throughout the state and nation are overcrowded. But Maryland’s ERs force patients to wait longer than most in the country. Fortunately, two city departments and area hospitals are trying to do something about it. Around the state, more backup units have been asked to respond to medical emergencies while other ambulances idle until hospital beds become available. This strain on Baltimore City Fire Department’s emergency medical services prompted William J. Goodwin Jr., the city fire chief, to ask area hospitals for help. In just over a month, the city and its hospitals have set a fine example of what regional cooperation can do to address a serious problem that affects all levels of government and social services. “We took a proactive approach to a growing national problem,” said Goodwin.

The right to smoke, or a right to clean air?

Originally published in the Baltimore Examiner

By Alison Lake
Published on Friday, June 02, 2006
BALTIMORE - On June 5, 2006, the Howard County Council will vote on a bill to ban smoking in all restaurants and bars. If the Robey-Ulman bill is passed, Howard County will join Prince George’s, Montgomery and Talbot Counties in legislating smoke-free establishments. Yet for Marylanders who detest cigarette smoke for health or personal reasons and for Marylanders who savor the experience of lighting up a cigarette, state and county tobacco policies are contradictory and not altogether helpful.

Empty Promises: The Reality of Prescription Drug Importation For Maryland

By Nina Owcharenko
Published on Wednesday, March 01, 2006
Policymakers in Maryland are jumping on the bandwagon in support of prescription drug importation. Recently introduced legislation would have Maryland follow other state efforts to import prescription drugs from Canada.[1] However, such policy recommendations are full of empty promises. First, the safety and economic consequences of drug importation are clearly legitimate reasons for concern. Second, federal and state efforts to prevent drug importation have all but failed. Maryland policymakers should take heed, recognizing that the prescription drug importation is a backdoor effort to import price controls and a slippery slope towards a Canadian-style health care system. [1] See Maryland Senate Bill 568 at http://mlis.state.md.us/2006rs/billfiles/sb0568.htm.