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Ill Communication

Health-Care Initiative Takes a Step Back to Build Public Support

By Afefe Tyehimba | Posted 10/3/2001

On the heels of unveiling an ambitious, long-awaited blueprint for statewide universal health-care coverage, the Maryland Citizens' Health Initiative (MCHI) is backing off its highly publicized plans to get the issue atop the agenda for next year's General Assembly session and state elections. Rather than confront the state legislature with a universal-coverage bill in 2002, as originally planned, organizers say they will spend the year working to build the kind of public support needed to sway lawmakers down the line.

"Whenever you introduce legislation that's making a major impact on a system, it's very unlikely it would pass the first year," says Dr. Peter Beilenson, Baltimore City's health commissioner and president of MCHI, a nonprofit organization formed in 1999 to develop and promote a universal-health-care plan. "We never thought it would pass in 2002 but did plan on introducing it to get people talking about it. Our major political goal was to elect a governor who would support [such legislation] so we could get it through in 2003."

Behind the decision to forego a legislative push in 2002 are practical as well as political considerations. For one thing, despite broad general support, MCHI still lacks firm endorsements.

More than 2,100 religious, labor, health-care, and community-based groups have signed a "Declaration of Health Care Independence"--the initiative's chief measuring rod for gauging support (along with polling that shows general public support for efforts to cover the uninsured). But the declaration's fine print states that organizations signing the form "reserve the right to review any proposals to implement [the plan] before endorsing such proposals." In other words, Beilenson says, "there was a caveat that they were only signing on in principle and we would come back to them with the final plan so we could turn this into an election issue."

Another likely obstacle to election-year lawmaking is MCHI's funding blueprint, which hinges on a 70-cent tax hike on cigarettes--an idea unlikely to fly given the 30-cent increase legislators approved in 1999. Moreover, some business groups have sounded alarms over additional funding proposals that call for culling millions from other government pots to fund the health-care initiative. On Sept. 7, the day MCHI released its universal-coverage plan, David Tuerck of the Maryland Foundation for Research and Economic Education, a nonprofit organization opposed to universal coverage, told the Associated Press that "money that goes into this has got to come out of something else. Taxes have to be raised ultimately."

In an attempt to overcome skepticism and garner support for statewide universal coverage, MCHI leaders have scheduled 14 town meetings throughout Maryland between now and the end of November (including two in Baltimore, on Oct. 11 and 29). In the meantime, they're making the rounds of agencies and groups whose constituencies might have an interest in universal health care.

On Sept. 19, MCHI executive director Vincent DeMarco was the featured speaker at the monthly meeting of Welfare Advocates, a coalition of universities, state agencies, and community organizations working to reduce Maryland's welfare rolls. Most of the 30 people gathered at Enoch Pratt Central Library knew of the universal-coverage effort, and knew it would directly affect their client base--the working poor, particularly those making the transition from public assistance to steady employment.

"Our basic premise is that there are folks going out every day, doing the right thing, and they should have health care," said Lynda Meade, director of social concerns for Catholic Charities and Welfare Advocates' chairperson.

But as DeMarco highlighted some of the 100-page plan's finer points, Meade and her fellow attendees took copious notes. Clearly, MCHI's plan for universal coverage was news to them. And if it was news to a roomful of folks toiling in the social-services field, it's probably news to other key constituencies whose support MCHI must enlist.

Simply put, MCHI's plan would extend health coverage to all Free State residents, nearly 650,000 of whom are presently uninsured. DeMarco told the Welfare Advocates audience that he envisions the plan as an extension to adults of Maryland's health-insurance program for children, implemented in 1998 to ensure coverage for all children from low- and middle-income families. The program would be administered by a trust overseen by a quasi-public board appointed by the governor. And eventually, he said, all state residents would be required to carry insurance, either privately or through the trust, which would use a sliding fee scale to ensure affordability for all.

DeMarco said MCHI's plan's offerings would compete with conventional plans that provide high-demand mental-health and substance-abuse services--and that its low cost would free lower-income workers from having to go without coverage for their families. On paper, it's a tough proposition to ignore. But there's one piece missing, and without it MCHI may have a hard time reviving its legislative efforts. The architects of universal health care have yet to articulate a definitive funding plan.

They have determined that universal coverage will cost an estimated $1 billion a year, based on current population data, and they've identified a handful of potential funding streams, including the cigarette-tax hike, state subsidies already earmarked for the uninsured, federal matching funds, and various state-budget savings--including the upgrading of computer systems to allow for online claims filing and payments--they contend the plan would create. But the plan's success invariably depends not on potential prospects for money, but on solid commitments. And so far, Maryland lawmakers aren't offering them.

Last December House of Delegates Speaker Casper Taylor Jr. (D-Allegany County) told The Sun that Maryland would "never get 100 percent coverage, but we can get close, and I think we're going to get there incrementally." In the same article, House Majority Leader John Hurson (D-Montgomery County) offered conditional support for the initiative, saying it would happen by "taking a number of smaller steps." (Neither legislator returned calls seeking comment for this story.)

But DeMarco and his fellow MCHI soldiers remain undeterred in their efforts to drum up interest in the cause--and, they hope, crucial support that will change the minds of folks like Taylor.

As DeMarco's spiel at the Sept. 19 Welfare Advocates meeting wound down, one attendee asked a question that may have been lingering in his audience's collective mind: Why doesn't Uncle Sam launch such a plan on a national scale?

"The federal government has one thing on its mind now, and will for a long time," DeMarco said, as heads in the crowd nodded at the reference to the terrorist attacks eight days earlier. But DeMarco quickly turned the focus back to the people in front of him, and what they, as advocates for Maryland's working poor, can--and, he contended, should--do to help make universal health-care coverage a reality.

"We have to help--and people who advocate for the uninsured are a critical part of this coalition--to make it happen," he said.

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