Maryland is making progress in its health care expansion efforts, but there’s still a lot of work to be done, said Secretary John Colmers, Maryland State Department of Health and Mental Hygiene.
On January 13, Secretary Colmers updated the GBC Health Care Committee on health care access activities; Medicaid expansion; budget constraints; the federal stimulus package; workforce issues; health IT; and emergency preparedness.
Health Care Expansion
Maryland has done an outstanding job expanding health care to children under Maryland’s Medicaid and State Children’s Health Insurance Program (SCHIP). Prior to legislation passed in November 2007, Maryland had almost 800,000 residents who were uninsured, and was ranked 44th in providing healthcare for parents through Medicaid, said Colmers. As a result of the legislation, Maryland has moved up to the 21st position, becoming one of the nation’s least restrictive states in providing health care to adults and children most in need.
The Working Families and Small Business Coverage Act expands health coverage access to more than 100,000 uninsured Marylanders by increasing the Medicaid income eligibility level for both parents and childless adults to 116 percent of poverty, said Colmers. To date, with the help of outreach partners, a lot of caregivers and parents have enrolled. The eligibility process is a lot less complicated. However, the small business piece kicked off in October 2008 around the time when the economy took a dive so small businesses suffered and enrollment decreased, he said.
“We are suffering budget shortfalls,” said Colmers. An effective way to stimulate the economy is to temporarily increase the federal matching rate for Medicaid. If the federal government pays a larger share of Medicaid costs through a temporary increase, states can sustain their programs, rather than cutting Medicaid when people most need help – while simultaneously facilitating national economic recovery, he said.
The state has gone through two rounds of cuts in 2009 and another round of cuts is coming up, said Colmers. “These types of cuts have been painful,” he said. Ninety-two percent of the budget goes to payments to providers, among other things. Cutting a round of services has to be done in a way that’s fair and smart to avoid cutting really important services, he said. “I hope it’s the last cut in 2009 because in 2010, it will be a very, very lean budget.”
It’s very clear that there will be no money, but it will be more about self-preservation, said Colmers. The state is paying close attention to the federal stimulus package, but it will still be a very “ugly budget.” People don’t understand the magnitude of the problems, but at least Maryland is not as bad as some states including Rhode Island and California, he said.
Health Care Reform – Federal Level
Former Senate Majority Leader Tom Daschle will lead the White House efforts to shape an overhaul of the nation’s health care system and push it through Congress. President Obama has made a commitment to change. Maryland is fortunate to have a delegation that knows health care, said Colmers. Senator Barbara Mikulski and Senator Benjamin Cardin are great advocates for Maryland’s health care reform, making sure it is fair and balanced, he said.
Colmers suggested a few principles that should be included in the health care reform plan:
- Do no harm. Don’t undermine the many positive things in the state and don’t penalize things enacted early.
- Protect innovation. Hope to see reform activity with national parameters but flexibility of coverage remaining largely local.
- Access. Maximize enrollment in existing programs. Ensure that processes are in place so that people who are eligible for programs can gain access to them.
- Significant investment in comparative research. Design payment systems that encourage and reward research/comparing treatments.
- States ought to be used as pilots. States would apply to become pilot laboratories. Maryland is in a good position for this.
Access and Reimbursement
The state’s Task Force on Health Care Access and Reimbursement, created as part of a bill passed during the Maryland General Assembly’s 2007 legislative session, just completed work on a report released in December 2008. The eight recommendations include establishing an expanded loan program that allows other physician specialties to participate in education loan forgiveness; simplifying the credentialing of physicians by hospitals and health plans; and a strong emphasis on improving primary care. (Full report)
President Obama also has indicated that the economic stimulus package would include funds for health care information technology efforts, such as the expansion and implementation of electronic health records, in an effort to decrease costs and reduce medical errors, said Colmers. Maryland needs to demonstrate to the federal government that “we are shovel-ready” for health reform, he said. As far as the development of health care IT, MedStar Health has indicated it would like to be at the head of the queue, said Colmers.
The Greater Baltimore Committee took the lead with the business community in preparing for an emergency in the event of a disaster. The state is looking to expand biopreparedness with the hospital community.