Single-Payer Health Care for Maryland: Two Analyses

By Marc Kilmer, Ian Munro
Published on Thursday, April 10, 2008
The Maryland Public Policy Institute of Rockville, Maryland and the Atlantic Institute for Market Studies (AIMS) of Halifax, Nova Scotia have released a joint evaluation of the proposal for a universal health care system in Maryland, providing both an American and Canadian prospective. Read More »

Let consumers make health care choices

Originally published in the Baltimore Examiner

By Marc Kilmer
Published on Thursday, April 03, 2008
BALTIMORE - The other day my 6-year-old niece told her mother that she thought the family should buy a boat. Her mother tried to explain to her how much boats cost, that the family needed to spend money on other things, and an elemental conception of having finite resources. To a 6-year-old, however, none of that mattered. She wanted a boat, and she saw her parents as having limitless resources to provide any desire she wanted. If they didn't buy a boat, it was because they selfishly wanted to keep her from enjoying it. Read More »

A Growing Fiscal Concern: Medicaid Spending In Maryland

By Marc Kilmer
Published on Wednesday, January 09, 2008
In a special session in late 2007, Maryland's General Assembly expanded the state's Medicaid program. Given that this special session was convened to deal with the state's deficit, expanding a program that has caused financial challenges for the state seems an odd decision. Over the past 15 years, this program has strained state budgets, especially during times of economic recession. A different approach is needed.Maryland contends with a long-term budget deficit and faces the possibility of a slowing economy. In this economic and fiscal climate, state policymakers should seek alternatives to Medicaid expansion. Steps to make health insurance more affordable for Marylanders and fundamental reform of the structure of Medicaid would benefit Marylanders more than expanding an expensive program.Anyone considering Medicaid expansion should keep in mind the state's recent experience with Medicaid and the Maryland Children's Health Program (MCHP). Looking at spending patterns in the years since 1992 gives a good snapshot of how Medicaid and MCHP work in both good economic times and bad. Medicaid occupies a significant share of the state budget and squeezes out spending on other programs during economic hard times. Although Medicaid is known as a program that is needed to help people who are in difficult economic circumstances, only during 1998 did spending actually decrease despite many years of high economic growth. Read More »

A Growing Fiscal Concern: Medicaid Spending In Maryland

By Marc Kilmer
Published on Wednesday, January 09, 2008
In a special session in late 2007, Maryland's General Assembly expanded the state's Medicaid program. Given that this special session was convened to deal with the state's deficit, expanding a program that has caused financial challenges for the state seems an odd decision. Over the past 15 years, this program has strained state budgets, especially during times of economic recession. A different approach is needed.Maryland contends with a long-term budget deficit and faces the possibility of a slowing economy. In this economic and fiscal climate, state policymakers should seek alternatives to Medicaid expansion. Steps to make health insurance more affordable for Marylanders and fundamental reform of the structure of Medicaid would benefit Marylanders more than expanding an expensive program.Anyone considering Medicaid expansion should keep in mind the state's recent experience with Medicaid and the Maryland Children's Health Program (MCHP). Looking at spending patterns in the years since 1992 gives a good snapshot of how Medicaid and MCHP work in both good economic times and bad. Medicaid occupies a significant share of the state budget and squeezes out spending on other programs during economic hard times. Although Medicaid is known as a program that is needed to help people who are in difficult economic circumstances, only during 1998 did spending actually decrease despite many years of high economic growth. Read More »

Expanding Medicaid ensures budget problems

Originally published in the Baltimore Examiner

By Marc Kilmer
Published on Thursday, December 13, 2007
BALTIMORE - During the recent special legislative session to address Maryland's structural deficit, lawmakers increased a variety of taxes so revenue could keep up with projected spending. With future spending obligations being the rationale to raise taxes, it seems sensible that our legislators would take steps to control spending. Instead, they actually increased eligibility for Medicaid, a program that is already one of the largest in the state budget. At a time when all are concerned about the state's deficit, this was a short-sighted move. Medicaid is one of Maryland's largest budget items, consuming 15 percent of general fund revenues. Moreover, Medicaid spending is growing at a worrisome rate; since 1999, program spending has more than doubled. Around 11 percent of Marylanders receive medical care from Medicaid or the Maryland Children's Health Program. Read More »

Cigarette tax increase plan is flawed

Originally published in the Baltimore Examiner

By Marc Kilmer
Published on Thursday, October 04, 2007
BALTIMORE - As part of his effort to close Maryland’s structural deficit, Gov. Martin O’Malley has set his sights on a favored taxman target: Cigarette smokers. The governor has floated the idea of doubling Maryland’s $1-a-pack tax on cigarettes, rekindling a proposal that died in the state Senate last spring. This raises a question: Why should cigarette smokers have to pay off so much of the state’s budget deficit? Moreover, is increasing Maryland’s fiscal dependence on the cigarette tax such a good idea? Anti-smoking advocates often claim that high cigarette taxes are justified because smoking imposes huge costs on society. Though it is true that smoking does impose some social costs, academic studies show those costs are dwarfed by the taxes already assessed on cigarettes. Cigarette users cost society around 32 cents a pack. The additional 68 cents that Maryland collects on each pack of cigarettes, plus any additional tax that Gov. O’Malley may implement, does not compensate for smokers’ cost; it is merely a subsidy going from smokers to everyone else in Maryland. Read More »

'Free' federal money for state health programs won't last

Originally published in the Baltimore Sun

By Marc Kilmer
Published on Tuesday, July 17, 2007
Maryland's lawmakers need to pay close attention to the state's dispute with the federal government over Medicaid. Maryland has been using a combination of state and federal Medicaid dollars to pay for a variety of services for children in special education. The federal government is now saying some of these payments were improper and wants its money back. This disagreement illustrates an often-overlooked fact about Medicaid: The federal government is looking for ways to reduce its Medicaid spending. That does not bode well for those looking to expand Medicaid in our state. Read More »

Raising state's cigarette tax comes at a high price

Originally published in the Baltimore Sun

By Marc Kilmer
Published on Tuesday, March 27, 2007
Discussions are under way in the General Assembly to raise the tax on cigarettes in Maryland. Although Gov. Martin O'Malley and certain key members of the Assembly are opposed to it, a bipartisan coalition is backing the plan. Raising cigarette taxes, however, brings with it a unique set of problems that may result in less revenue and cost the state more to enforce compliance than advocates claim. If some policymakers get their way, Marylanders will be paying $2 in taxes on each pack of cigarettes they buy in the state. That is a 100 percent increase from the current tax of $1 a pack. More significantly, it is also much higher than any of Maryland's neighbors. If results from other states are any indication, a significant number of Marylanders will start buying cigarettes out of state, leading to much less tax revenue than anticipated. The side effect will also mean that Maryland businesses that sell cigarettes, such as gas stations and convenience stores, will lose sales to out-of-state businesses. Read More »

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. Read More »

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. Read More »