The Maryland Public Policy Institute
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Across the country, hospital CEOs, physicians, patients and just about everyone else have been anxiously awaiting the Supreme Court's ruling on the constitutionality of President Barack Obama's health care reform law.
In Maryland, though, not so much.
It's not for lack of caring or people without health coverage, a number that includes an estimated 34,000 on the Lower Shore alone. It's politics: Maryland's Democratic majority is likely to plow ahead with many of the reforms, including perhaps a state-run health insurance "exchange," even if the federal law gets struck down.
"If we're left in a position of having to go with a state-by-state approach with federal partnership, I think you can anticipate that Maryland will be a state that's in the forefront of those states that move forward," Gov. Martin O'Malley told reporters in March as the court held several days of hearings on the issue.
Justices will announce their decision at about 11 a.m. today.
Moving forward with its own individual mandate -- a requirement that all residents be covered by health insurance -- "certainly would be an option," Joshua Sharfstein, head of the Maryland Department of Health and Mental Hygiene, told The Daily Times last week. "But we wouldn't make a snap judgment. We would think it through."
The mandate was necessary to win support from insurance companies. Without it, they feared that only people with existing health problems would buy into the new plans, forcing them to charge sky-high premiums or go bankrupt.
A state having its own health-insurance mandate wouldn't be unprecedented. Under then-Gov. Mitt Romney, Massachusetts enacted one in 2006, and it became the model for the law signed by Obama four years later.
The issue has put Romney in a tough spot politically. Now the GOP's presidential nominee, he has said he supports allowing states to make their own health care decisions but is against the federal mandate that has generated so much right-wing opposition.
For his part, Marc Kilmer, a health care policy expert for the conservative Maryland Public Policy Institute, said he expects to see a mandate in Maryland, regardless of how the Supreme Court rules.
"The state of Maryland will say, 'We spent all this money and got the health exchange set up and changed the regulations and expanded Medicaid, and they'll be prohibitively expensive without the individual mandate,' " said Kilmer, who lives in Salisbury. "I think they can make the case 'we've done these things and they need the individual mandate to work, so we need to go ahead and enact it.' "
Under the health care law, better known popularly as Obamacare, the federal government promised states it would cover the cost of expanding Medicaid eligibility and for poorer patients, that it would subsidize their premiums. If the court strikes down the entire law and Maryland moves forward, expect taxes to go up in the Old Line State to pay for the programs, Kilmer said.
Speculation has swirled about what the Supreme Court will do. The thorniest issue: It's unclear whether the court can strike down the individual mandate and keep the rest intact or if the whole law must go down with it. That would include some popular provisions, such as mandated coverage for chronically ill children and allowing young people to stay on their parents' plans until age 26.
Maryland is one of 10 states that have created a health exchange, a competitive marketplace where the uninsured can buy subsidized insurance. The plans are set to go into effect in 2014 -- unless the court halts them.
The state won't be on the hook for the $34 million in federal grants it has used so far to create the exchange. Still, Kilmer and other conservatives say, state Democrats shouldn't have moved so quickly.
"Even if you are in favor of the law, with the uncertainty with the Supreme Court or if Romney gets elected, it seems prudent to let other states go ahead and take their chances and learn from their mistakes," Kilmer said.
Leaders at Peninsula Regional Medical Center, which features the Eastern Shore's only trauma center, are rooting for the law to stay intact, said Doug Wilson, executive director of strategy and marketing. Under a 1970s-era law, Maryland hospitals already share the cost of providing care to uninsured patients with each other. Obamacare would take the vast majority of those costs off their books.
Wilson said the health care law doesn't force people with health insurance to pay for those who don't, as some critics have insisted. They already do in the form of higher medical bills, which are used to defray the costs of unpaid bills.
During oral arguments about the health care law, Justice Anthony Kennedy, considered the court's swing vote, sharply questioned the Obama administration's lawyer, prompting many watchers to question the fate of the federal mandate. But Maryland's will probably survive no matter what Kennedy decides, Wilson said.
"We're already moving forward with the things we want to do and probably will continue to do," he said. "To coin a terrible phrase: The train's already left the station."