While President Obama pushes for a nationalized health care "public option," Maryland is busy making it happen without federal legislation. And so far the result is much higher costs for state and federal taxpayers footing the bill.

In the November 2007 Special Session - with rumblings of a financial meltdown all around - state legislators passed a law to expand Medicaid coverage. The bill, SB6, reduced income limits for those eligible to receive assistance. Under the new law, a family of four with annual income of about $24,000 qualifies. That is 116 percent above the federal poverty level.

At the time, the state estimated that about 27,000 new people would sign up in fiscal 2009. One week into fiscal 2010, about 44,000 people have signed up, with a goal of adding 100,000 new people by 2013. Because of an influx of federal dollars from the stimulus package, the state can pay for those people and any more who qualify in the next two years.

This year there is a 10.7 percent increase to $342.1 million in federal aid for Medicaid in Maryland. Medicaid funds from the stimulus, available from October 2008 to December 2010, total $1.4 billion in the state.

But as the Maryland Department of Legislative Services said in its evaluation of the most recent legislative session, "when the (stimulus) funds are no longer available, the state will need to replace the funds or reduce spending."

Since the goal of the state seems to add more people, reducing spending is not an option.

In announcing the program last year, House Speaker Michael E. Busch (D-Anne Arundel County) described health care as a "right" rather than a "privilege."

If the legislature agrees with him, then the cost will grow astronomically as more and more people are added to the public roles, despite Busch's and others' claims that doing so will save the state money.

The DLS estimated in 2007 that the Medicaid portion of SB6 would cost $239 million in fiscal year 2010 which just started. But the head of Medicaid planning for the state said it was going to cost $50 million more than anticipated.

With entitlement programs eating up a larger and larger percentage of the budget each year, that means less and less money for other government services - save for massive tax hikes since legislators are incapable of cutting the budget. As noted in an earlier column, entitlement spending has grown from 16.2 percent of the budget in 2001 to 20.8 percent this year, with no slowdown in sight.

Legislators should have known better than to create a massive new spending program on the eve of a recession without a plan to pay for it.

As Maryland Public Policy Institute Senior Fellow Marc Kilmer wrote in a January 2008 report, "earlier this decade the rise in enrollment and the drop in revenue caused the program to grow from 13 percent of general fund revenues in 2000 to 17 percent in 2003."

Legislators have a habit of passing legislation without having a funding source to pay for it -- the 2002 Thornton legislation increasing K-12 spending being one of the biggest examples. But this time their habits will hurt more than Maryland taxpayers.

As Republican lawmakers said in a letter to President Obama last month,"At a time when major government programs like Medicare and Medicaid are already on a path to fiscal insolvency, creating a brand new government program will not only worsen our long term financial outlook but also negatively impact American families who enjoy the private coverage of their choice."

They were referring to the "public option" Obama supports. But expanding Medicaid in the state will also hasten the program's demise nationally as more federal matching dollars flow to the state.

When the economy improves fewer people may qualify for Medicaid even under the relaxed guidelines. But with state leaders pushing for a more expansive state role in health care, costs can only rise.

This reveals the lie at the heart of so much of the debate about health care: Spending goes up when more people gain coverage, not down. Any debate about health care must be honest about the numbers.

Examiner columnist Marta H. Mossburg is a senior fellow at the Maryland Public Policy Institute.