July 20, 2010 - By Garrett Browne

In Maryland the tax on wine and beer hasn't changed since the 1970's, but one coalition in the state is proposing an increase.

The resolution calls for a dime a drink increase in Maryland's alcohol taxes which have not been raised since 1972 for wine and beer and since 1955 for spirits.

Now a coalition of healthcare groups in the state is saying the time is now for a new tax increase on alcohol.

Vincent DeMarco is the President of the Maryland Citizens Health Initiative. He says a new hike would raise millions, and politicians should listen.

"We are going to make sure that this summer, that the candidates that are running for the general assembly, hear from those groups and we think many of them will endorse this proposal," says DeMarco.

An increase in the alcohol tax is nothing new to the Maryland general assembly but it has been shot down several times. However, DeMarco says his groups are going to use the same tactics that got a cigarette tax passed.

"This is the same process that worked, very successfully, four years ago that got us a dollar increase in the cigarette tax," he says.

Money raised from the tax increase will go towards healthcare programs in the state.

By Andrea K. Walker
The Baltimore Sun

July 20, 2010

A health advocacy group is hoping to use this year's election to pressure General Assembly members into passing a "dime a drink" liquor tax increase to help pay for health care for the disabled and poor.

Maryland Citizens' Health Initiative sent out letters Monday to all candidates running for the state Senate or House of Delegates, urging them to sign a pledge supporting the tax. The group said they plan to direct voters to call candidates who don't respond to the pledge. The letter wasn't sent to gubernatorial candidates Gov. Martin O'Malley or his Republican challenger, former Gov. Robert L. Ehrlich Jr.

Liquor tax proposals have failed in previous sessions, including last year when a 10-cent liquor tax increase never made it out of committee. In 2008, a 5-cent increase also failed to pass. Taxes on wine and beer have not been raised since 1972; they haven't been raised on spirits since 1955.

Tax increases have been a tough sell in the run-up to this November's election, but Vincent DeMarco, head of the health initiative, said he hopes more lawmakers will commit to the measure if they hear from constituents and think it could cost them votes.

"I think people on the fence are going to realize it's in their political interest to sign this, as well as it's good policy," DeMarco said.

DeMarco said the tax could raise $249 million that could be used to provide health care coverage to those with mental health and developmental disabilities, as well as fund drug and alcohol cessation programs. A portion also would go to funding health insurance for poor adults without children, a measure that passed in 2007 but was never implemented because of lack of funding.

DeMarco's group contends that an alcohol tax also would help reduce alcohol consumption. A report by the Johns Hopkins University Bloomberg School of Public Health found that 10 cents per drink would result in almost 15,000 fewer cases of alcohol dependence.

The proposal is backed by a coalition of groups, including AARP Maryland, labor union 1199E SEIU Health Care Workers East, the Maryland Nurses Association and National Association of Social Workers.

A spokesman for state Senate President Thomas V. Mike Miller didn't return calls Monday regarding the tax.

Alexandra Hughes, a spokeswoman for House Speaker Michael E. Busch, said he doesn't sign pledges because he has to take into consideration the views of all members of the House.

She pointed out that funding for the Developmental Disabilities Administration increased in fiscal 2011 to $807 million, up from $789 million the year before, and that other revenue sources pay for these services. Under the coming federal health care reform, adults without children would become eligible for health coverage, she added.

"We believe the current revenue structure would further fund these services so we wouldn't need a tax," Hughes said. "We'll look at it in the context of what revenue looks like next year and how the governor presents the budget."

Health care groups still lobbying for hike in MD alcohol tax

By Emily Mullin, Staff
July 19, 2010

Health care and labor groups continue to push a proposal that would raise the state alcohol tax by a dime for every drink.

The money raised by the tax would expand state Medicaid coverage, provide services for people with developmental disabilities and mental health needs and offer alcohol and drug prevention and treatment programs.

A coalition that includes AARP Maryland, Maryland Assembly of Family Physicians, Maryland Nurses Association, Maryland Citizen’s Health Initiative, American Academy of Pediatrics, Maryland Chapter of the National Association of Social Workers and Maryland NAACP have signed on in support of the proposal.

The proposal was submitted Monday to candidates seeking seats in the General Assembly, urging them to endorse the tax.

The drink tax would seek to fill some gaps in the federal health care reform law by expanding Medicare coverage to childless adults in Maryland who earn below $12,563 annually.

The coalition estimates that raising the state’s alcohol tax by a dime a drink will reduce state health care costs by $249 million.

Maryland's alcohol tax is the second lowest in the nation and has not been raised since 1972 for beer and wine and 1955 for spirits.

The proposal would raise the tax of beer from $0.09 to $1.16 per gallon. The tax on wine would increase from $0.40 to $2.96 per gallon, and the tax on spirits would be raised from $1.50 per gallon to $10.03 per gallon.

"These are big jumps because our tax is so low right now," said Vincent DeMarco, president of the Maryland Citizens' Health Initiative, in an interview Monday.

For consumers, a dime a drink translates to an extra $0.60 for a six-pack of beer, $0.59 for a bottle of wine and $2.25 for a bottle of liquor.

The Enterprise

Wednesday June 9, 2010

By Alan Brody, Staff Writer

Nearly 4,000 previously uninsured Southern Marylanders are beneficiaries of the state's 2007 expansion of Medicaid, according to a health care advocacy group.

The Maryland Citizens' Health Initiative celebrated the figures at a Friday afternoon news conference in North Beach, the last in a series of election-year events across the state designed to thank supporters of the expansion and push for further progress.

Statewide, 61,000 Marylanders have enrolled in Medicaid under the new guidelines, which made adults earning up to 116 percent of the federal poverty level-- about $20,000 a year for a family of three -- eligible for the benefit.

As a result, Maryland has climbed from 44th in the nation in adult health care coverage to 16th, said Vincent DeMarco, president of the Maryland Citizens' Health Initiative and a leading health care advocate in Annapolis.

That's progress, but not the end of the road, said Rawle Andrews, senior state director for AARP Maryland.

"Nobody holds up a thumb and says 'We're No. 16,'" he said. "We want to be No. 1."

The event at the Twin Beaches Community Health Center highlighted the 979 Calvert County residents who are now enrolled in Medicaid, the federal-state health insurance program for the poor, because of the state expansion.

The community health center, which opened in 2002, has provided care to more than 2,700 Medicaid recipients in the last two years, said Dr. Robert Schlager, vice president for medical affairs at Calvert Memorial Hospital, which is affiliated with the North Beach facility.

The state's goal should be to extend health coverage to everyone because those with insurance pay for uncompensated care through higher premiums, said Del. Sue Kullen (D-Calvert).

About 1,400 Charles County residents have enrolled in Medicaid since the expansion, according to May figures released by the Maryland Citizens Health Initiative. Nearly 1,350 St. Mary's County citizens are newly insured since 2007, according to the statistics.

Stacey Davis, deputy director of planning for the state health department's Medical Assistance Program, said the number of Medicaid recipients since 2007 will likely surpass 65,000 when the latest numbers are reported this week.

The Medicaid expansion is on track to reach its goal of providing coverage for more than 100,000 Marylanders within five years. At the time the measure passed, approximately 800,000 state residents lacked health insurance.

abrody@somdnews.com

Rate-setting panel cuts hospitals' share of $123 million Medicaid shortfall

Listening to health care advocate Glenn E. Schneider, right with back to camera, testify before the Health Services Cost Review Commission are, from left, Chairman Donald A. Young, Executive Director Robert Murray and Commissioner Herbert S. Wong. Baltimore Sun photo by Amy Davis April 6, 2010

By Jamie Smith Hopkins

April 7, 2010

That will hit insurers, self-insured employers and the uninsured starting in July, when the next fiscal year begins. Eventually, insurers said, the costs will show up in health insurance premiums that employers and workers pay. The increase of about three-quarters of 1 percent will add about $110 to the average hospital bill of $11,500, but the bottom-line effect on premiums is unclear.

Gov. Martin O'Malley's spending plan for fiscal year 2011 would balance the budget in part by shifting $123 million in Medicaid expenses - part of the state's share of the federal insurance program for the poor - to other pocketbooks. That left the Health Services Cost Review Commission, which sets the rates that hospitals charge and everyone must pay, with the job of figuring how to distribute the pain.

The commissioners decided Tuesday to make the paying public responsible for 70 percent and have hospitals pay the rest out of their operating budgets. That's a reversal from last month, when the body voted to divide the extra costs 50-50. Hospitals, which wanted patients and insurers to pick up the full amount, lobbied heavily for a second vote, arguing that they weren't given time to respond.

"We are pleased with the commission's movement," Carmela Coyle, chief executive of the Maryland Hospital Association, said after the Tuesday meeting. "We would have preferred to see all of the needed Medicaid shortfall built into rates, but I think we saw an important step in the right direction today."

Operating margins at Maryland hospitals are "razor thin," Coyle said during the hearing. She said the February snowstorms cost hospitals about $68 million, most of which won't be covered by federal disaster aid. An extra hit of more than $60 million - half the Medicaid shortfall - would probably force hospitals to cut about 1,000 jobs, she said.

"We really need your help," said Robert A. Chrencik, chief executive of the University of Maryland Medical System, who testified alongside the heads of the Johns Hopkins Health System and MedStar Health.

Insurers and health care advocates came out in support of the commission's original decision, arguing that the 50-50 split was the fairest option at a time when everyone is financially pinched. That's how the commission passed on $35 million in Medicaid expenses the state needed to get off its books during the current fiscal year.

The state budget for the fiscal year beginning July 1 hasn't been approved, but legislators are deliberating with the assumption that the state will be able to save $123 million by passing it on to hospitals or ratepayers.

"We need to be able to share the burden," said Glenn E. Schneider, a board member with the Maryland Health Care for All! Coalition. "We know that hospital margins are tight. The margins of all the groups that purchase health care are tighter than normal, too."

Howard County Health Officer Peter L. Beilenson, chairman of the Healthy Howard Health Plan, said he's seen "a significant increase" in the number of members who can no longer afford the plan's current fees, which range from $50 to $85 per person a month. The plan is the county's attempt to cover uninsured residents and provide universal coverage, and it would have to cover the higher hospital rates. Even a small bump in the plan's rates would hurt, he said.

Health care consultant Hal Cohen, representing insurers CareFirst BlueCross BlueShield and Kaiser Permanente, said they saw the 50-50 split as a reasonable compromise and urged the commission not to change its mind.

But Kevin J. Sexton, vice chairman of the commission and chief executive of Holy Cross Hospital in Silver Spring, said a 70-30 split - which the commission's staff recommended - seemed the best of the "crummy choices" available. That spreads the tab more broadly so it doesn't have an outsized effect on hospitals and their employees, he said.

"What we're really pondering is, 'Who's going to be hurt and how much?'" Sexton said.

All five of the commissioners present voted in favor of a 70-30 split.

The federal government, through Medicaid and Medicare, is on the hook for the biggest share - about $44 million - because those programs pay hospital rates. CareFirst, the state's largest insurer, will be responsible for $16 million.

Schneider, with the Health Care for All! Coalition, said political leaders ought to have handled the budget problem themselves rather than shunting it off to the commission as a "hidden tax."

"We shouldn't even be here talking about this," he said.

Copyright & copy; 2010, The Baltimore Sun

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Local Reactions Vary on Health Care Reform

By Meredith Cohn and Kelly Brewington

Baltimore Sun reporters

March 23, 2010

While some benefits kick in right away, the provisions that will enable most low and moderate income people to get insurance won't become available until 2014. That has left the states to decide if they will add people to the rolls early or if they will seek to opt out of the federal requirements. Maryland has worked to expand coverage in recent years, but it's not yet clear how far the cash-strapped state is willing to go ahead of federal timelines.

Of those uninsured and underinsured in Maryland, some, such as Megan McCurdy, a 24-year-old single working mother, say they hope the aid comes immediately.

"If people get sick they ought to be able to see a doctor," she said. "My doctor has been CVS."
McCurdy, who lives in Burtonsville, said her job as a contractor for the U.S. Food and Drug Administration doesn't offer benefits. Her 4-year-old daughter is enrolled in a state program for care, but since being dropped from her father's insurance 18 months ago when he went on disability, McCurdy has been unable to find affordable coverage.

During that time, she's developed migraine headaches, blurred vision and an eye infection. After a trip to the emergency room yesterday, she left with a $135 prescription and a payment plan for the hundreds of dollars the visit cost. She also left with an inconclusive diagnosis and no way to pay for more tests.

With health care reform, she's hoping she will now qualify for coverage in the state's high-risk pool for those with pre-existing conditions or that she can get coverage through her mother's health insurance. The federal legislation allows for children up to 26 to remain on their parents' policies.

She's hoping she won't have to wait until 2014 when the states are required to set up health care exchanges where the uninsured can shop, most with federal subsidies.

"I put off going to the eye doctor, and now I have added costs," she said. "The doctor told me I could go blind and I'm only 24 years old."

Since 2007, Maryland has moved to cover more low-income people, adding thousands of kids and their parents to the Medicaid rolls. Amid budget troubles, others have been left waiting for help, particularly those without children. Still more have watched their premiums skyrocket.

Gov. Martin O'Malley said Maryland expects a "net benefit" from the federal reform, with the state saving about $1 billion over the next 10 years. He called Sunday's vote "courageous and important." Still, Maryland Secretary of Health and Mental Hygiene John Colmers said that O'Malley and the legislature will have to decide how much farther to go in expanding coverage early.

"We'll be taking a look at everything," he said.

O'Malley, who will join Obama at the bill signing, announced that a task force, led by Colmers and Lt. Gov. Anthony Brown, will analyze the national legislation and make recommendations about its implementation.

For a city like Baltimore, struggling with high rates of uninsured, the legislation's impact would be "huge." said Kathleen Westcoat, president of Baltimore HealthCare Access, a quasi-public agency which helps link low income people with Medicaid.

"This is an amazing and tremendous step forward," she said.

Of the 600,000 Marylanders who will be covered under the federal legislation, about half would quality for Medicaid coverage, and half for subsidies to purchase insurance, according to an analysis by the nonprofit.

To add more people to the rolls, the pro-reform Maryland Citizens' Health Initiative has advocated for increasing the alcohol tax, a political non-starter for years.

Vincent DeMarco, president of the group, said if the state would pass a new dime-a-drink tax next year, coverage could be extended to 100,000 childless adults, in addition to tens of thousands of children and their parents who have been added since 2007 through a tobacco tax.

"The rest of the uninsured would get coverage in 2014 when the exchanges are created and federal subsidies kick in," he said.

DeMarco said that those with insurance will also benefit. "They now pay a "hidden tax" in their premiums to pay for the uninsured who still use the health care system. When everyone's covered, the insured won't pay for the uninsured. Further, competition from exchanges create by each state should help bring down costs for everyone," he said.

"We recognize this isn't the end of the end, but this will make insurance more affordable," he said. "In Maryland, we'll build on this."

Rawle Andrews Jr., state director of AARP in Maryland, said that other provisions will benefit its senior members. The federal legislation will begin to close the so-called doughnut-hole, a gap in Medicare drug coverage. And while baseline benefits will be protected, providers will have to certify the care they offer so patients will be subjected to fewer tests performed solely because they bring in more revenue. That should save tens of millions, if not billions of dollars, Andrews said.

Medicare and Medicaid, federal programs for seniors and the poor, will consider more in-home care rather than nursing home care. And the federal legislation will limit the amount that insurers can charge seniors over younger people.

That is a meaningful provision for Gloria Brennan, 66, who uses Medicare but would like to buy supplemental insurance on a state exchange. She said extra coverage now is unaffordable.

Brennan, a medical make-up artist and skin care consultant who lives in Owings Mills, has battled insurers for years. She was dropped in the 1990 after going to see a specialist even though she was not diagnosed with an illness.

However, soon after she was diagnosed with rheumatoid arthritis, a painful joint disorder. She thought she had secured new insurance but it didn't actually offer any benefits. And when she finally did sign onto a new policy, the insurer refused to cover anything related to her illness.

She was able to enroll in a study at Johns Hopkins Hospital, which paid for a new drug, which worked for Brennan. The study continues to pay for her medicine today, although a year ago, the 66-year-old qualified for Medicare.

With health care reform, she hopes to buy supplemental insurance on an exchange to pay for the percentage of care the federal program doesn't cover. If the legislation holds down the cost for seniors, as promised, that may be possible, she said.

"How can anyone say Americans don't want this? I don't know who they are talking about," she said. "Everyone has something to gain, even people with coverage. I know it's not perfect, but I was watching the debate and I was clapping away."
Also pleased was Jay Wolvovsky, president and CEO of Baltimore Medical System. The group supports six Baltimore City and county clinics and believes expanding insurance to low-income people could double the nearly 50,000 patients who come through the doors over a decade.

Such health centers, seen as a safety net for those who can't afford coverage, have struggled for years to meet the demands of a growing uninsured population, particularly of late as job losses leave many without insurance.

But adding more people to the rolls will mean the need for more practitioners to serve them and Wolvovsky estimated the system will need double the estimated 50 providers it has now.

While many patients are happy with the bill, the state's medical society is not. The nation will have to confront a severe shortage of family doctors, said Gene Ransom III, chief executive officer of MedChi.

Ransom said his members are most frustrated with the bill's failure to confront an expected 21 percent decrease in Medicare reimbursement rates for doctors and tackle tort reform. While the American Medical Association threw its support behind the legislation, MedChi did not.

"There are some good things in the bill, but we said we could not support it if it did not address these two things," he said. "Our concern is that physicians are simply not going to be able to take Medicare patients if they are going to face a 21 percent rate reduction. And this will put a lot of seniors in a bad situation."

Maryland hospitals, meanwhile, are supportive of the bill, even if it produces deep rate cuts. The nation's hospitals agreed to $155 billion in cuts over 10 years to help pay for insuring millions of Americans. Those cuts will put pressure on Maryland's rate setting system, said Carmela Coyle, president of the Maryland Hospital Association. Still, said Coyle, the bill presents a "tremendous opportunity."

"If we can really get people access to care where they need it and when it's most appropriate, we can save money overall, instead of catching people downstream when their conditions are the most extreme and most expensive," she said. "Not only can it potentially lower costs, it's the right thing to do,"

Still, the potential costs have outraged many Americans. Dave Schwartz, Maryland director of Americans for Prosperity, spent Saturday in Washington protesting the measure, along with, he estimates, about 1,000 Marylanders.

AFP has already sent out thank you notes to the two Maryland congressmen who voted against it and issued warnings to the six who voted for it, saying that AFP "will be devoting a heck of a lot of time to educating citizens on how they voted for a bad bill."

"Health care has brought in so many people who are now turning their attention to things like spending at the local level, taxes, the state budget," Schwartz said. "And I think health care is going to continue to motivate our activists."

Staff writer Julie Bykowicz contibuted to this article.