Don’t Look Behind the Curtain

If you want to understand Maryland’s “structural deficit” you need look no further.

Maryland health advocates and their allies in state government are reviving legislation to extend medical coverage to thousands of uninsured residents, an ambitious plan similar to one that died this year in the General Assembly.

As advocates today unveil their third effort in as many years to map a path toward universal health coverage, lawmakers and aides to Gov. Martin O’Malley (D) say a new window of opportunity for change is opening — even as state leaders struggle with a $1.5 billion budget shortfall.

The renewed momentum for a proposal to offer coverage to a portion of Maryland’s 800,000 uninsured residents is rooted in political strategy: A deal to close the deficit with spending cuts, tax increases and revenue from slot-machine gambling could require the state’s political leaders to reach an agreement to address soaring medical costs.

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The mission of the General Assembly in the upcoming session should be fairly straightforward. There is a $1.5 billion hole in the state budget which will grow exponentially each year as the state’s cash reserves are burned up to plug various gaps. As taxpayers we know we’re going to be hit up for extra money. That is the Maryland way, after all. But we have the right to expect the General Assembly to take some basic steps towards reducing spending and institutionalizing some of the changes to ensure we don’t get in this position again.

Now providing free or low cost health care to lots of people you are unacquainted with may, arguably, be a laudable goal. Free or low cost plastic surgery and liposuction might be laudable also. The question becomes whether or not the state can afford to do this and if it can, have the downstream costs and impacts been adequately considered.

This sounds like something a bit less measured but it sounds like something we’ve seen time and again: a bait and switch.

Senate President Mike Busch has declared medicaid expansion to be one of his top priorities. House Speaker Mike Miller isn’t in favor unless and until the deficit is closed. Mike Miller wants slots. Mike Busch, not so much.

Estimates of slots revenues will be revised upwards. Busch will allow passage of a slots bill in return for medicaid expansion. Miller will allow medicaid expansion because of slots. The slots revenue will not reach estimates. Hell’s bells, we can’t roll back health care coverage for the least fortunate so we’ve got no choice but to raise taxes. For the children.

Get used to in folks. This is just the first round of pocket picking in the making.

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