Maryland Approves of ObamaCare

A majority of Americans oppose ObamaCare, but that sentiment isn’t shared everywhere. In Maryland–where, I should point out, a number of people work for the U.S. government–53% of people surveyed support the new law.

Medical-Tort Law: Ranking the States

How much do a state’s laws governing medical malpractice and other torts relevant to health care affect the availability of care?  Plenty!

Lawrence J. McQuillan’s & Hovannes Abramyan’s 2010 edition of the U.S. Tort Liability Index, which has a number of measurements included in the U.S. Index of Health Ownership, ranks states according to 42 variables.

Eight of the measurements in the U.S. Tort Liability Index are relevant to the U.S Index of Health Ownership: One output and seven inputs. The previous edition of the U.S Index of Health Ownership included six measurements of medical tort, but McQuillan & Abramyan have discovered more variables for their 2010 edition of the Tort Liability Index, allowing more detailed measurement.

As a partial update of the U.S. Index of Health Ownership, this brief analysis calculates a medical-tort index from a simple average of the eight relevant variables.  Mississippi, Nevada, Michigan, Colorado, and Louisiana lead the pack; while Vermont, Rhode Island, Kentucky, Pennsylvania, and Iowa bring up the rear. Even the leaders, however, lag in some measurements.

Mississippi, for example, leads on procedural rules: Pre-trial screening or arbitration and conditions on the use of expert witnesses. However, it does not limit lawyers’ ability to abuse their privilege by limiting their share of awards. Colorado and Louisiana also fail to impose limits. Unfortunately, the laggards do not show a similar pattern: The bottom five states perform poorly in all eight measurements.

Reducing the burden of medical tort is critical to increasing Americans’ health ownership and reducing medical costs that curtail our access to care. Some progress is evident, but states aiming to improve their medical-tort laws still have a long way to go.

Balancing the Maryland Budget with Imaginary Dollars

Marta Mossburg of the Maryland Public Policy Institute the state’s political class to task for balancing the state budget with “imaginary federal dollars for Medicaid.”

In anticipation of the money (which may not be forthcoming), the Legislature drew down some fund balances, which is fine enough. But they also borrowed money from funds meant for local governments, putting those officials at risk–if not immediately, then down the road–of having a mess created by the state capitol.

Maryland Frees Up Nurse Practitioners (A Little)

A surprising victory for health care freedom in Maryland:

Gov. Martin O’Malley signed legislation Tuesday to allow Maryland’s nurse practitioners to cut bureaucratic delays and start practicing more quickly, a move providers hope will help alleviate the state’s primary-care doctor shortage.

The law streamlines the bulky credentialing process required for nurse practitioners to treat patients in Maryland. A process that now requires approvals by separate boards of doctors and nurses –- and can take up to six months — will be shortened to about a month, cutting the standard 19-page working agreement between nurses and doctors to a single page.

Reducing the bureaucratic burdens on nurse practitioners is good news. It would have been better news, though, if the scope of practice law would have been liberalized to allow them to work independently of a doctor. Jay Hancock, a Baltimore Sun columnist, makes this point:

It’s nice that the General Assembly cut the paperwork needed to become a nurse practitioner. But it will do little to increase medical expertise where it’s needed. The legislature should have allowed nurse practitioners to eliminate ties to doctors altogether and practice on their own. But it caved to pressure from Med Chi, the Maryland doctor trade group concerned to preserve the monopoly of licensed physicians. Washington, Oregon, Alaska and seven other mostly Western states (rural states where docs in the backcountry are scarce) already allow independent N.P. practice. So does the District of Columbia.

Even though it didn’t go far enough, it was an unexpected ray of sunshine from a state that is generally opposed to expanding health care freedom.

Health Care Freedom Fails in Maryland

It looks like Maryland won’t be joining Virginia, Idaho, and other states in an effort to block the federal health care bill:

Maryland’s Democratically controlled House of Delegates on Saturday rejected an attempt by Republicans to follow Virginia’s lead and set up a showdown with the Obama administration over whether the federal government has the right to require individuals to buy health insurance.

Democrats’ move was hardly seen as a surprise. They were rebuffing an attempt by the chamber’s Republican minority to hijack a bill that Gov. Martin O’Malley’s (D) administration had sought to begin implementing the health-care reform….

House Minority Leader Anthony J. O’Donnell (R-Calvert) proposed an amendment to a bill that would allow state officials to administer Maryland’s share of a national health-care exchange. His amendment would have made it illegal for any “penalty, tax, fee, or fine of any type” to be imposed on Marylanders who declined to buy health care coverage.

This shouldn’t come as a shock, given the liberal tilt of the Maryland General Assembly, but a few Democrats did join Republicans in supporting the measure.

Maryland Embraces ObamaCare

While some states are fighting ObamaCare in the courts, Maryland has taken a different path. Yesterday Governor Martin O’Malley announced the formation of a task force to “make Maryland a national leader in the health care overhaul.” The governor contends that this legislation will save the state $1 billion over 10 years as it reduces the number of uninsured.

It’s unclear how the governor came up with the $1 billion figure. Most estimates show that the state will have to increase its expenses because of the mandated Medicaid expansion. It seems as if the governor is being overly optimistic that the cost of treating the uninsured will decrease or that there will be fewer visits to the emergency room, resulting in some savings for the state. Given the experience in Massachusetts, though, large-scale savings seems unlikely. Of course, in 10 years O’Malley won’t be governor and it’s likely few people will remember this prediction, so he can say whatever he wants without the prospect of suffering any consequences. The taxpayers of the state, however, will be paying for O’Malley’s support for this misguided legislation.

Combatting False Medicaid Claims in Maryland

The Maryland Senate passed legislation aimed at cracking down on false Medicaid claims. It gives more power to whistleblowers and raises the amount the state can seek from those who filed the false claim. It does not, as some desired, allow whistleblowers to sue over fraudulent claims without state action. Many feared this would lead to frivolous lawsuits.

The state estimates that fraudulent Medicaid claims cost $300 million a year. The state has only recovered $78 million in the past four years. This false claims legislation was strongly supported by Governor Martin O’Malley and the Democratic leadership in the General Assembly. They also strongly supported expanding the state’s Medicaid program in 2007 and were in favor of the federal Medicaid expansion in the recently-passed health care legislation. This high level of fraud illustrates one of the problems with the Medicaid program, though. Simply expanding it without reforming it will just perpetuate the fraud and other issues that have plagued Medicaid since its inception.

Maryland Governor Thinks “Reform” Will Save Money

Governor Martin O’Malley of Maryland has broken with many of his fellow governors and says that federal health care legislation will result in “net savings” for the state. In this piece for the Maryland Public Policy Institute, I ask “what savings?”:

As the Department of Legislative Services noted, the state could be facing up to $285 million (likely more, given the fact that Medicaid spending usually exceeds estimates) a year once the feds cut back on their funding for the reform legislation’s mandated Medicaid exemption. It’s difficult to see how the bill would provide money to the state in order to produce net savings.

Maybe he meant that the state would save money because it would spend less on uncompensated care for those without insurance. Some hospitals claim that the bill will result in savings because, in the words of a spokesman for the Maryland Hospital Association, “when you have insurance you tend to go to the doctor and get care at the right time.” As we saw in Massachusetts, though, which enacted legislation that was quite similar to this federal legislation, emergency room usage went up after its enactment and there were shortages of doctors to treat the newly ensured. It’s highly unlikely that hospitals will be seeing any significant savings from this legislation.

Even if this bill did result in less money being spent by the state government and hospitals, it should be remembered that this money has to come from somewhere. This bill imposes a variety of new taxes to fund its expensive new programs. Marylanders will be paying these new federal taxes. It’s also likely that Marylanders will be paying higher state taxes to pay for new Medicaid spending. Unless Governor O’Malley is using some sort of new math, there are no savings in this health care reform bill. It’s just new taxes, new spending, and cost-shifting to trick people into thinking that the government is fixing the nation’s health care problems when all it’s doing is exacerbating them.

Where Will the Money Come From?

Governor Martin O’Malley of Maryland has proposed a budget that relies on nonexistent federal Medicaid funds to balance it. This is bad budgeting, certainly, but it’s also the result of the policymakers’ failures to reform Maryland Medicaid, as I write in a recent op-ed:

Instead of looking for ways to control Medicaid’s growth, the governor and legislators expanded the program in 2007.

While other states, such as Florida and Georgia, were restructuring their Medicaid programs to contain costs, Maryland policymakers preferred to ignore the problems in the system.

Without Medicaid reform, Maryland will continue experiencing budget difficulties, especially during recessions. The refusal of O’Malley and the General Assembly to address Medicaid’s structural problems has resulted in the budget trickery we see this year. The governor rightly deserves condemnation for his reliance on nonexistent federal funds, but state policymakers deserve even more condemnation for their continual refusal to fix Medicaid’s spending problems.

A Very Narrowly Tailored Insurance Mandate

Legislators love to mandate what procedures health insurance companies must cover. In Maryland, though, one legislator is taking it to a whole new level by introducing a mandate that would cover only one couple in the state:

A seemingly minor bill introduced by Sen. Joan Carter Conway dominated debate in the Senate Monday night.

The measure would have expanded insurance coverage of costly in vitro fertilization in one very specific instance: when the man can’t produce sperm because of a condition called non obstructive azoospermia AND the woman has ovarian hyper stimulation syndrome.

Sen. Andrew P. Harris, a Baltimore County Republican, was skeptical. A doctor by training, Harris told his colleagues the medical conditions outlined in the legislation are so narrowly crafted that the bill most likely “only covers one person.”

Conway says that up to 1% of the population could be covered by the mandate, but did admit that she introduced it at the request of one of her constituents.

If this mandate passes (although it was narrowly defeated, it is up for reconsideration later this week), we can look forward to more personalized health care mandates in the future. If you have something you want insurance to cover, just tell your legislator so you can get a narrowly-crafted mandate to please you!