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Maryland readies for federal health reform

Although the bulk of federal health care reform is still a few years from being implemented and is even under assault in court, Maryland legislators will start drafting the framework for it this session.

“Some legislation is going to need to be passed this session,” said Senate Budget and Taxation Committee Vice Chairman Edward J. Kasemeyer, D-Howard and Baltimore. “It will probably go to two, three different committees like Budget and Taxation since we’re not sure what funding will be needed.”

Research for potential legislation has been conducted by the Health Care Reform Coordinating Council, which was appointed by Gov. Martin O’Malley after the federal legislation passed. Some major parts of the act will not take effect until 2014, but the council was formed to keep Maryland in line for early adopter status to receive special federal funding.

“Maryland is way ahead of other states in terms of preparation,” Kasemeyer said. “We’re on the leading edge of looking at the federal legislation and preparing for what actions we need to take.”

As part of that preparation, Senate Finance Committee Chairman Thomas M. “Mac” Middleton, D-Charles, said his committee will look into setting up an insurance exchange.

Under health care reform, each state will create a marketplace to offer health benefits to individuals and small businesses. Two popular ways to do this, Middleton said, are to put it in the hand of a government entity or a nonprofit.

“Figuring out how to do this is going to be a significant issue for us,” Middleton said.

Maryland has 700,000 to 800,000 uninsured residents at this time, according to estimates by the state Department of Health and Mental Hygiene. Once federal health care reform is fully implemented, that number will likely be cut in half, according to a report issued by the coordinating council over the summer.

Efforts to pass legislation implementing health care reform could be stymied by the uncertainty caused by the ruling of a federal judge in Virginia who found a key portion of the federal law to be unconstitutional.

“We know at least one federal judge has declared this law to be unconstitutional and another federal judge in Florida will probably rule soon,” House of Delegates Minority Leader Anthony J. O’Donnell, R-Calvert and St. Mary’s, told the Associated Press in mid-December.

“That brings into question whether we should be rushing to set up infrastructure when we don’t know if the law can withstand these tests. When you overlay this issue with our budget problems, I find it hard to accept we would create new programs when we can’t pay our current bills for a federal mandate that may not go forward,” he said.

Kasemeyer agreed, but said he felt legislators would press on to be ready if the reforms are carried out.

“We’re still in a place of uncertainty to some degree,” Kasemeyer said. “The feelings seem to run the gamut from going full-speed ahead to ‘Some issues are suspect and let’s proceed cautiously.’”

In another health care issue, legislators will examine the use of telemedicine to increase access to medical expertise in underserved, often rural areas of the state. As defined by the American Telemedicine Association, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.”

A pre-filed bill by Del. Michael D. Smigiel Sr., R-Upper Shore, would create a task force to study the issue. A second bill he pre-filed would outline circumstances that would require health insurers to reimburse telemedicine providers.

“Let’s say it’s 3 a.m. on a Wednesday and an ER doctor on the Eastern Shore maybe can’t reach anyone for assistance, but they can talk to someone across the country — why shouldn’t an insurer pay for that?” Smigiel said. “On the Eastern Shore, we are underserved and this is something of an answer to the problem.”

Middleton agreed that the issue of telemedicine needs to be raised, especially since it will play a role in expanding health care services under federal reform. But, he said, it was not a simple issue and would take some work to find the right answer.

“We’re going to have to look at that issue,” he said. “Saying we need it and getting reimbursements is significant, but how do they reimburse someone if they have a specialist on the other end of the phone who might be in another country? A lot of that has to be looked at.”

The Associated Press contributed to this article.

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