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C. Fraser Smith: Health care reform started here

Crystal Moon could be Exhibit A in the case for Maryland’s leadership in the struggle to make health insurance available to all Americans.

In December 2009, Moon felt poorly enough to see a doctor — something she couldn’t have afforded had the state not made her eligible for health care insurance. She would have diagnosed herself and gone home to cope with what she thought might be the flu.

Instead, she saw her doctor. Turns out she had a blood clot that might have killed her.

Like 993 other residents of Garrett County, she had gained eligibility for health insurance when Maryland’s General Assembly passed a bill making coverage available for families with income of less than 116 percent of the federal poverty threshold, about $25,000 a year for a family of four.

That law provided coverage for more than 100,000 Marylanders. It moved the state from 44th in health insurance for its residents to 14th. Other similar changes over the years have made a total of more than 300,000 Marylanders eligible for coverage.

Much of what has been accomplished here was a foreshadowing of the changes offered under “Obamacare” — the derisive term employed by Republicans to decry as socialism the reforms pushed through by Democrats over Republican opposition.

President Barack Obama has given some indication that he will adopt Obamacare as a badge of honor — something many have been urging him to do, because there are many Crystal Moons out there.

A vote for small business

Maryland’s overwhelmingly Democratic legislature made one advance after another since the 1990s — pushed relentlessly by an organization well-known now as Health Care for All, an initiative of the Maryland Citizens’ Health Initiative. For example, allowing children to stay on their parents’ insurance until they are 26 — a popular feature of the Obama plan — was adopted in Maryland in 2007.

These advances in Maryland illustrate how the political dynamic can change in the face of inspired lobbying and reality as exemplified by Crystal Moon.

The bill that made her and her family eligible was supported by her district’s Republican representatives in Annapolis: state Sen. George C. Edwards and Del. Wendell R. Beitzel.

Beitzell said he had a struggle with himself before he voted yes. He put it this way: “Socialized medicine aspect vs. the free economy. I kind of wrestled.”

He voted yes when he realized that a majority of small-business workers didn’t have coverage. Small business, he knew, was the backbone of the economy. So voting for the expanded eligibility, he decided, had to be “the right thing to do.”

Who knows if Republicans in Congress will ever depart from orthodoxy long enough to recognize cases like Crystal Moon’s. It could happen, though. All politics is local.

What is needed in other states, probably, are organizations like Health Care for All, which has worked for more than a decade to get more coverage for Marylanders. The legislature has approved coverage for another 100,000, but budget constraints have placed these changes in a state of suspension. Under Obamacare, these Marylanders will be covered.

The Fair Share plan

Maryland’s role actually began earlier than the Crystal Moon story.

In 2005, with health care reform still dead nationally after the defeat of President Bill Clinton’s plan in the early 1990s, Maryland passed what was called a Fair Share plan. It came to be known as the “Wal-Mart” bill because it covered only companies with more than 10,000 employees.

That bill, vetoed by Gov. Robert L. Ehrlich Jr., required large employers to spend a minimum amount on health care for their employees or pay a penalty.

The bill drew tremendous media coverage across the U.S. because it targeted Wal-Mart. And it reignited the health care issue.

The Wal-Mart mandate presaged passage of a health care bill in Massachusetts under then-Gov. Mitt Romney. The theory, identical to the Fair Share idea, was that an insurance program would have to have a large pool of subscribers to be financially sustainable.

Massachusetts residents were required, under Romney care, to buy insurance or pay a penalty. The so-called individual mandate is essentially the same as the requirement imposed on Wal-Mart and later on residents of the Bay State and essentially copied in Obamacare.

So, if you have occasion to think about the origins of the Affordable Care Act, remember it started here.

C. Fraser Smith is senior news analyst for WYPR-FM. His column appears Fridays and other days in The Daily Record. His email address is