Although from 1996 to 1998 20 states were able to reduce their percentage of uninsured, Maryland’s rate increased from 11.4 percent in 1996 to 13.4 percent in 1997 to 16.6 percent in 1998. That is an increase of 5.2 percent. Only two states had higher increases: Montana, with an increase of 6 percent, and Nevada, with an increase of 5.6 percent. But because those two states have much smaller populations and larger numbers of uninsured persons, their rates of increase were smaller than Maryland’s. Maryland’s level of uninsured went up 45.6 percent, while Montana’s went up 44 percent and Nevada’s went up 35 percent.
Many states were able to lower the number of people without health insurance. Arkansas did the best by lowering its percentage of uninsured by three points, followed by Missouri and South Carolina (2.7), Nebraska (2.4), Iowa (2.3) and Tennessee (2.2).
The states that did the best are mostly midwestern and southern border states, so it might be tempting to dismiss them as having regional economies that are different from Maryland’s. But all the states neighboring Maryland did better than it did, even though they all experienced an increase in the number of uninsured persons: the three‐year increase in Delaware was just 1.3 percent; in the District of Columbia, 2.2 percent; in Pennsylvania, 1.0 percent; in Virginia, 1.6 percent; and in West Virginia, 2.3 percent.
So it might be worth wondering why Maryland is different. What does Maryland do that increases the problem of uninsured compared with its neighboring states? Certainly one way Maryland differs is the existence of its Health Care Access and Cost Commission, recently renamed the Maryland Health Care Commission. The MHCC is a big bureaucracy composed of 13 commissioners and a 65‐person staff that regulates health care in Maryland. Among other things, the commission determines what kind of insurance coverage small businesses in the state are allowed to buy.
For instance, the MHCC has pushed small businesses into HMOs far more than has been done in most of the country. Nationally, about 30 percent of employees are enrolled in HMOs, but in Maryland that number is about two‐thirds of all employees. MHCC has also virtually eliminated the possibility of a small business in Maryland accessing a medical savings account program.
If a small business in Maryland is having a tough year, it is not allowed to adjust its deductible or co‐payment to lower the cost of the plan. The business may buy only the level of deductible and co‐payment dictated by the commission. The small business’s only other option is to drop coverage altogether, sending its employees into the ranks of the uninsured. The whole notion of having a government bureaucracy dictate the kind of insurance you may buy is offensive to most Americans. Employers who are free to choose whether to buy insurance at all, should also be free to choose what kind of insurance they will buy.
As important as freedom of choice may be, Marylanders might decide that the value of helping the uninsured is worth the sacrifice of giving up the freedom to choose. But just the opposite has happened. Putting the commission’s bureaucrats in charge has made the problem of the uninsured worse than ever. So, not only have Marylanders surrendered the right to choose their own insurance, but also growing numbers are losing the ability to have any insurance at all.
Maryland needs to look to its neighboring states or to the states that have been successful in increasing the numbers of insured people to learn what to do next. Just as those states will surely be looking at Maryland to find out what not to do.