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Moving Together Toward Reform

Photograph by Chris Hartlove

Moving Together Toward Reform

When Peter Beilenson founded the Maryland Health Care for All Coalition in the late 1990s, he looked to Vincent DeMarco (above), now an adjunct assistant professor in HBS, to lead the charge. A tireless grassroots organizer with a proven track record, DeMarco had waged winning campaigns for gun control and an increase in the state’s tobacco tax.

As president of the health care coalition, DeMarco used his organizing skills to win the endorsements of more than 1,100 businesses, labor unions, nonprofits and religious groups. The health plan has gone through several versions, the most recent one introduced in this year’s legislative session.

In its present form, the plan would expand Medicaid to cover nonparents earning less than 200 percent of federal poverty or parents with incomes under 300 percent of poverty. Uninsured people making more than that would be required to buy coverage on the open market, but policies would, in theory, be made cheaper through the creation of a giant statewide risk pool. And the state would provide catastrophic “reinsurance” that would cover most health care expenses exceeding $35,000—a measure that would reduce premiums while safeguarding families from medical bankruptcies. The plan would also create an institute that would identify best practices for various medical conditions and establish reimbursement rates accordingly. All told, it would cost an estimated $3 billion a year, financed by the 2 percent payroll tax and increases in levies on cigarettes and alcohol.

DeMarco doesn’t expect passage this year or even next. But he remains patient and optimistic. “We’ll make it an election issue in 2010 and pass it the next year in 2011,” he predicts. “We’re a very cautious, practical organization.”

Jonathan Weiner, Bloomberg professor in HPM and one of the plan’s original authors, notes that states enacting their own plans could provide a path to national reform.

“Any Obama plan is likely to build upon state plans,” says Weiner, DrPH ’81. He also expects the president to leave some options open to the states no matter what he proposes. “Do you wait for the feds or move forward? Our goal is to say yes and yes. Move forward but hope that the president will move ahead.”

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