"Health care is the number one issue we need to address in the state of Maryland," House Speaker Michael E. Busch, D-Anne Arundel, told members of the House Health and Government Operations Committee.

The bills range from ambitious plans to revamp health care in Maryland by establishing a universal care plan for all state residents, to less costly proposals such as that of Gov. Martin O'Malley, which would require businesses with more than 10 employees to offer a so-called "cafeteria plan" of health insurance.

Many of the proposals share similar components. They would loosen eligibility requirements for state-funded health care and allow children to stay on their parent's health insurance plan longer.

There are an estimated 640,000 Maryland adults and some 140,000 children without health insurance, according to the most recent report from the Maryland Health Care Commission.

"Dr. Martin Luther King, Jr. once said that, of all the forms of inequality, injustice in health care is the most shocking and inhumane," said Vincent DeMarco, president of the Maryland Citizens' Health Initiative.

While most witnesses supported most bills under consideration, each had his or her favorites. One aspect of the legislation that drew a lot of attention was a proposal to finance it through a $1-a-pack increase in the cigarette tax.

This would raise about $211 million, far short of what would be needed to pay for some of the more ambitious plans, such as one offered by Health and Government Operations Committee leaders that would cost upwards of $600 million.

The chairman of that committee, Delegate Peter A. Hammen, D-Baltimore, said he wants to extend health care coverage for low-income families and individuals.

"We do an OK job of covering children," Hammen said, "but a terrible job of covering adults."

Hammen's proposal relies in part on the cigarette tax. Busch agrees that this is a natural solution.

"There's a nexus between health care and tobacco," the House speaker said.

But both the governor and the Senate President, Thomas V. Mike Miller, Jr., D-Calvert and Prince George's, oppose the cigarette tax increase.

As expected, tobacco lobbyist and retailers voiced opposition to the proposed cigarette tax increase, but offered to assist the committee in finding alternate funding sources.

Dennis C. McCoy, a Philip Morris lobbyist, said the state should not use the cigarette tax to pay for a social issue. Revenue from the tax would not be reliable because of the steady decline and the small population of smokers.

"You're taking a societal issue and putting it on 18 to 20 percent of the people," said McCoy

Delegate Karen S. Montgomery, D-Montgomery, proposed a plan that would provide health care coverage for all Marylanders, called the Universal Health Care Plan.

She said the more incremental approaches offered by her colleagues were like "putting a Band Aid on a bleeding artery."

A bill by freshman Delegate Kris Valderrama, D-Prince George's, would change the eligibility requirements for the state's insurance program for low-income children and abolish the current requirement for families to contribute 2 percent of their annual income as a premium payment.

She said her bill "is an outgrowth of my deepening concern as a mother over the skyrocketing health-care costs and the absence of a broad umbrella of universal health care for our ever increasing number of uninsured children."

Copyright © 2007 University of Maryland Philip Merrill College of Journalism