A day after the historic vote in Congress to overhaul the nation's health care system, local patients and their advocates cheered the legislation and said they were already looking ahead to the extension of coverage to 600,000 uninsured Marylanders.
While some benefits kick in right away, the provisions enabling most lower-income people to get insurance won't become available until 2014. That has left the states to decide whether they will add people to the rolls early, or if they will seek to opt out of the federal requirements. Maryland has worked to expand coverage in recent years, but it's not clear how much further the cash-strapped state is willing to go.
Of those uninsured and underinsured in Maryland, some, such as Megan McCurdy, a 24-year-old single working mother, say they hope the aid comes immediately.
"If people get sick they ought to be able to see a doctor," she said. "My doctor has been CVS."
McCurdy, who lives in Burtonsville, said her job as a federal contractor doesn't offer benefits. Her 4-year-old daughter is enrolled in a state program for care, but since Megan McCurdy was dropped from her father's insurance 18 months ago when he went on disability, she hasn't found affordable coverage.
During that time, she's developed migraine headaches, blurred vision and an eye infection. After a trip to the emergency room Monday, she left with a $135 prescription and a payment plan for the visit's cost. She also left with an inconclusive diagnosis and no way to pay for more tests.
With health care reform, she's hoping she will now qualify for coverage in the state's pool for those with pre-existing conditions or that she can get coverage through her mother's health insurance. The federal legislation allows for people up to age 26 to remain on their parents' policies.
She's hoping she won't have to wait until 2014 when the states will need to set up exchanges where the uninsured can shop, most with federal subsidies.
"I put off going to the eye doctor, and now I have added costs," she said. "The doctor told me I could go blind and I'm only 24 years old."
Since 2007, Maryland has moved to cover more low-income people, adding thousands of kids and their parents to the Medicaid rolls. Amid budget troubles, others have been left waiting for help, particularly those without children. Still more have seen their premiums skyrocket.
Gov. Martin O'Malley said Maryland expects a "net benefit" from the federal reform, with the state saving about $1 billion over 10 years. Still, John M. Colmers, Maryland health secretary, said O'Malley and the legislature will have to decide how much more coverage can be offered early.
O'Malley, who will join President Barack Obama at the bill signing, announced that a task force, led by Colmers and Lt. Gov. Anthony G. Brown, will analyze the national legislation and make recommendations.
For a city like Baltimore, which has a high rate of uninsured, the legislation's impact would be "huge," said Kathleen Westcoat, president of Baltimore HealthCare Access, a quasi-public agency that links low-income people with Medicaid.
Of the 600,000 Marylanders who would be covered under the federal legislation, about half would qualify for Medicaid coverage, and half for subsidies to purchase insurance, according to the group's analysis.
To add more people to the rolls, the pro-reform Maryland Citizens' Health Initiative has advocated increasing the alcohol tax, a political nonstarter for years.
Vincent DeMarco, president of the group, said if the state would pass a new dime-a-drink tax next year, coverage could be extended to 100,000 more people.
Rawle Andrews Jr., state director of AARP in Maryland, said other provisions will benefit its senior members. For one, the reform law would begin to close the "doughnut hole" gap in Medicare drug coverage. Also, there will be curbs on unnecessary tests and procedures, and limits on how much insurers can charge seniors over younger people.
That is a meaningful provision for Gloria Brennan, 66, who uses Medicare but would like to buy supplemental insurance on a state exchange. She said extra coverage now is unaffordable.
Brennan, a medical makeup artist who lives in Owings Mills, has battled insurers for years. She was dropped for unknown reasons, and diagnosed with rheumatoid arthritis before she could get new coverage. A policy she bought wouldn't cover the illness. She finally got care through a medical study at Johns Hopkins Hospital and, last year, qualified for Medicare.
It doesn't cover all the costs. So, if reform legislation holds down the cost for seniors as promised, buying extra insurance might be possible, she said.
"How can anyone say Americans don't want this? I don't know who they are talking about," she said. "Everyone has something to gain, even people with coverage."
While many patients are happy with the bill, the state's medical society is not. The nation will have to confront a severe shortage of family doctors, said Gene Ransom III, chief executive officer of MedChi.
Ransom said his members are most frustrated with the bill's failure to seek tort reform and confront an expected 21 percent decrease in Medicare reimbursement rates for doctors.
The potential costs have outraged many. Dave Schwartz, Maryland director of Americans for Prosperity, spent Saturday in Washington protesting the measure, along with, he estimates, about 1,000 Marylanders. AFP has sent out thank-you notes to the two Maryland congressmen who voted against it and issued warnings to the six who voted for it about the next election.
Sun reporter Julie Bykowicz contributed to this article.
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