State moves forward with health care program as Supreme Court questions federal law

By Justin Snow

Equal justice under law Supreme Court

U.S. Supreme Court facade by Kevin H.

As the U.S. Supreme Court heard its third and final day of arguments Wednesday on the constitutionality of President Barack Obama’s health care law, Maryland plunged ahead in preparing the state for the law’s implementation.

Despite concerns that the 2010 Affordable Care Act could be overturned by the Supreme Court, both chambers of the General Assembly have approved bills backed by Gov. Martin O’Malley that lay the groundwork for the execution of the federal law on the state level.

The two bills establish an exchange system beginning in late 2013 designed to help individuals and small businesses find more affordable health and dental plans on the open market. The Senate passed its version of the bill last week, voting 35-12, and the House of Delegates approved its version Monday, voting 94-44.

Under the federal law, every state is required to devise an exchange system or use the model provided by the federal government. Maryland is one of the few states to advance this far in the process of putting its own plan in place.

Federal grant to Maryland funded implementation

The federal government has provided the state with $34 million in grants with $27 million allocated for the establishment of the exchange program and the other $6.2 million awarded as one of six states leading the way in implementing reform. The exchange program would be funded almost exclusively with federal dollars until the end of fiscal 2014.

However, with the fate of the Affordable Care Act in the hands of the Supreme Court justices, Republicans have argued for prudence until the court issues a ruling on the federal law’s constitutionality.

Speaking on the House floor Monday, Del. Michael Smigiel, R-Cecil, questioned what the rush was about.

“This is the biggest big government project this legislature has come out with,” Smigiel said.

Despite objections about its timing, the legislation has received largely favorable reviews from those in the health insurance industry.

Bill Simmons, president of Group Benefit Services of Hunt Valley, which is a major provider of health insurance to small businesses, applauded the legislation. A self-described “right-wing capitalist,” Simmons said the state has incorporated stakeholders and been progressive and transparent in their approach.

“I don’t usually say nice things about politicians, but they went the extra mile,” Simmons said of legislators’ efforts. Simmon’s views have been echoed by other health insurance brokers, who initially feared the exchange program could put them out of business.

The O’Malley administration has been working on the legislation for more than a year, with Lt. Gov. Anthony Brown leading the charge. The passed legislation adopts many of the operational recommendations made by the Maryland Health Benefit Exchange Board formed last spring.

Doubts by Supreme Court justices

However, comments from some Supreme Court justices during oral arguments Wednesday shed doubts on the federal law’s ultimate survival, raising questions about what the repercussions could be on the state level.

Although opponents have mainly taken issue with the individual mandate in the federal law, which would require nearly every American to purchase health insurance, some conservative justices left open the possibility that the entire law could be scrapped.

Justice Antonin Scalia said it was “totally unrealistic” for the court to go through the bill’s more than 2,000 pages and decide item by item which to keep, as lawyers for the Obama administration have suggested. Throwing out the entire bill could create unforeseeable problems for states and insurers across the nation, who have been preparing for the law’s implementation since its passage in 2010.

O’Malley would move forward whatever the ruling

O’Malley, who said he has read parts of the transcripts from the court proceedings, told reporters Thursday that no matter the final ruling, the state would move forward with health care reform in some way.

“I would hope to do this as a country,” O’Malley said. “If this somehow turns into a situation where states opt in or this is only a coalition of the willing, we will be among the states that are willing to partner with the federal government to extend universal health benefits to all.”

O’Malley said implementing health care reform was the state’s best shot at controlling costs and keeping the state competitive as a job creator.

Brown’s Press Secretary Marc Goldberg said that while the administration is following the Supreme Court’s oral arguments, they aren’t reading into them too much.

“There are too many possible outcomes and various ways the court could rule,” said Goldberg, adding that the administration is moving forward with the expectation that the federal law will be upheld.

Although repeal of the individual mandate would not dramatically affect the state exchange program, it remains unclear what the repercussions could be not only for the program but awarded federal grant money if the entire federal law were repealed. The Supreme Court is expected to issue a ruling on the law’s constitutionality in June.

About The Author

Len Lazarick

Len Lazarick was the founding editor and publisher of and is currently the president of its nonprofit corporation and chairman of its board He was formerly the State House bureau chief of the daily Baltimore Examiner from its start in April 2006 to its demise in February 2009. He was a copy editor on the national desk of the Washington Post for eight years before that, and has spent decades covering Maryland politics and government.


  1. JGwen

    The O’Malley Administration does have available bills in the hopper ready to go forward, if not this session for the next, including:

    SB 206 Crossfiled with HB 1015- The Maryland Health Security Act of 2012 Establishing the Maryland Health System; requiring the Health System to Provide Health Care Services to All Residents of the State UNDER A SINGLE SYSTEM That Is Not Dependent on Employment
    (2012 Senate fully voting Yea on Voting Record that was marked “Unfavorable.” The House Vote was also a Uniform Yea on the Voting Record, Marked “Unfavorable” and “Withdrawn by Sponsor”)
    HB 1090 Palliative Care – Services and Education  requiring health care providers to provide information and counseling about palliative care (Alleviating Pain Without Curing) options to specified patients….
    (2012 The House Vote was 3 Yeas, 18 Nays and 2 Excused with Motion considered Favorable, although Final Action was marked UNF and noted as “Unfavorable Health and Government Operations.”

  2. Bcpotter

    How does the state plan to keep accurate records? Obviously asking people to show an ID would keep some elderly and some minorities from access to care since we have been assured that there is no way for these people to get the ID.
     So, are the democrats now telling us that these people can get ID for care, but not for voting?

  3. Mary_toth

    Many years ago, my father, who was 41 at the time, contracted the flu, which then exposed him to Guilliam Barre. GB is treated by treating the symptoms and letting the virus run its course–usually about two weeks. My father’s insurance somehow did not cover the cost of the iron lung, which was in the basement of the hospital, and would have allowed him to breath while GB ran it’s course.

    The way my mother told it, some hospital administrator asked her how she was going to pay. My mother didn’t know. And my father died, a few hundred feet from the machine that could have saved him. He left four children, all under 10. My little brother was 18 months old.

  4. Dale McNamee

    If the Md. government wants health insurance to be affordable, just get rid of the GOVERNMENT GRANTED MONOPOLY that only allows 1 or 2 carriers to sell in Md. and allow Md. companies and individuals to buy health insurance across state lines. Open up the market !

    • Bcpotter

      Now how is that going to give more free stuff to the democrats pets?


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