Showdown over health insurance

In the middle sits new Gov. Martin O’Malley, who really doesn’t care about the specifics ultimately written into the health coverage expansion bill as long as he can claim credit for a progressive piece of legislation.

On the surface, this looks like a dispute between Miller and Busch over the use of a $1 per pack cigarette tax increase to extend Medicaid coverage to children of middle-class parents as well as to adults earning slightly more ($11,000) than the federal poverty level.

Miller says this extra tobacco tax revenue will be needed to close the state’s $1.5 billion budget deficit next year. He also notes the tobacco tax is a declining source of revenue that won’t come close to covering the cost of the House health-coverage bill. He says it will add to the state’s deficit woes.

Busch, Scarlet O’Hara style, says we can worry about the looming deficit tomorrow. He wants to reduce the number of uninsured as a way to eliminate needless expenses on health care.

Below the surface, a sharp ideological dispute is being waged. Busch leads a very liberal House of Delegates and bends to its will. The health coverage expansion bill symbolizes that liberalism. It attempts to give more working families health care for their children at little or no cost. Maryland and federal taxpayers pick up the tab — although there’s not nearly enough money being allocated to pay ongoing expenses.

It’s the same mindset as the legislature followed in 2002 in approving the Thornton school aid bill that boosted education spending $1.3 billion over six years but without any major new funding source. It’s a major factor in the projected $1.5 billion budget deficit in 2008.

The bottom line: Liberal legislators have the courage to pass needed social legislation to improve health care and classroom learning but they lack the political fortitude to support unpopular revenue-raising plans needed to pay education and medical bills links to those programs.

Over in the state Senate, Miller leads a more moderate chamber. It’s still a hotbed of progressive Democratic lawmakers, but there’s a stronger tradition of fiscal caution among members. Take the two top leaders of the Senate’s budget committee, Ulysses Currie of Prince George’s County and P.J. Hogan of Montgomery County. They are committed social liberals but on financial matters they are wary spenders. So is Mac Middleton of Charles County, the powerful chairman of the Senate Finance Committee.

They follow Miller’s lead. The Senate president is a fiscal conservative within the context of Maryland’s Democratic Party. He sees a possible train wreck in 2008 in trying to raise enough taxes to wipe out the state’s huge deficit. He doesn’t want to repeat the mistake he and others made in 2002 when the legislature enacted the Thornton education bill without first coming up with adequate funding.

Miller also is trying to prod O’Malley to address some of the deficit problems in the next few weeks instead of next year. His solution includes slot machine revenue at race tracks and other locations — a no-no as far as Busch is concerned. The Senate president is insisting this be part of an overall package that also would include higher cigarette taxes.

The budget crisis is staring us straight in the face, according to Miller. Or in his own colorful words, ‘‘There are fire bells clamoring in the night, and we’ve got people with earmuffs on.”

Miller rather than Busch holds the strategic advantage. He is in position to determine the size of health insurance expansion this session. He’s holding firm that it won’t be financed through a cigarette tax hike. That may be subject to negotiations, but those talks will be on Miller’s terms. A step toward getting the state’s fiscal house in order is what the Senate president wants. He’ll probably get it, too.

This tug of war is a continuation of the five-year-old Miller-Busch power struggle. Each wants to be the legislature’s paramount leader. Neither wants to share power.

O’Malley, meanwhile, is learning valuable lessons as an observer. For someone new to his job, it must be an eye-opener. It will help him as he pieces together a massive tax bailout plan in the months ahead and begins discussions with legislators.

In the end, some kind of health insurance expansion will pass. Miller and Busch are committed to delivering on one of the new governor’s stated objectives. It’s the spotlight issue of the 2007 session.

But the size of the expansion will be determined largely by Miller. He controls the votes that count. It is likely he will emerge, at least on this issue, atop the legislative hill.

Barry Rascovar is a communications consultant. His Wednesday morning commentaries can be heard on WYPR, 88.1 FM. His e-mail address is brascovar@hotmail.com.