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Angela Newman was studying for a master's degree in health care administration last August when she lost her job as an administrative assistant and, with it, health care benefits for her and her two children.

"I was not entertaining the thought that I would be a recipient of what I was studying," the Baltimore resident said.

As much as she had learned, she was at a loss for where to turn for her own health care. She knew about the Maryland Children's Health Program and went about enrolling her children. That action triggered a call from Baltimore HealthCare Access, a quasi-public arm of the Baltimore City Health Department, telling her about Medicaid coverage for parents that had just become available through the state's health care expansion.

Today, Newman is one of the 44,225 Marylanders who are covered by the expansion, which was passed by the General Assembly in 2007.

Newman joined more than 100 people at the Patterson Theater in Baltimore on Wednesday for an AARP-sponsored summit that celebrated Maryland's effort to expand Medicaid coverage and looked at the ongoing debate in Congress over a national health care reform plan.

While enrollment numbers have exceeded expectations, health care advocates estimate that about 15,000 Marylanders are eligible for coverage under the expansion but are not yet enrolled. They are planning outreach efforts in the Washington suburbs like those launched last year in Baltimore to inform more people of the coverage option.

Advocates used Newman's story to argue that government can do health care well and that a public option should be included in a national plan.

It is a lesson that U.S. Rep. Donna F. Edwards learned growing up in a globe-trotting Air Force family whose health care was covered by the Department of Defense.

"People say ‘The U.S. doesn't know how to do health care.' That wasn't my experience growing up," Edwards (D-Dist. 4) of Fort Washington told the audience of mostly senior citizens.

Newman agreed.

Her coverage never lapsed under the Medical Assistance for Families program. She did not have to change doctors and says her prescription plan is better than before. She encountered "some of the best customer service I ever received" from Baltimore HealthCare Access and UnitedHealthcare, the managed health care company with whom she enrolled through the program.

Edwards said that while she knows the government can provide high-quality health care, "I also know that there are times when this system doesn't work at all."

A reform plan needs to focus on quality care, lowering costs, continuity of costs and choices, she said. That includes competition for private insurers from a public plan option.

The government needs to invest in preventative medicine and to be able to pool resources to negotiate lower prescription drug costs, Edwards said.

Lower drug costs "is not just a fix for our seniors," Edwards said. "It's a fix that's important for all of us."

The federal government also must do more to reimburse patients for at-home care, a key concern for seniors, said U.S. Rep. John Sarbanes (D-Dist. 3) of Towson.

"I'm very interested in what you call ‘place-based' health care," he said. "Instead of having the patient come to the system, let's look at ways to have the system come to the patient."

The government must provide incentives to ensure consistency and continuity in care, to reduce administrative costs and to improve training for at-home care and for a continuum of care that relies on the best medical practices available, said Renee Cohen, a legislative aide to U.S. Sen. Benjamin L. Cardin (D) of Pikesville.

While Democrats at Wednesday's forum are onboard with the Obama administration's push for a public plan, U.S. Rep. Roscoe G. Bartlett (R-Dist. 6) of Buckeystown is not.

"He believes it will reduce competition, lower quality and increase costs for taxpayers," Bartlett spokeswoman Lisa Wright said.

Instead, Bartlett supports giving doctors tax credits against uncompensated care costs and eliminating punitive damage awards in malpractice lawsuits. Doing so would make doctors' insurance costs cheaper "and would take the cost drivers out of health care while increasing quality," Wright said.

Bartlett also supports health savings accounts that "reward people for being healthy" by allowing them to bank money that they don't spend on health care and take that money, plus interest, with them if they change jobs.

Pros, cons of public health care

A public component is a cornerstone of President Obama's health care reform plan being vetted on Capitol Hill. On Wednesday, members of Maryland's congressional delegation or their representatives made their case for the plan at a forum in Baltimore sponsored by AARP.

Speaking in support of a public option were U.S. Rep. John Sarbanes (D-Dist. 3) of Towson and U.S. Rep. Donna F. Edwards (D-Dist. 4) of Fort Washington and representatives of Sen. Benjamin L. Cardin (D) of Pikesville, Sen. Barbara A. Mikulski (D) of Baltimore, U.S. Rep. Christopher Van Hollen Jr. (D-Dist. 8) of Kensington, U.S. Rep. Frank M. Kratovil Jr. (D-Dist. 1) of Stevensville and U.S. Rep. C.A. Dutch Ruppersberger (D-Dist. 2) of Cockeysville.

A spokeswoman for U.S. Rep. Roscoe G. Bartlett (R-Dist. 6) of Buckeystown laid out the congressman's opposition to a public component.

Many of the arguments on both sides were outlined in a June 19 brief by the policy journal Health Affairs.

Arguments for:

Provides competition to private insurers and customer choice.

Lower administrative costs (for marketing, advertising and personnel), as seen in Medicare.

More bargaining power to negotiate rates with doctors, hospitals and drug customers.

Higher quality coverage (based on surveys of Medicare beneficiaries vs. people in employer-based plans).

Public programs like Medicaid have lower costs than private insurance plans due to lower out-of-pocket expenses and reduced payment rates to providers.

Arguments against:

A more attractive public option could "crowd out" competition with people leaving their private insurance for the public plan.

A public plan could be funded largely or entirely by taxpayers. Plans being vetted in the U.S. Senate would cost at least $1 trillion over 10 years. Republicans say it still would leave more than 30 million uninsured.

Increased government bargaining power could effectively lead to price controls, squeezing out competition and leading to a de facto single-payer system.

Lower payments to doctors and hospitals could reduce the quality of care.

— Sean R. Sedam

Correction: The headline on this story erroneously gave the impression the AARP endorsed a public health care plan. The AARP simply sponsored the summit at which a public health option was discussed.