With a dramatic vote to approve a path-breaking bill late last week, the Maryland Legislature may have provided the jolt that could revive the comatose national debate over expanding access to healthcare.
The Maryland legislation, which requires large employers to contribute to healthcare for their employees, apparently would affect only a single company: Wal-Mart.
But the bill could have a powerful ripple effect because it brings back to the surface an issue that has been submerged for too long: the role of employers in maintaining access to health insurance.
State of the Union -- In a Jan. 29 Washington Outlook column on President Bush's address, and in previous columns, about 46 million Americans were said to lack health insurance. That figure included noncitizens living in the United States.
And that debate could ultimately pressure business to join with other key interests to craft solutions to the debilitating spiral of rising costs and declining access.
Business hasn't been a target in the healthcare debate since the 1994 collapse of President Clinton's blueprint for universal coverage. Clinton proposed a "play or pay" plan that would have required all employers to insure their workers or pay into a federal fund for the uninsured.
Some large employers that provide insurance initially welcomed the proposal as a way to level the playing field with companies that saved money by refusing coverage. But small-business groups, many of whose members said they could not afford to provide insurance, fiercely opposed the idea. And after those groups played a central role in sinking Clinton's overall package, healthcare reformers over the next decade looked to government, not business, to fund expansions of coverage.
The Children's Health Insurance Program that passed in Clinton's second term used state and federal tax dollars to cover children of the working poor.
In the 2000 and 2004 campaigns, Democratic presidential nominees Al Gore and John F. Kerry avoided employer mandates and instead proposed to cover more of the uninsured entirely through public dollars. Kerry, in fact, offered to subsidize employers now providing coverage through an innovative proposal for Washington to absorb part of the cost for workers who generated the biggest healthcare bills.
President Bush has proposed much more limited measures to expand coverage, but his ideas -- mostly tax credits for the uninsured -- also rely on public, not private, dollars.
