Since President Obama has called for health care reform in this coming year and has selected Kansas Governor Kathleen Sebelius as Secretary of the Health and Human Services Department, the perennial debate about universal health care will soon be roaring fast and furious. What the opponents of universal health care apparently fail to appreciate is that the United States already has universal health care - emergency rooms.

In 1986, President Reagan signed the Emergency Medical Treatment and Active Labor Act into law, which requires virtually all hospitals to provide emergency care regardless of the patient's ability to pay, citizenship or immigration status. The Act imposes significant penalties on hospitals for noncompliance but provides no funding to finance emergency room care. This causes hospitals to increase the price of emergency room care so that it can recoup some of its costs from insured patients who access emergency room care. It also causes hospitals to increase the cost of non-emergency medical care provided to insured/paying patients.

While the Act was enacted for the noble purpose of insuring that poor patients received the same care that more wealthy and insured patients can receive, the emergency room system of universal health care has proven to be extremely costly. According to the National Coalition on Health Care (www.nchc.org), nearly 46 million Americans, or 18% of the population under age 65, lacked medical insurance in 2007. About 20% of the uninsured stated that their usual source of care is the emergency room compared to only 3% of those covered by insurance.

The US spends nearly $100 billion per year to provide health services to the uninsured, often for preventable diseases that could be treated more efficiently if diagnosed at an earlier stage. The uninsured are 30% to 50% more likely to be hospitalized for an avoidable condition, with the average cost being about $3,300. The National Coalition on Health Care also found that hospitals pay about $34 billion worth of uncompensated care per year; another $37 billion is paid by private and public payors for health services for the uninsured and $26 billion is paid out-of-pocket for those who lack coverage.

When the health care debate begins, Republican politicians will inevitably pontificate about the need to let the free market reign and the danger to our economic system of universal health care. While higher emergency room medical costs may not be the primary culprit of our runaway medical costs, it is time to remind them that we already have universal health care under a system enacted by a Republican president-the emergency room and the Federal mandate that emergency rooms provide all patients receive care regardless of ability to pay. Proponents of universal health care simply want to supplement it with a system that is less costly, more effective, and more humane.

Autism Coverage

Lawmakers, parents and advocates called for health insurers to provide coverage for the diagnosis and treatment of autism Thursday at a rally and hearing in the House Health and Government Operations Committee.

A bill in the General Assembly would force insurance companies to include up to $50,000 per year for autism treatment in Marylanders' health insurance plans. Many parents now pay out of pocket for their autistic child's treatment.

Autism is a developmental disorder characterized by impaired social interactions and communication. Its cause and cure are unknown, but families have found that treatment -- called applied behavioral analysis, or ABA -- is an effective tool to improve behavior and communication.

Delegate Kirill Reznik, who introduced the bill, said he felt Maryland needed to enact these requirements because it is thought of as a progressive and innovative state, particularly in regards to medicine. Eight other states have already required autism coverage by insurance companies.

But the Maryland Chamber of Commerce opposed the legislation because of the potential cost to employers. And health insurance lobbyists argued that this treatment is primarily educational instead of medical, and that the effect on the insured would be uneven in terms of both cost and coverage.

Debbie Rivkin, a lobbyist representing the League of Life and Health Insurers, said the bill would only affect 15 percent of Marylanders with health coverage, because the bill only targets the large group insurance market, which includes people insured through larger businesses

Miami Gardens Health Insurance

Higher medical costs await state workers -- Consultant's study says rates must rise 29.4 percent unless actions are taken Health insurance premiums for 225,000 local government workers, retirees and their dependents would skyrocket under estimates presented by a consulting firm.

The study warns that rates could jump by nearly 30 percent for health plans handled by the Hawaii Employer-Union Employees Health Benefits Trust Fund.

Marie Laderta, trustee chairwoman and state human resources director, says that if agreement is not reached at a March 18 meeting, the state will be forced to try to negotiate extensions for the insurance programs handled by HMSA, HMA and Kaiser.

Said union leader John Radcliffe, "If we cannot agree on what to do, all public employee health insurance in Hawaii ceases to be as of July 1."