Maryland lawmakers are considering ways to extend health insurance coverage despite a budget deficit and national efforts to extend health benefits. In Virginia, lawmakers turned back an attempt to legislate coverage of autism disorders and were considering a move to exempt some small businesses from complying with all state health coverage mandates. Health plans in Virginia were holding onto members in 2008 but the rising unemployment rate means certain enrollment losses in 2009. Interest in consumer-driven health plan options is increasing, and one of the offerings comes from nHealth, a new Virginia firm that offers an affordable CDHP option by covering physician services through a separate deductible. In Maryland, the insurance commissioner has told physicians who operate so-called concierge practices how they can run their businesses without falling under the state's definition of insurance.