Leaders optimistic about health care reform General Assembly could pass strong measures this session

February 28, 1993|By John W. Frece | John W. Frece,Staff Writer

A growing number of legislative leaders are boldly predicting that the General Assembly will pass meaningful health care reform before this session adjourns in mid-April. If it does, they say, Maryland could become a model for the country even before Hillary Rodham Clinton's health care task force completes its work.

"I don't think we can sit and wait for Washington to come up with something," said House Speaker R. Clayton Mitchell Jr., D-Kent. "I think we have a golden opportunity in the state to move ahead this year."

It will not be easy. Legislators even disagree over what the central problem is: Is it sky-high doctors' fees, or the expense of prescription drugs, excessive laboratory tests, or costly medical equipment purchases? Or, is it a system of insurance that is hard to get unless you are healthy or you work for the government or some big corporation?

Legislators don't lack for ideas on how to solve these problems. By one count, there are at least 23 different comprehensive health care reform proposals before the Assembly. Some have been tried elsewhere and have worked; others are novel home-grown approaches. The dilemma may be that legislators have to choose among too many competing approaches.

Each passing year, lawmakers find themselves under increasing pressure from businesses that cannot get or afford insurance, or labor organizations that see their workers' pay eaten up by higher deductibles and co-payments or other insurance costs, or residents who cannot buy insurance at any price.

An estimated 570,000 Marylanders currently have no health insurance at all.

Being uninsured, however, does not prevent them from getting sick or injured. Many end up in hospitals, where the cost of their care is shifted to all other hospital patients. Coupled with budget cuts to Medicaid and local health care programs that have left many working poor with nowhere else to turn, the amount of uncompensated care Maryland hospitals dispense is itself soaring: up from $36 million in 1977 to $394 million last year.

"The public knows we have to do something. It doesn't know what, but it knows we need relief," said Sen. Paula C. Hollinger, a Baltimore County Democrat.

As Mrs. Clinton is surely discovering at the national level, Maryland's delegates and senators have learned that what they're tampering with affects some of the biggest, best-financed and most politically potent special interests that appear before a legislature: doctors of virtually every description, hospitals, drug manufacturers, insurance companies large and small, health maintenance organizations, pharmacists, psychologists, nurses, chiropractors and more.

Almost every major lobbyist in Annapolis has a piece of the action. They warn constantly of unintended consequences. Such advice can paralyze legislators searching for a way to help, not hurt, their constituents. All the while, the lawmakers realize that such groups can wield considerable political clout when the next election rolls around.

The House Economic Matters Committee is likely to take the first step. Pushed hard by Chairman Casper R. Taylor, a Democrat from Cumberland, the 28-member committee has been working for a month on House Bill 1359, loosely patterned after a successful health insurance program in Rochester, N.Y.

The program sounds almost utopian: a system in which nearly everyone would have health insurance, everyone would pay the same rate for the same basic benefits, and no one would be denied coverage just because he or she was unlucky enough to become sick or injured.

The idea was first presented to the legislature by Johns Hopkins Health System President James A. Block, who helped implement the plan in Rochester.

The legislation embodies an old-fashioned approach known as "community rating" that has become increasingly popular in both houses this session. In simplest terms, it is a way of improving the availability of insurance and stabilizing its cost by spreading insurance risks throughout an entire community. In this case, the goal is to involve as many people as possible throughout Maryland.

By contrast, health insurers now set premiums based on actual claims experience -- how often those in an insured group actually became sick or injured.

Most of the state's biggest employers -- the state and most big county governments, industries such as Baltimore Gas and Electric Co. or Westinghouse, and even large health care providers such as the Hopkins Hospital or nonprofit Blue Cross and Blue Shield of Maryland -- don't have to worry about that. They can self-insure, contracting with an organization such as Blue Cross to handle all the paperwork and process the claims.

By self-insuring, large employers hope to control costs by avoiding insurance premium taxes and limiting some benefits.

Health insurance costs in Maryland nevertheless have risen at a rate of about 20 percent a year. Businesses in the state spent $3,161 to insure the average employee in 1992.

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