Health insurance bill is passed by delegates, 123-12

March 10, 1993|By John W. Frece | John W. Frece,Staff Writer

The state House of Delegates, refusing to wait for Washington to act, overwhelmingly approved legislation yesterday designed to make health insurance more available and more affordable to Marylanders.

Described by House Speaker R. Clayton Mitchell Jr., D-Kent, as "one of the most important pieces of legislation you'll have coming before you this year," the measure cleared the House 123-12.

Afterward, lawmakers twice applauded Del. Casper R. Taylor Jr., the Allegany County Democrat who chairs the committee that developed the legislation.

Ten of the 12 dissenters were Republicans, some of whom objected to a controversial provision that would permit the state to place limits on how much doctors may charge for their services.

"I think we're setting forth on a very dangerous trend," warned Minority Leader Ellen R. Sauerbrey, the Baltimore County Republican. "This is called 'wage and price controls.' "

The carefully crafted bill now goes to the Senate, where it is likely to take a back seat -- at least initially -- to a separate proposal being drafted quietly by Finance Committee Chairman Thomas P. O'Reilly, D-Prince George's. Other senators also have introduced their own insurance reform bills.

House Bill 1359 is loosely modeled after a successful health insurance program in Rochester, N.Y. It would begin by requiring insurers to offer policies to small companies that often cannot get or cannot afford health insurance for their employees.

For those policies, the bill would prohibit insurers from setting premiums based on how often the employees have been sick or injured in the past. It also would gradually eliminate the practice of denying insurance to people because of pre-existing medical conditions, such as diabetes or cancer. The policies would have to be issued to anyone who wants them and renewed upon demand. Coverage under those terms would be made available to nearly all state residents if roughly 1.6 million Marylanders -- slightly more than one-third of the under-65 population that has health insurance -- signed up.

Proponents and critics alike acknowledge that the net result of such changes could be higher premiums for some.

To offset that, the legislation attempts to get a handle on costs by creating a new data collection commission similar to Maryland's Health Services Cost Review Commission, which has gained national recognition for controlling hospital costs.

The seven-member commission would collect and analyze information on services rendered by doctors, pharmacists and other nonhospital providers. Should it determine that prices charged for a particular procedure or by certain specialty physicians appeared excessive, the commission could propose limits.

Such a rate schedule would have to be developed by October 1995 and would go into effect in July 1996, unless altered or stopped by the General Assembly.

Mrs. Sauerbrey said she was philosophically opposed to such in

tervention in the free market system, asking rhetorically whose fees the legislature would cap next: Lawyers? Realtors? "Where does this lead us?"

Delegate Taylor's Economic Matters Committee added the fee schedule provision, and a similar amendment aimed at controlling insurance company profits, to ward off criticism that the bill did little to control costs.

The measure, however, does not address several aspects of the health care problem, including the cost and availability of long-term care.

Del. Robert L. Flanagan, a Howard County Republican, said patient practices, the cost of high tech medical equipment and a litigious society that forces doctors to carry wildly expensive malpractice insurance also contribute to high health care costs.

"There are a number of problems causing doctors' fees to go up, but this bill addresses none of those problems. It sweeps them under the rug," he said. "Instead, it establishes a bureaucracy to try to regulate the market."

In the Senate, Mr. O'Reilly said yesterday he was not ready to discuss details of his proposal except to say it will attempt to divert more patients into "managed care" settings, such as health maintenance organizations.

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