Annapolis Tackles Health-Care Reform

March 14, 1993

It's no secret that reforming the health-care system ranks near the top of most Americans' priority list. This pressure for change has now found its way to Annapolis, where the House of Delegates has seized the moment to approve a far-reaching set of moves aimed at putting Maryland in the forefront of efforts to bring medical costs under control and vastly expand insurance coverage.

It is an ambitious proposal but one tempered with cautious planning. The bill is based loosely on a successful health insurance program in Rochester, N.Y., that Dr. James A. Block, president of the Johns Hopkins Hospital, champions. A key to the plan is community-based rating, which changes the way insurance companies set health-care rates. Instead of basing premiums on a company's record of health-care claims, rates would be set based on the claims experience of the entire community, or region. That should make it easier for tens of thousands of Marylanders to obtain coverage, though it will mean higher rates for some.

Initially, this plan would be offered to all small businesses; later, larger companies could opt in. Insurers would have to offer a basic package of coverage to employees at participating companies.

But what about soaring medical costs? To keep these under control, delegates want to set up a state commission, similar to the one that has worked so well in controlling hospital costs in Maryland, to collect data on charges by health-care providers. If the data shows prices charged for a procedure or by certain specialty physicians are excessive, the commission could propose limits.

That last point is controversial, especially among doctors. But unless non-hospital costs are brought down to earth, there's little chance of reining-in the state's soaring medical bill.

Del. Casper R. Taylor of Cumberland has succeeded in crafting a bill that goes a long way toward tackling many health-care questions. Now the Senate must act, and what emerges could be quite different. Mr. Taylor and Sen. Thomas P. O'Reilly have engaged in bitter jurisdictional disputes in recent years; Mr. O'Reilly is currently drafting his own health-care plan. Indications are that he might try to force more Marylanders and doctors to join managed-care programs similar to health-maintenance organizations. Such an approach might be hard to reconcile with the House bill.

Before the April 12 adjournment, senators and delegates ought to be able to resolve enough differences to enact a bill that starts Maryland down the road of health-care reform. Modifications will be needed in the years ahead as Washington crafts its own program. But that should not stop Annapolis legislators from coming up with a way to let more citizens obtain and keep health insurance and to crack down on excessive health-care charges.

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