Members of a Maryland Senate committee put health care reform legislation back on track yesterday -- and put it on the fast track while they were at it.
The Finance Committee shoved aside a complex health care proposal unveiled last week by its chairman, a measure so different from what the House has in mind that it threatened to undermine efforts to get any bill passed this year.
Instead, the committee voted, 9-2, for legislation similar to a bill already approved by the House that would make health insurance available to thousands of Marylanders who work for small companies that don't provide coverage.
The Senate committee's new approach revived hopes that the General Assembly will pass a reform measure before it adjourns next month. But with some of the richest and most powerful special interests in the state still arrayed against any reform -- including doctors, insurance companies and other health care providers -- final passage is far from assured.
One key difference is that the House bill would give a new health care data commission authority to cap doctors' fees by 1996 and to limit insurance company profits by the end of this year. The Senate version would do neither.
"I don't believe we are that far apart on anything," Finance Committee Chairman Thomas P. O'Reilly said of House-Senate differences after the committee's vote. "I believe any differences can be worked out."
Despite the Prince George's Democrat's optimism, the bill still must be approved by the full Senate and then survive a six-member joint conference committee, which would be asked to strike a compromise between the House and Senate. The TC legislature's presiding officers have been encouraging their committees to enact health care reform before it is imposed on the states by the Clinton administration. About 600,000 Marylanders are uninsured, many of them employed by small companies.
The Finance Committee version could be brought to the Senate floor as early as today, but with adjournment less than three weeks away, action will have to be quick to avoid a potential bill-killing filibuster at the end of the session.
Like its House counterpart, the Senate measure would establish a new state commission to collect data on the fees charged and procedures performed by doctors and other health care providers. But the Senate committee stripped away the limits on doctors' fees and insurance company profits -- measures added by the House, ironically, in anticipation of Senate criticism that the House bill did too little to contain costs.
"In a couple years, when we have data, maybe we'll see the need," said Sen. Patricia Sher, a Montgomery County Democrat and one of the most vocal supporters of physicians. "Right now, [capping fees] is extremely premature and punitive."
Instead, the Senate committee proposed creation of a doctor-dominated 15-member commission that would set medical procedure guidelines -- called practice protocols -- for four specialty disciplines: obstetrics, radiology, anesthesiology, and emergency-room services.
Under the legislation, physicians who follow the protocols would be able to use that as an affirmative defense in medical malpractice suits. The proposal is an attempt, Mr. O'Reilly said, to reduce the cost of medical malpractice insurance.
The Senate committee agreed with the House that insurance companies must be required to issue policies to employees of companies with two to 50 workers. Such policies would be automatically renewable.
Premiums would be set based on a "community rating," which spreads risk among all those insured, rather than "experience rating," which drives up the cost or even denies coverage to those who have been sick or injured in the past.
Both the House and Senate measures would phase out the insurance industry practice of denying coverage to people because of pre-existing medical conditions, such as diabetes or cancer. The Senate bill would do so two years faster than the House.
Last week, it appeared unlikely the House and Senate committees would be so close to agreement so fast. The House had passed its bill and several senators were pushing their own competing proposals.
Then Senator O'Reilly passed out his own 110-page plan, a complex, even radical proposal that would have pushed many insured Marylanders into health-maintenance organizations and attempted to control health care costs by keeping them within a single "global budget." The move was immediately interpreted as an attempt to kill health care reform for this year.
Mr. O'Reilly insisted yesterday he still believes in that approach, but said he realizes such a proposal this late in the session "would have invited those forces opposed to this legislation in any form." Instead, he urged his committee to simply "tighten up" provisions in the House bill and not go any farther this year.
"If we are going to do anything in this area at all, we've got to get the bill out very, very quickly," he told the committee.