Insurance reform bill survives attack in Senate STATE HOUSE REPORT

March 26, 1993|By John W. Frece | John W. Frece,Staff Writer

The state Senate cleared the way yesterday for passage of a health insurance reform bill by withstanding a determined attack by lawyers against a provision aimed at discouraging medical malpractice suits.

The legislation is intended to stabilize insurance costs and make policies more available to employees of small companies, many of whom cannot afford insurance. About 13 percent of Marylanders, or more than 600,000 people, are uninsured.

A final vote on the bill is expected today or tomorrow, said Senate President Thomas V. Mike Miller Jr., a Prince George's Democrat, who added that prospects for passage are excellent.

"Doctors aren't going to be happy with the final product. Certainly lawyers aren't going to be. And I doubt very seriously the insurance companies are going to be. But Marylanders will be able to obtain coverage, hopefully at a reasonable rate," Mr. Miller said.

The Senate bill differs in several key respects from a House bill with the same purpose -- differences that will have to be worked out by a conference committee before adjournment April 12 if a measure is to become law.

The House bill, for example, calls for caps on doctor's fees and limits on insurance company profits, while the Senate bill does not.

The Senate bill does attempt to cut down on the high cost of malpractice insurance by requiring that specific guidelines for clinical procedures -- called practice protocols -- be established for obstetricians and gynecologists, anesthesiologists, radiologists and emergency room physicians. Physicians in those specialties who follow the protocols could use that as an affirmative defense if accused of medical malpractice.

Lawyers in the Senate rebelled. They said to avoid malpractice suits, doctors would follow the protocols even if they were unnecessary, thus adding to the cost of health care.

Patients or their families, they added, would be the ultimate losers because it would be harder for them to bring suits on behalf of someone who was injured or even killed due to malpractice.

Judicial Proceedings Committee Chairman Walter M. Baker, whose panel normally considers malpractice issues, opposed the provision. He compared it to his opposition to mandatory sentences in criminal cases.

"I don't believe you can make a laundry list of items a doctor should follow in every case," said Mr. Baker, a Cecil Democrat.

But Thomas P. O'Reilly, a Prince George's Democrat and chairman of the Finance Committee, which sent the health reform bill to the Senate floor, said the provision was aimed at controlling costs.

He said the protocols not only would save on the expense of malpractice insurance but also would discourage doctors from performing expensive and sometimes unnecessary procedures to assure they will not be sued -- what is known as "defensive medicine."

Sen. John A. Pica Jr., a Baltimore Democrat, attempted to strip the practice protocol provision from the bill, but his motion, capping a three-hour floor debate on various proposed amendments, failed 29-16.

Both the House and Senate reform bills would require insurers to offer companies with two to 50 employees a minimum package of health benefits and to renew those policies upon demand. Both also would phase out an insurance industry practice of denying coverage because of pre-existing medical conditions, such as cancer.

As a minimum, the Senate bill says the insurance coverage offered those firms must be equivalent to that required of federally qualified health maintenance organizations. The House would let a commission decide what should be in the benefits plan.

Premiums under both House and Senate bills would be set by spreading the risk among everyone covered by an insurer (a "community rate"), rather than basing them on the past medical experience of those who are insured.

Mr. O'Reilly bluntly warned the Senate that the bill was intended to improve access to insurance for the uninsured and may well result in premium increases for some.

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