Health care bill sailing smoothly in Assembly Key legislators predict passage of state reforms

March 27, 1993|By John W. Frece | John W. Frece,Staff Writer

A far-reaching health reform bill that could make medical insurance available to thousands of Marylanders now without coverage sailed through the state Senate yesterday.

While there remain significant differences between the Senate measure and a previously passed House bill, key senators and delegates confidently predicted a compromise can be reached before the General Assembly adjourns in two weeks.

If they are right, Maryland will have gone further faster than most legislators thought possible when they convened in January. And the state will have enacted a home-grown health care reform law a full month before the Clinton administration's proposal even lands in Congress.

"We're extremely close to a comprehensive reform package," said Delegate Casper R. Taylor Jr., the Allegany County Democrat who chairs the House Economic Matters Committee.

His committee already is crafting amendments to meld the House and Senate versions into one, a complex and politically tricky exercise given the lateness of the session and the annual threat of a bill-killing Senate filibuster.

While any final bill is likely to drive up the cost of health insurance for some, backers say the reform will stabilize overall insurance costs. And, they note, it will initiate the collection of data on medical procedures and charges in Maryland, data that could identify ways of reducing health care costs.

Sen. Thomas P. O'Reilly, the Prince George's County Democrat who chairs the Finance Committee, had personally drafted an even more sweeping proposal, and he candidly acknowledged he had hoped for more.

"This is not comprehensive. I wish it was," he told the Senate before its 41-6 vote. "But if we get it past the House, and the governor signs it, many of your constituents will say, 'You really helped me out.' "

The governor's signature does not appear to be an obstacle: the Senate proposal is actually an amended version of Gov. William Donald Schaefer's own bill to provide more affordable insurance to employees of small companies.

The Senate bill, like its House counterpart, would require insurers to offer a standard package of health insurance benefits to companies with two to 50 employees, and to guarantee that the policies are renewed upon demand.

To break insurance companies of the practice of "cherry-picking" -- that is, insuring those who are healthy and avoiding those who are health risks -- both bills would phase out the insurance industry practice of denying coverage because of diabetes, cancer or some other "pre-existing" medical condition.

Despite their common thrust, the House and Senate bills still differ in several important respects.

The House bill would allow larger companies to buy insurance under the new small-business terms, but only if enough large employers agree to participate. But the Senate bill is limited to providing insurance for small companies, where many of the state's more than 600,000 uninsured hold jobs.

To contain costs, the House bill calls for eventual caps on doctors' fees and limits on insurance company profits and administrative expenses by brokers and agents. The Senate version contains neither.

But the Senate, in an attempt to rein in the high cost of physician HTC malpractice insurance, would establish specific guidelines for clinical procedures -- called practice protocols -- for doctors. Doctors who follow the prescribed procedures would be able to use their compliance as an affirmative defense if sued for malpractice.

That provision rankles trial lawyers, who still hope to strip it from the bill before it is put in final form.

"This bill reduces years of medical training to cookbook medicine," complained Sen. John A. Pica Jr., a Baltimore lawyer and one of yesterday's six dissenting votes.

Delegate Taylor said the trick to keeping everyone happy is to preserve as many provisions of both bills as possible. "All the pieces have to stay there: insurance carrier reform, health care -- provider reform, malpractice reform, as well as agents and broker reform," he said.

For example, Mr. Taylor said he already has met with doctors in an attempt to soften their opposition to the House bill's proposal to cap doctors' fees. What they have tentatively agreed to, he said, is a provision that would say if a new medical data review commission concludes certain physicians are overcharging, the problem would be first referred to the state medical society. If it is not corrected, then a cap on fees could be imposed.

To persuade the Senate to accept the House provision to expand the program to large employers, Mr. Taylor said his committee may simply suggest a higher threshold -- requiring that a greater number of employers agree to participate before it could happen.

"Between the two bills, all the pieces are there," he said. "Our job now is to fashion all those pieces in an acceptable form."

COMPARING HEALTH CARE LEGISLATION

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Insurance reform

* House Bill 1359:

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