Health-Care Reform: So Close

April 01, 1993

What once seemed impossible is on the verge of becoming reality: both the state Senate and the House have passed far-reaching health-care reform bills that could extend medical insurance to thousands of Marylanders now without coverage.

All that remains is for legislative leaders to meld the two versions, which could happen quickly. The result: a home-grown health-care remedy that puts Maryland on a parallel course with the Clinton administration's broader health reforms.

Administration officials have signaled that they want to encourage the kind of state initiatives Maryland is about to embrace. In at least one key area, both Washington and Annapolis are headed in the same direction: broadening medical insurance so uninsured families can obtain protection.

Both the Senate and the House bills require insurers to offer a standard package of benefits to companies that employ up to 50 workers. Insurers could not refuse to renew these policies and eventually would be unable to deny coverage to individuals because of preexisting medical conditions. Premiums would be set by spreading the risk among a broader-based community of people rather than on the medical history a company's employees.

By making it easier and more affordable for small businesses to offer health insurance to workers, legislators aim to bring a large number of Maryland's 600,000 uninsured individuals under the health-insurance umbrella.

A second key element is setting up a panel to gather data on health-care costs, similar to the successful state panel that has kept hospital costs in Maryland below the national rate. This panel will determine if certain doctors are charging too much for a procedure. But the House and Senate bills differ on how to contain medical costs: delegates want to limit fees when areas of overbilling are found; senators have avoided that issue. Similarly, senators want to develop guidelines for doctors that could be used as a defense in malpractice cases; delegates didn't address this issue.

Del. Casper Taylor and Sen. Thomas P. O'Reilly appear to have buried old rivalries on health care. If both men remain flexible, Maryland could have its first big dose of health-care reform before the General Assembly's April 12 adjournment. It would be the biggest and best surprise of the session.

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