Legislators strike deal on proposal to offer health coverage to uncovered

April 07, 1993|By John W. Frece | John W. Frece,Staff Writer

State House and Senate conferees struck a compromise last night on a major health care reform proposal that could make medical insurance available to thousands of Marylanders now without coverage.

A primary goal of the bill is to make insurance affordable for employees of small businesses. Many of the approximately 600,000 Marylanders who have no health coverage work for small companies.

The three delegates and three senators signed the deal around 11:30 p.m. after the two sides worked out agreements on controlling fees charged by physicians and other health care providers, limiting medical malpractice costs and providing a "trigger" that would allow large companies to purchase insurance under the same new terms being offered to small businesses.

Sen. Thomas P. O'Reilly, D-Prince George's, chairman of the Finance Committee, said he expected his colleagues in the Senate to launch a filibuster in an attempt to stop the bill's passage.

But he predicted that effort would fail.

"Yes, there's a chance of a filibuster, but, yes, it's going to pass," Senator O'Reilly said.

He noted that the bill has the support of both Senate President Thomas V. Mike Miller Jr. and House Speaker R. Clayton Mitchell Jr., who see the legislation as the most important measure before the General Assembly this year.

Throughout countless revisions, the basic thrust of the bill remained: a requirement that insurers offer companies with 2 to 50 employees a standard package of health care benefits.

Such policies would be renewable upon demand, and the ability of insurers to deny coverage due to a pre-existing medical condition would be phased out.

The bill also would establish a pair of commissions that would collect data on medical costs and procedures and create a system of clinical guidelines for physicians to follow.

The compromise goes even farther.

It would establish a new system of paying doctors and other health care providers based on the relative value of the procedures they perform, while taking into consideration their individual training, experience, location of employment, office overhead, medical equipment or other factors.

The approach is loosely modeled after a federal Medicare program already in operation known as "Resource Based Relative Value Scale."

To control high medical malpractice costs, the six conferees want to set up a system in which the performance of doctors could be judged only against a statewide "standard of care." The goal is to keep Maryland physicians from being accused by outside experts of malpractice for failing to meet a standard of care that is different from the type of medicine typically practiced in that physician's Maryland community.

Del. Casper R. Taylor Jr., the Allegany County Democrat who shepherded the initial version of the legislation through the House of Delegates, said the bill does a lot more than provide insurance to small companies that now cannot afford it or cannot purchase it at any price. It also attempts to control health care costs in several ways, he said.

Insurance company profits would be limited, and insurance brokers and agents would be limited in the money they could spend on administrative costs, among other provisions.

Mr. Taylor conceded the bill may be difficult to understand for legislators who have not been dealing with its complicated issues. And he said he expected special interests affected by the legislation to lobby for its defeat.

"The interests where lives are being affected here would like to see it go away," he said.

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