House passes health bill Reform measure goes to Senate

stiff test awaits

April 08, 1993|By John W. Frece and Michael Hill | John W. Frece and Michael Hill,Staff Writers

The House of Delegates last night overwhelmingly passed a major health care reform bill that experts say would put Maryland ahead of the nation in getting a grip on spiraling medical costs.

The bill, which is being touted by legislative leaders as the most important measure the General Assembly will consider this session, now goes to the Senate, where it is expected to run into stiff opposition and a potentially fatal filibuster as the 90-day session heads toward Monday's midnight adjournment.

"The trial lawyers are prowling the halls. The doctors are calling. Health care people and claims-processing people are calling," said Senate President Thomas V. Mike Miller Jr., D-Prince George's, who supports the bill. "There are lots of people aggrieved by it."

Yet Mr. Miller predicted the Senate would pass the bill, although he said the vote would be close.

"This is the issue on everyone's tongues. If we don't act this session, we've failed our constituents," Mr. Miller said.

That was clearly the view in the House, where the final House-Senate compromise on the bill passed easily by a vote of 117-14. Speaker R. Clayton Mitchell Jr., D-Kent, said later, "If everyone is complaining, it must be a good bill."

The bill is aimed at ensuring that employees in small businesses have access to health insurance.

It also would set up a system for examining the fees charged by doctors and other medical providers -- and would allow the state to limit those fees if regulators found them out of line.

While not unique nationally, the legislation is considered among the more far-reaching proposals adopted by states.

"The insurance provisions basically give Maryland a two-year jump-start ahead of national legislation," said Jonathan Weiner, a professor of health policy and management at the Johns Hopkins School of Public Health.

"The way this bill tries to control doctor's fees is fairly far-reaching. It puts Maryland in the vanguard," he said. "It's not clear that the Clinton federal task force will grapple with these issues. Whatever they propose in this area will probably not go this far."

The bill began simply enough as a measure to make health insurance more available and affordable to employees of small companies who now cannot afford it, or cannot get it at any

price. More than 600,000 Marylanders are uninsured, many of them workers in companies with fewer than 50 employees.

But by the time the House and Senate finished with it, however, the measure called for much more:

* The bill would set up a powerful seven-member commission, similar to the one that has regulated hospital costs in Maryland, to oversee all nonhospital health care costs. Among its responsibilities would be to collect data on costs and procedures to determine whether specific doctors or other providers are charging too much, doing a certain procedure too often, or are otherwise out of line with the norm.

If such "voluntary and cooperative efforts" to control costs would fail, the commission would have the authority to impose controls.

* In tracking fees charged by health care practitioners, thcommission would be charged with taking into consideration the "resources" they personally bring to their work, such as training and experience, and the relative value of the procedure they are performing. The idea is modeled after a federal Medicare program called the Resource Based Relative Value Scale.

"The beauty is we'll now have a uniform, legitimate basis for determining fees," said Nelson J. Sabatini, Maryland's secretary of Health and Mental Hygiene.

* It would phase out by Jan. 1, 1995 the insurance company practice of providing policies for the healthy but denying coverage to those with pre-existing medical conditions, such as diabetes and cancer. It also would put limits on insurance

company profits.

* It would create clinical guidelines, called "practice parameters," for physicians. And it would attempt to control medical malpractice insurance costs by saying that physicians who are accused of malpractice must be judged based on a peculiarly Maryland "standard of care" -- as practiced by "the same health care profession with similar training and experience situated in the same or similar communities."

That is an attempt, said House Economic Matters Committee Chairman Casper R. Taylor Jr., D-Allegany, to keep costly outside experts from testifying before Maryland juries about how a Maryland doctor may have violated a standard of care practiced elsewhere.

Trial lawyers swarmed the State House yesterday, fighting the bill in an attempt to defeat that provision.

Providers of services for the mentally ill and those who treat drug and alcohol abusers also announced opposition yesterday, saying the final House-Senate compromise failed to address their concerns.

But the state medical society supported the landmark legislation despite the provisions involving the fees doctors may charge.

Health Secretary Sabatini and other supporters of the measure conceded it is unknown how the well the bill's many complicated provisions will work, and acknowledged that a lot future tinkering is likely.

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