Assembly approves health care reform Goal is to make insurance more available, cheaper

April 09, 1993|By John W. Frece and Michael Hill | John W. Frece and Michael Hill,Staff Writers

The General Assembly gave final approval yesterday to legislation that virtually guarantees sweeping changes in Maryland's health care system.

Pushed to the top of the legislative agenda by growing national interest in health care reform, the bill should make health insurance more available and affordable to employees of small companies.

Premiums for some who already have insurance may go up; but for those who now cannot get insurance at any price, premiums should be within reach. More than 600,000 Marylanders are uninsured, many of them workers in small businesses.

Even more far-reaching, the legislation will set up a powerful new state commission that will have broad authority to collect information on and ultimately control the procedures and fees of all health care practitioners in the state.

The commission is to develop a system of guidelines for doctors and others to follow in charging their patients. If such "voluntary and cooperative efforts" to control costs would fail, the commission has the authority to order lower fees.

The bill already is considered the most significant

accomplishment of the 1993 legislative session, which ends Monday at midnight.

Final action came on a 45-2 vote in the state Senate following a four-hour debate that revealed uncertainties about the bill's long-range impact, but never seriously jeopardized its passage.

Gov. William Donald Schaefer is certain to sign the bill into law. Early in the day, he offered to intervene, if necessary, to help stop a threatened filibuster that could have killed the bill, but which never materialized.

Sen. Christopher J. McCabe, a Howard County Republican who joined Patricia R. Sher, D-Montgomery, as the only senators to oppose the bill, explained: "There are just too many unknowns."

The new seven-member Health Care Access and Cost Commission, for example, is to develop a set of standard benefits that all insurers must offer companies with two to 50 employees. But precisely what benefits will be offered and how much policies will cost -- and thus how many companies might be willing to buy them -- are all unknown.

As for the increased regulation of the medical community, it is unclear just how much the commission's work might change the way medicine is practiced in Maryland. Through its authority to impose price controls, for instance, the commission could discourage the use of certain procedures and tests that might now be considered routine.

The bill's supporters conceded it is hard to predict exactly how the new law will work, but said doing something -- even if it has unintended consequences -- was better than doing nothing.

Almost everyone agreed the measure will have to be fine-tuned in the years to come.

"I don't believe this bill is perfect, but I do believe it's an honest and sincere attempt" to deal with the health care problems, said Senate Minority Leader John A. Cade, an Anne Arundel County Republican. "It is a step in the right direction. Probably a step in any damned direction would be preferable to the inertia we have today."

Passage of a bill affecting so many well-financed speciainterests -- doctors, lawyers, insurance companies and a host of others -- was in itself a surprise unanticipated when the legislature convened in January. But with early backing from legislative leaders in both houses, and an open attempt to address a wide variety of serious concerns, the measure developed an almost unstoppable momentum.

Yesterday, with lawmakers hoping to take a breather for Good Friday and Easter and with Monday's adjournment fast approaching, leaders in both houses pushed for a quick vote so they could move on to a backlog of other legislation.

During the debate, senators arguing on behalf of trial lawyers complained that a provision intended to lower malpractice insurance costs would end up hurting patients. The provision says that a doctor accused of malpractice may be judged only against the care offered by another physician in the same or a similar community, and with the same or similar training.

"What if there is only one doctor in town? Is anything he does OK?" asked Sen. John A. Pica Jr., a Baltimore Democrat. "What if there is only one hospital? Is its standard of care automatically acceptable?"

He said physicians in a small community would participate in "a conspiracy of silence" rather than testify against one of their own.

Sen. Thomas P. O'Reilly, the Prince George's County Democrat whose Finance Committee authored Senate changes to the health care legislation, countered by decrying the attempts of the trial lawyer lobby to scuttle the bill.

"You've all seen them roaming the halls in their $1,500 suits," he

told his colleagues.

Montgomery County senators, whose constituents include some of the wealthiest medical professionals in the state, complained that the bill unfairly goes after doctors when there are other reasons health care costs are high.

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