What Marylanders can expect from health care reform bill

April 11, 1993|By Sandy Banisky | Sandy Banisky,Staff Writer

The Maryland General Assembly's most significant accomplishment of the 1993 session was the passage of a sweeping health care reform bill meant to extend coverage to more workers while limiting increases in medical fees.

While the goal of the legislation is clear, many questions remain as to the effect the reforms will have. Lawmakers concede it is hard to say exactly how the new law will work. Even so, they say they had no choice but to tackle one of the most pressing issues on the public's agenda.

Here are questions raised by the health care reform bill and answers:

QUESTION: What is the General Assembly trying to achieve in its health care reforms?

ANSWER: Legislators had two goals: to make insurance available to the 600,000 Marylanders(mostly employees of small businesses) without coverage and to slow rising health care costs. For example, Maryland businesses are experiencing increases in health insurance premiums of 15 percent to 20 percent each year. A new state commission will establish health care cost goals.

Q: Will all businesses be required to buy insurance for their employees?

A: No. The legislation requires all insurers to offer coverage to small businesses, many of which have found the cost of providing health insurance prohibitive. But the bill doesn't require the businesses to buy coverage for their employees. It's unknown how many small companies will take advantage of the opportunity to buy insurance now that it's less costly.

Q: What benefits must insurers offer to employees of small businesses?

A: A new state panel -- the Health Care Access and Cost Commission -- will develop a "basic benefits" package that all insurers must offer companies with two to 50 workers. But precisely what benefits will be offered and how much the policies will cost are unknown.

Q: What about people with pre-existing medical conditions, such as cancer and diabetes, who in the past have been denied coverage?

A: The practice of denying coverage because of pre-existing medical conditions will be phased out by January 1, 1995.

Q: If I have insurance through my employer now, will my rates go up?

A: It depends. If your employer is a large company, it is unaffected now by this legislation. But premiums at some already insured small companies may go up as insurers use "community rates" -- rates set by spreading the risk among the small group market -- instead of the rates calculated solely for that employer.

Q: How will Maryland control health care costs?

In several ways. Maryland will collect data on health care to develop strategies for cost containment and report annually on variations in fees and cost of services. That would allow consumers to make more informed decisions about choosing health care providers.

In addition, the new Health Care Access and Cost Commission will set guidelines by Jan. 1, 1995, for all health care practitioners to follow in setting prices.

The legislation also limits insurance company profits. It restricts the amounts insurance brokers and agents may spend on administration and attempts to reduce the costs of processing medical claims by requiring them to be sent through central clearinghouses electronically.

In addition, it hopes to discourage overreliance on certain tests by establishing guidelines for their use.

Q: Who will serve on the Health Care Access and Cost Commission?

A: The seven members will be appointed by the governor with Senate approval. At least four members will have no tie with management or policy of a health care provider.

Q: By establishing a commission to help curb health care costs, is Maryland creating an expensive new bureaucracy?

A: Yes. The legislation mandates a $5 million annual budget for the new health commission and requires central clearinghouses to process allhealth insurance claims. The $5 million will be paid for through assessments on health care providers, insurers or administrators. But legislators say they believe they had to enact reforms -- with the commission playing a central role -- because the public is clamoring for an end to runaway health costs.

Q: Will Marylanders still be able to choose their own doctors?

A: Yes. The legislation does not attempt to control health costs by creating incentives to switch from using private physicians to health maintenance organizations, in which patients have fewer choices.

Q: What effect will the legislation have on doctor's fees?

A: Doctors and other health professionals are expected to set their fees according to guidelines established by the Health Care Access and Cost Commission. The guidelines must consider factors including training, experience, office and insurance costs and geographic variation in costs, as well as the relative complexity of procedures and the time and skills involved.

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