Maryland's health plan may be precursor of Clinton's recommendations

September 24, 1993|By John W. Frece | John W. Frece,Staff Writer

As President Clinton calls on Congress to enact landmark reforms in the way Americans receive and pay for their medical care, Maryland appears well-positioned to adapt to any changes the federal government may impose.

Thanks to the General Assembly's passage this year of a significant Maryland health care law, the state is already putting in place some of the president's reform recommendations. And it is setting up a structure that could neatly fit into the national plan Mr. Clinton envisions, if and when such a plan is enacted.

"We're just starting on a smaller scale and starting earlier than the president envisions," said John M. Colmers, executive director of the state's Health Care Access and Cost Commission.

The Maryland law was designed to make medical insurance more available and affordable to employees of small companies, many of whom do not have insurance now. It also created a powerful new commission to oversee the cost of and access to medical care in the state.

The commission, which began its work several months ago, will be collecting a broad array of information about the procedures used by medical providers in Maryland and the fees they charge.

Under Mr. Clinton's proposal, states would be required to develop the capacity for collecting that data. The idea is to allow states to measure and compare the quality of care being offered their citizens.

The Maryland commission is also in the process of developing a standard package of health benefits that insurers will be required to offer small businesses. The fees charged for that coverage must be set through a pricing technique called "community rating," which is expected to make the insurance less expensive for small companies.

Businesses would not be required to offer such insurance to their employees or to pay for it -- a difference from the president's plan. But state officials note that companies here will have the option of purchasing that insurance by next summer.

Most observers agree that Congress, by contrast, will be lucky to have a health care reform bill enacted by then. And even if it does, it may be years before some of its major provisions are phased into effect.

Here are some of the other ways Maryland's legislation is similar to the president's proposal:

* It outlaws the practice by insurers of denying coverage based on "pre-existing" medical conditions, such as diabetes or a heart condition -- a practice that has allowed insurers to cover the healthy while refusing coverage for the sick. The practice will be phased out in Maryland by Jan. 1, 1995.

* The law requires that the new health policies for employees of small businesses be issued upon demand and that they remain in force as the insured moves in and out of employment, or from one job to another, or even if the insured or a member of his or her family becomes seriously ill.

* The legislation limits insurance company profits, as well as the amount of money that brokers and agents may spend on administrative costs. Mr. Clinton's proposal calls on states to regulate private health insurance premiums under certain circumstances.

State officials, legislators and health care experts concede that Maryland may have to change parts of its plan to comply with whatever Congress ultimately does.

But by putting it into effect now, they say, the state can begin providing health care coverage for some of the 600,000 Marylanders who are currently uninsured and begin squeezing some of the high cost of health care out of the system even before a federal plan is imposed.

"Nothing the president said [Wednesday] night interferes with the Maryland plan," said Del. Casper R. Taylor Jr., D-Allegany, chairman of the House Economic Matters Committee and one of the authors of the state law.

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