Interest groups ranging from patients to insurance companies yesterday picked away at a bare bones health benefits plan that could become the standard for small businesses across Maryland next year.
During a daylong public hearing in Baltimore, many praised the benefits package as a strong effort to make health insurance more accessible to workers in small businesses. Most, however, found at least something to criticize.
Hospitals opposed the $50 co-payment for some emergency room visits. Women complained about the lack of coverage for contraceptives.
Doctors didn't like the exemption of certain organ transplants. Maryland Right to Life Inc. asked that abortion be excluded.
Amid the hours of often technical testimony, Michele Hax of Baltimore offered a glimpse of the plan's potential human cost. Her 15-year-old son, Matthew, suffers from leukemia. If he has a relapse, he would need an autologous bone marrow transplant, she said.
"If these procedures are eliminated from coverage," she said, "you are eliminating one of the main options for keeping my son alive."
Ms. Hax and others offered their comments before Maryland's Health Care Access and Cost Commission. The commission, created by the state's health reform law earlier this year, is expected to meet Tuesday in Annapolis for a work session where it may finalize the plan.
Unless the legislature moved specifically to change it, the plan would become law July 1. Insurance companies would have to offer it to operate in Maryland, though small businesses would not be required to buy it for their workers.
Yesterday's hearing provided coming attractions for one of the main events in U.S. domestic policy -- the debate over the Clinton administration's national health care reform plan. A federal plan -- if enacted -- could in time render the Maryland law meaningless. But the state's plan would remain in effect in the meantime.
The plan's purpose is to make health insurance more available to the estimated 600,000 Marylanders who do not have it. Three quarters of those people either work in small firms or are their dependents. The commission hopes that as insurers offer the same plan, market forces will drive prices down.
The state plan would effectively wipe the slate clean. Small businesses offering insurance would have to start with the standard benefits plan, though they could choose one or more of four different delivery systems.
They could offer additional benefits -- like lower co-payments for procedures or doctor's visits -- that would be priced separately.
The four systems would include:
* A traditional indemnity plan, where patients can chose their doctors, who are paid on a fee-for-service basis.
* A health maintenance organization.
* A preferred provider network.
* An HMO in which patients could go outside the network for a fee.
The plan would cost an average of $3,080 per year. How much of that -- if any -- businesses might pay would be up to them.
The traditional indemnity system would cost the most on average, $3,310. A representative of the League of Life and Health Insurers of Maryland told the commission that many of the organization's members thought the figure was under-priced by 20 percent.
"Every single carrier told me the indemnity piece is too low," said Debbie Rivkin, the organization's executive director.
To keep emergency care costs down, the plan calls for patients to pay $50 for each emergency room visit if they aren't admitted to the hospital.
Some argued that the cost wouldn't deter people. Emergency rooms can't enforce the co-payment, because they are federally mandated to treat people who come there, said Barbara Marx Brocato, a government relations consultant.
Andrew B. Wigglesworth, senior vice president with the Maryland Hospital Association, said a family could spend $1,200 on co-payments and deductibles for emergency room visits before insurance kicked in.
Late in the day, Planned Parenthood of Metropolitan Washington, D.C., was preparing to argue for coverage of the birth control drug Norplant as well contraceptive devices, including the IUD and the diaphragm.
Maryland Right to Life argued that if the commission insisted on including abortion as a rider, it should allow health insurers to decide whether to offer it.
"Health insurance companies have consciences," wrote executive director Roger Stenson, in his prepared testimony.