State commission unexpectedly decides to seek controversial health reforms STATE HOUSE REPORT

January 27, 1994|By John W. Frece | John W. Frece,Staff Writer

In an attempt to assure that Maryland's health care laws remain in place even if Congress enacts a national plan, a state commission has unexpectedly decided to ask the General Assembly to consider a new set of controversial reforms.

A day after President Clinton used his State of the Union address to emphasize his desire to enact national health reform, the Maryland Health Care Access and Cost Commission met to discuss ways in which the state could strengthen its argument that Maryland's laws be allowed to stand -- to be "grandfathered in" -- regardless of what the federal legislation does.

"We do not want to be in a position a year from now of saying, 'Gee, if we had only acted this year, if we had only put in these provisions,'" said John M. Colmers, executive director of the commission.

But the commission is getting a late start. This year's 90-day legislative session is already two weeks old, and the proposals are not likely to be drafted into bill form for another week. The commission yesterday directed its staff to work with the state health department and Insurance Administration to write a bill that would institute four changes:

* Extend to the self-employed or others who are in what is known as the "individual insurance market" many of the reforms enacted by the 1993 General Assembly to help small businesses provide insurance to their workers. Those changes include a guarantee that a policy would be issued to any applicant and that it would be renewed upon expiration regardless of the health of the insured.

* Establish four regional, nonprofit, privately run health insurance purchasing cooperatives around Maryland. Such cooperatives would give employees of small companies or individuals seeking insurance more choices of benefit plans and potentially lower costs due to the mass buying power of a cooperative.

The same concept was proposed last year, but rejected by the General Assembly under intense pressure from angered insurance agents and brokers. This latest proposal would be similar to cooperatives that would be created under President Clinton's plan, but without the regulatory authority of the proposed federal purchasing organizations.

* Launch a study of health care delivery networks, those constantly changing configurations of insurers, doctors and other providers that have evolved in an era in which the country is moving away from sole practitioners and toward more cost-conscious "managed care."

The study would attempt to determine if these new networks are accountable to their patients in terms of access to and quality of care, financial solvency, payment procedures and other matters.

* Attempt to resolve a growing dispute between doctors and managed care networks, such as health maintenance organizations, over the question of whether such networks should be required to accept any doctor who wishes to join.

The commission recommended a provision in which insurers or other network organizers would have to establish with the Insurance Administration specific criteria for those who wish to join their network. They also would be required to inform, in writing, any doctor or other provider who is rejected for membership the reason why.

Mr. Colmers said such a provision would not prevent networks from rejecting anyone they choose, nor would it establish a grievance procedure for doctors who are rejected.

The emergence of such legislation caught some commission members as well as health care lobbyists by surprise. Backers of Maryland's 1993 reforms had said nothing new would be proposed this year. But William C. Richardson, president of the Johns Hopkins University and chairman of the commission, said the pressure of reform at the federal level combined with the state legislature being in session prompted the commission to change its mind.

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