Assembly takes up money bills

March 28, 1994|By John W. Frece | John W. Frece,Sun Staff Writer

As Maryland's General Assembly grinds toward adjournment, the issue likely to dominate the last two weeks of the 90-day session has finally burst into full bloom like so many daffodils in spring.

That issue, of course, is money.

Bill after bill pending in the session's final days has to do with money: Someone has it, and someone else is trying to change Maryland law to get it.

Health maintenance organizations (HMOs) and insurers have it, but doctors are demanding a piece of the action. Local governments have it, but long-distance telephone companies want a tax break to get some of it back. The tobacco industry has it, but the governor wants to grab a share for the state by raising the tax on cigarettes.

For those who think legislating is simply an abstract exercise in setting public policy, think again. Legislating is usually about cost-shifting: taking the money from one group's pocket and putting it into another's.

As business interests clash, one group after another relentlessly chips away at its competitors. They seek to stiffen regulations that would hurt the competition, or relax laws to help themselves, or require competitors to be licensed, or taxed, or to publicly reveal their business practices through some new, mandated reporting.

Optometrists battle opticians, dental hygienists fight with dentists. Massage practitioners bicker with physical therapists, car dealers complain about car manufacturers. The franchisee tries to stick it to the franchiser. Licensure for one means exclusion for another.

A word here, a comma there, a "shall" that becomes a "may," and suddenly the world changes.

"If you or your business becomes marginalized because of the way your customers are acting, you're going to seek some way to change it back," explained Champe C. McCulloch, president of the Maryland Business Council. "Ideally, you change the law to preserve your market share and the dislocation the economy brings."

Maryland hospitals sought legal protections because an increasing number of patients are moving to unregulated clinics, leaving for the hospitals the patients who cannot afford to pay. Hospital rates set by state regulation include the cost of care for those who cannot afford to pay. But clinics, often set up by doctors, don't have to meet the same requirements.

Western Maryland dairy farmers, unhappy with the prices they are getting for their products, tried unsuccessfully to set up a Maryland Milk Commission that they hoped would raise and stabilize milk prices.

Chronic-care hospitals tried to stop a move by the health department that would have let patients who need life-support ventilator equipment be cared for in nursing homes instead. Publicly, the debate was about the standard of care such patients could expect. But the real agenda was the shift of paying customers from one provider of medical care to another.

One delegate even introduced legislation for a constituent who drives a dump truck that would have set a minimum wage for independent dump truck operators.

The cliche all the supplicants use is that they are only seeking "a level playing field." But what is a level playing field to one group usually seems tilted to another.

Doctors, for example, are engaged in the most politicized and perhaps most lobbied issue of the session: legislation that would require HMOs and other insurer-backed networks of physicians either to let in any doctor who wants to join or allow patients inside the networks to go to other doctors -- and have the networks pay for at least part of that care.

Probably no issue this session demonstrates better how one group -- in this case, the physicians -- can appeal for a legislative remedy when economic forces have changed how they do business.

For years, many doctors refused to join HMOs or other emerging physician networks. But times changed. The public, business and government discovered that such "managed care" options make medical care less expensive. Networks are suddenly in demand, and doctors who are not part of one have discovered that they are losing business.

So, the doctors are demanding to be let in. Opponents say such changes will simply usher back "the good old days" and in the process destroy the cheaper "managed care" method of delivering medical services.

But this is an election year, and the doctors -- who are among the most active and powerful special-interest groups in Annapolis -- have turned the heat up so high that the Senate's Finance Committee has threatened to rebel against its chairman and vote for the bill this week.

If the chairman refuses, committee members vow to bring the bill to the Senate floor by petition over the objections of opponents such as the legislature's two presiding officers, the state's health secretary and new health care cost commission, and even the governor.

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