HMO lobby succeeds in fending off Assembly Watch out next year when key legislators expect to push reform

April 13, 1997|By Michael Dresser | Michael Dresser,SUN STAFF

It was 11: 56 p.m. on Monday, the last night of the General Assembly session, when the House overwhelmingly approved the final version of the most significant piece of managed health care legislation in Maryland this year.

Immediately, Del. Michael E. Busch, chairman of the House Economic Matters Committee, raced to the Senate with the conference committee report on a bill that would have streamlined appeals for patients who were denied medical coverage.

But just as Busch was presenting it to Sen. Thomas L. Bromwell, chairman of the Finance Committee, he heard the voice of the Senate majority leader moving to adjourn the Senate sine die -- until next year.

Thus died the next-to-last bill to pass the House this year. It was that kind of year in the Maryland General Assembly for critics of health maintenance organizations.

The HMO industry was the target of many bombshells in Annapolis this year -- more than 60 bills by one lobbyist's count -- but few found their mark during the 90-day legislative session.

The industry managed to derail its most-feared bill -- one that would have subjected medical directors to physician disciplinary procedures -- after it passed the Senate.

Another bill the health insurers opposed, one that would have allowed hospitals and providers to nonprofit "community health networks" to compete with HMOs, died in conference committee on the final day.

Even the emotionally charged bill to mandate a minimum 48-hour hospital stay after breast cancer surgery was defeated in the Economic Matters Committee.

As a result of legislation that did pass, HMOs will have to deal with a few added consumer information disclosure requirements, some small-ticket mandated benefits and some new protections for providers in billing disputes.

However, its highly skilled army of lobbyists managed to waylay every bill that posed a significant threat to the industry's profits.

"The HMO industry feels like the session was a good one for the industry," said D. Robert Enten, chief lobbyist for the Maryland Association of Health Maintenance Organizations. "There were a tremendous number of bills that would have impacted the industry, and looking at the final results I don't think there's anything that has a significantly negative impact."

L But next year the HMOs could face an ever stiffer challenge.

House Speaker Casper R. Taylor Jr., said last week after adjournment that HMO legislation will be "one of my central themes" for the 1998 session.

Taylor conceded that health care issues "were pushed off the table" during this year's session, which was preoccupied with higher-priority matters such as tax-cutting, sprawling development and Baltimore schools.

"I can't let that happen again next year," said the Cumberland Democrat.

Taylor said he is planning to take a "comprehensive look" at the problems posed by managed care during the Assembly's "summer study" period.

Senate President Thomas V. Mike Miller Jr. said he expects to be joining the speaker in initiating such a review.

"Cost is now driving everything in the health care industry," said Miller.

The result is that next year the HMO industry could be faced with sweeping regulatory legislation that goes far beyond anything passed this year. And instead of worrying about narrowly drawn bills sponsored by little-known delegates and senators, HMO lobbyists could find themselves trying to block sweeping bills sponsored by the presiding officers. Such bills start out with a built-in advantage over bills with less august backing.

There are other reasons that health care issues are likely to take center stage next year:

It will be the fourth year of the four-year legislative term, and lawmakers on the key health committees are as comfortable with the issues as they will ever be.

While education funding is certain to be back in the spotlight, tax cuts, election reform and Smart Growth are out of the way.

Incumbents running for re-election will want to put their names on successful bills that constituents care about. There are few issues that strike home as much as managed care.

There is a strong feeling among key legislators that the Assembly left a lot of unfinished business in the HMO field this year.

Among the legislators who feel that way are Bromwell and Busch, both of whom led committees that spent hours this year hearing horror stories about stingy and insensitive HMO care from patients and providers.

Bromwell, a Baltimore County Democrat, said he doesn't think the industry can hold off additional regulation indefinitely.

"You're going to see an enormous amount of bills next year on health care, and they won't be able to dodge them all," he said.

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