HMO plan to be issued Glendening will offer a patients' 'Bill of Rights'

Unveiling set for today

Governor making health care reform a priority issue

July 21, 1998|By JoAnna Daemmrich | JoAnna Daemmrich,SUN STAFF Sun staff writer Thomas W. Waldron contributed to this article.

With the public clamoring for reform of managed health care, Gov. Parris N. Glendening is making the issue a priority as he begins to articulate his agenda for a second term.

Glendening will visit a hospital and senior center today to announce a "Bill of Rights" for Maryland patients. Included will be a half-dozen legislative proposals by which the incumbent Democrat now hopes to put his imprint on the movement for reform.

"There have been a lot of growing pains for the managed care industry," said Peter S. Hamm, a spokesman for the Glendening campaign. "The governor felt this is an area, especially in context of the national debate, where he should share his thoughts with the public."

As Glendening seeks re-election, he is proposing for the first time additional reforms to the nationally acclaimed patient protections passed by the Maryland legislature. Most of those reforms, which he will detail at Bethesda's Suburban Hospital and a Catonsville senior center, would require health maintenance organizations to provide more non-routine, and usually more expensive, services for patients.

One would require HMOs to refer patients who need services the group cannot provide to a doctor outside the network. Another would force the HMO specialists treating patients with serious illnesses also to provide routine care. A third would establish "standing referrals," instead of forcing patients repeatedly to seek referrals from their doctors for the same treatment by a specialist.

Glendening also wants to require a minimum 48-hour hospital stay after a mastectomy or testicular cancer operation, and to force insurers to pay for prescription drugs, instead of providing substitutes. Finally, he will announce plans to hire an ombudsman to provide HMO information to consumers.

Regulating managed care has been a popular, but highly contentious, cause in Maryland's General Assembly in recent years. Glendening has largely stayed on the sidelines, away from the intensive lobbying between competing health interests, including hospitals, doctors and HMOs.

Several legislators who have been key players appeared surprised yesterday at Glendening's proposals, but expressed general support.

"I think the governor is covering several areas of consumer concerns that have not yet been addressed. And I applaud him for that," said House Speaker Casper R. Taylor Jr.

Taylor added: "I do, however, caution that all of us have to be very careful in the way we balance consumer concerns in order to maintain the basic value of managed care, which is affordability."

Elsewhere in the country, pressure is building to rein in health maintenance organizations that are often seen as insensitive and preoccupied with holding down costs.

On Capitol Hill, Democrats and Republicans have proposed separate versions of federal health care legislation. Last week, President Clinton made a personal appeal to Congress to put aside partisan differences and create better protections for the 80 percent of the nation's workers who are enrolled in managed care.

In Maryland, the managed care lobby has repeatedly fought legislative attempts to require more benefits by arguing that they will drive up the cost of health care.

"Anytime you tinker with the system, you're adding costs," Gerard E. Evans, an Annapolis lobbyist for two large health care groups, said yesterday. "We already have more mandated benefits than any state in the country. The cost of health care is escalating rapidly, not falling. If we keep adding bells and whistles on the system, soon we'll be [at] the point where we'll have limited health care."

Still, HMO lobbyists agreed that they expected Glendening to seize on the public discontent in an election year. "It's a hot button we frankly expected him to push," Evans said.

Glendening stopped short of seeking the most far-reaching legislation, opposed by the HMOs, that would hold their medical directors personally responsible for inappropriate health care decisions.

The governor's chief Democratic rival, Harford County Executive Eileen M. Rehrmann, backs subjecting HMO directors to the same discipline as doctors. Rehrmann also has called for the creation of an advocacy office in the state health department to help patients cope with conflicts with their HMOs.

The legislature defeated the HMO director bill this year. Instead, the legislature enhanced the system under which HMO patients can appeal coverage decisions to the state insurance commissioner.

Pub Date: 7/21/98

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