Health care emerges as legislature's gem

General Assembly: Lawmakers put prescription drugs, mental health on governor's radar screen.

April 11, 2001

LEADERS of Maryland's General Assembly can rightly claim that the defining moments of their just-concluded 90-day session were initiatives of their own making and not the governor's.

By the time the final gavel sounded at midnight Monday, health care had emerged as the dominant concern. Slowly, the governor came around to support lawmakers' views.

It took strong, persistent pressure from lawmakers to convince Gov. Parris N. Glendening to pump over $58 million into a prescription-drug program for poor seniors and into community mental health clinics.

The governor was harshly criticized for his lack of attention to the state's growing health care crisis. Lawmakers demanded more money during negotiations on his $21 billion budget.

In the end, Mr. Glendening agreed to a one-time tax amnesty, with the first $30 million going to pay off accumulating bills from the state's struggling mental health clinics.

Then the General Assembly mandated that the state begin to pay higher reimbursement rates for Medicaid and children's health programs, starting next year.

That could be an expensive long-term item -- as much as $200 million from state coffers. But Maryland must end its practice of starving medical programs for the poor. Fees to doctors and providers should be in line with rates paid by private health insurers.

Another expensive future cost was acknowledged by the governor when he agreed with demands of lawmakers that more be done to help those who work with the developmentally disabled.

The state's unacceptably low reimbursement rate is less than the minimum wage. But starting next year, there will be a five- year, $80 million phase-in of pay increases.

That's welcome news for the 32,000 workers who care for 21,000 adults with developmental disorders.

It comes on top of the latest installment in Mr. Glendening's five-year, $68 million drive to enlarge the pool of programs for this needy population.

The governor added another $1.4 million to help move more developmentally disabled adults out of state hospitals and into community settings. This must be done to comply with a Supreme Court ruling.

In its final hours, the General Assembly reversed course on a hotly debated issue fought by the state's medical society. It gave a one-vote victory to the nursing profession: From now on, members of HMOs will be able to select nurse practitioners as their primary care providers.

That's a small step toward making nursing a more appealing career.

Mayor Martin O'Malley got his prime health care desire -- $8 million more for city drug-treatment slots and an additional $8 million next year. This is a crucial step in bringing down the city's addiction -- and crime -- rates.

Prescription drugs turned into an obsession for both Sen. Thomas Bromwell of Baltimore County and Del. Michael Busch of Anne Arundel County, two powerful committee chairmen. They had sharply different approaches in mind, but found common ground. As a result, as many as 100,000 Maryland seniors could get drugs at reduced cost.

It's a risky move, though. The three-pronged approach is billed as a temporary, two-year fix until Congress enacts its own drug program. But there's no guarantee this will happen, especially with the shrinking amount of federal money available for domestic programs as the president implements his tax-cut plan.

Additionally, politicians in Annapolis may find it hard to withdraw money for this program after a two-year run. Lobbyists for seniors may insist that the state continue and even possibly expand its role.

This could pose a fiscal threat, especially when you add up future extra money flowing into programs for the developmentally disabled, drug treatment and mental health clinics.

But that is a problem lawmakers put off until 2002 or later.

Also on the next legislative agenda could be a move to increase the rates hospitals are allowed to charge patients. The state commission that sets these rates came under withering attack from influential lawmakers for being so stingy that hospitals may have to cut back on services.

That's not acceptable to legislators. They want the commission to pay less attention to profit-making insurers, who favor tough cost controls, and more attention to the unmet needs of Maryland's not-for-profit hospitals.

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