Setting a brief agenda for his inaugural year, incoming House Speaker Michael E. Busch said his priority list for the coming General Assembly session comprises just two issues, both concerning health care costs.
In an interview this week, Busch said he planned to use his increased power as leader of the House of Delegates to promote a pair of important but relatively low-profile topics: better pay for doctors at Maryland's hospital trauma centers, and lower health insurance premiums for small businesses.
Busch's truncated wish list contrasts sharply with those of his predecessor, Del. Casper R. Taylor Jr. of Allegany County, who gained a reputation as a thoughtful public-policy advocate.
Taylor included 20 bills in a leadership package in 2000, and 15 in 2001. A year ago, the package contained 10 bills - including the creation of a commission to study the state's fiscal structure, a black-bear hunting season, and guidelines for the conversion of not-for-profit CareFirst BlueCross BlueShield to a for-profit company.
As he settles into his new job - Busch will replace Taylor, who lost his re-election bid, when legislators convene next week - the speaker-designate said he would like to focus on fewer issues.
"I've come to the conclusion that there have been too many [priority bills]," said Busch, an Anne Arundel County Democrat. He will target no more than five bills a year, he said.
But during uncertain times with a Republican governor-elect and a $1.2 billion revenue shortfall for the coming budget year, Busch will reduce his objectives even further.
He said he supports the creation of a fund to supplement the salaries of doctors who treat accident and shooting victims at the state's 11 certified trauma centers.
One possible source of money: an additional fee on vehicle insurance policies. A $1 surcharge would generate $4.5 million for the state, according to some estimates; Busch said he is considering a charge of up to $2 per policy.
The funding issue came into sharp focus in June, when the trauma center at Washington County Health System in Hagerstown closed during a dispute over pay for doctors working there.
Doctors said they were losing money by agreeing to work at the center, because they could not see patients or schedule procedures while on call. The center reopened in October after the hospital found money to compensate its staff, but state officials agreed a permanent solution was needed.
Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services System, called Busch's support of trauma funding "outstanding."
Trauma doctors lose money because federal Medicaid funds for patients without insurance cover hospital expenses but not physician salaries, Bass said. In rural areas, the neurosurgeons and other specialists required to staff trauma centers around the clock don't treat enough patients to compensate for the money they lose by forgoing business from other patients.
A legislative committee studying the problem "has defined the problem pretty well, and they've got a list of potential solutions," Bass said.
Busch also said he wants to lower the cost of health insurance for small businesses by changing a formula contained in a state law requiring coverage at companies employing up to 50 workers.
State law says insurance premiums can't exceed 12 percent of the average salary in Maryland. Busch wants to lower the cap to 10 percent - for a savings of roughly $300 per premium.
"It's designed to reduce the cost of health care for small businesses," he said.
Robert O.C. "Rocky" Worcester, president of Maryland Business for Responsive Government, said he welcomed changes to make health insurance more affordable.
But Busch should also address a related problem, Worcester said, by limiting the types of medical services the state requires insurance companies to pay for.
"Maryland has more mandates than any state in the union," Worcester said. "Some of them, by everybody's admission in private, are ludicrous."
Gov.-elect Robert L. Ehrlich Jr. has not expressed an opinion on either of the priority issues offered by Busch, said Ehrlich spokeswoman Shareese N. DeLeaver.
Ehrlich released a legislative priority list last month that consisted of charter schools, a faith-based social services initiative and a tougher gun-crime program modeled after Project Exile in Virginia.
"Between the executive and the legislature, the budget needs to be first and foremost on everyone's mind," DeLeaver said. "Hopefully, we can respectfully compromise for the greater good of Maryland."