Ehrlich plans limited health reforms in '04

Help: Care for the frail elderly and tighter malpractice rules are among reforms sought by the governor.

November 13, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

While continuing work toward comprehensive health reform over the next few years, the Ehrlich administration said yesterday, it will seek more limited gains in the next legislative session - from finding less costly settings to care for the frail elderly to expanding clinics for the poor to stiffening malpractice rules.

Health Secretary Nelson J. Sabatini told a health summit in Annapolis that the administration also would look to develop an insurance plan with fewer benefits that will make coverage more affordable to small employers.

He also will weigh using the state's market power to gain lower prices on prescription medications.

Once the state solves its immediate budget problems, he said, the administration intends to develop a package of tax credits and tax penalties to encourage individuals without health insurance to buy coverage.

The aim is to discourage "socially irresponsible" people who can afford insurance but don't purchase it, Sabatini said.

Gov. Robert L. Ehrlich Jr. told summit participants that he viewed the tax code as "the No. 1 policy tool with respect to access" to health coverage.

The health care summit was sponsored by legislative leaders to deal in advance with what is expected to be a major issue in Annapolis this winter.

The governor told the 200 participants, including legislators, hospital administrators, insurance executives and representatives of health advocacy groups, that the summit was "a precursor to an awful lot of debate and hard work" over the legislative session that begins in January.

The governor also said rising malpractice rates were driving doctors to leave their practices. "We need to move because we cannot afford to lose our best and brightest," he said.

Among malpractice reforms the administration will consider, Sabatini said, are a change in the cap for pain and suffering damages (beyond actual medical costs and lost wages), now $635,000 in Maryland; a different method of calculating economic losses; and a cap on attorney fees.

The state medical society and hospital association have supported similar reforms, but they have been opposed by trial lawyers.

"There are no bad guys in this debate," the health commissioner said at the summit's opening session, although "when a problem is this big and this complex, we are bound to have differences of opinion."

The summit sought to address ways to cover the state's estimated 690,000 uninsured, who make up nearly 13 percent of the state's population.

John Holahan, director of health policy research at the Urban Institute, presented data at the summit showing that 29 percent of uninsured adults in Maryland are in households with income of at least four times the federal poverty level - or at least $55,000 for a family of three.

Dr. Peter Beilenson, Baltimore health commissioner and board chairman of a statewide group called Maryland Citizens' Health Initiative, called his group's medical plan "the most economically sound and politically viable way to expand health coverage."

The plan, developed over several years, would expand eligibility for the Medicaid program for low- and moderate-income adults, subsidize coverage for those with moderate incomes, and require higher-income individuals to purchase coverage.

An increase in tobacco taxes and a payroll tax aimed at employers who do not offer health coverage to their workers are proposed as the means to pay for the plan.

"This is the year for comprehensive action," said Vincent DeMarco, executive director of the health initiative group, noting that: "Five years ago there wouldn't have been this kind of summit."

Del. John Adams Hurson, chairman of the House Health and Government Operations Committee, said the state cannot afford health insurance for all who need it. He urged instead for the state to concentrate on providing health care, such as helping clinics that treat the uninsured.

Hurson's proposal, called the Maryland Community Health Care Initiative, would provide primary care through existing clinics to low- and moderate-income Marylanders and try to expand specialist care through the clinics. The state would offer the clinics loans and bonds to expand their services, he said.

Gail Wilensky, a health analyst with Project HOPE, a group that runs health service and policy programs, said there is strong interest in health reform nationally because of a combination of rapidly rising costs and a soft economy.

Sen. Paula Hollinger, chair of the Senate Education, Health and Environmental Affairs Committee, said lawmakers might eventually adopt "a piece of everybody's plan," with some incremental coverage improvements in the next session and broader reform in the future.

Sabatini said the frail elderly now account for nearly one-third of the state's $4.5 billion a year in Medicaid spending, although they represent only 4 percent of the Medicaid population.

He said he thought some could be cared for with "more dignity" outside of nursing homes, and at lower costs, but didn't have details of how such a program might work.

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