2 health issues likely to be back

Malpractice reform, wider coverage got sidetracked

April 14, 2004|By M. William Salganik | M. William Salganik,SUN STAFF

Advocates vowed yesterday to continue to fight for two health initiatives - medical malpractice reform and extending coverage to more of the uninsured - after both high-profile initiatives sputtered out in the waning hours of the legislative session.

"We still have an 800-pound monkey on our back," said T. Michael Preston, executive director of MedChi, a professional organization for the state's doctors. "The malpractice insurance problem is going to result in an explosion this summer, as doctors face another round of huge price increases."

"It's disappointing, but we'll be back," said Vincent DeMarco, president of Maryland Citizens' Health Initiative, a group that pressed to extend health insurance to all Marylanders.

DeMarco is pointing toward next year's legislative session for another effort at covering the uninsured, but the malpractice issue could be back sooner.

Gov. Robert L. Ehrlich Jr. has "left open the prospects of a special session if there is another dramatic increase in rates over the summer," Henry Fawell, an Ehrlich spokesman, said yesterday. Also possible is a study commission on the issue.

The malpractice issue reached a boil last fall, when the company that provides malpractice coverage for most of the state's doctors raised its premiums 28 percent. White-coated doctors rallied in Annapolis as the session began, seeking lower limits on damages and other reforms in the way malpractice cases are handled.

The Ehrlich administration introduced a similar proposal, and the doctors and other providers lined up behind it.

The Maryland Trial Lawyers Association argued that the problem results not from awards to malpractice victims but from insufficient policing of negligent doctors and from the way malpractice insurers set their rates.

A House of Delegates work group put together a malpractice package designed to institute reforms and to avoid the most controversial parts of the agendas of the doctors and the trial lawyers. The bill that passed the House called for a task force to study the issue. Its recommended changes were meager enough that MedChi and the trial lawyers, opponents on the issue, both backed the bill.

But the watered-down package never emerged from the Senate Judicial Proceedings Committee, which has generally been sympathetic to the trial lawyers.

"I don't think at the end of the day, the General Assembly felt confident they understood what was causing the problem, and, without that, they couldn't come to a consensus on a solution," said Steven B. Larsen, who led the Alliance to Preserve Access, a coalition of doctors, hospitals and other health providers pushing for reform.

Kevin McCarthy, a board member of the trial lawyers group, saw it differently.

"The more [legislators] got into it, the more they understood that the problem isn't the tort system. It's the insurance system and the doctors," McCarthy said.

Preston, of MedChi, said the trial lawyers "obfuscate" the issue by focusing on the reserves and stock market returns of malpractice insurers. He predicted another round of hefty premium increases and added, "I guarantee you the doctors are going to be raising hell."

McCarthy, Larsen and Preston said they would welcome a study. If a special session is called, they said, it would be useful for a commission to have sorted through the facts and to have attempted to build a consensus in advance.

Like malpractice, the issue of the uninsured - about 700,000 of 5 million Marylanders, generally adults, lack health coverage - drew wide agreement that there is a problem but no consensus on a solution. The biggest barrier to a coverage-extension bill was not how to structure an insurance program but how to pay for it.

Del. John Adams Hurson, a Montgomery County Democrat who chairs the House Health and Government Operations Committee, crafted a House-approved plan to extend limited benefits to parents in households earning up to $37,700 for a family of four. It was to be financed by a 1 percent tax on health maintenance organization premiums.

The Senate Finance Committee, pushed by its chairman, Sen. Thomas M. Middleton, a Southern Maryland Democrat, amended the bill to offer a full package of benefits to about 75,000 uninsured. To generate the money for the richer benefit package, the committee sought a 2 percent tax on HMO premiums.

That plan died on a 22-to-24 vote on the Senate floor Monday night, as the session wound to a close. Opposition coalesced around the HMO tax, which had drawn a veto threat from Ehrlich.

"Sixty to 70,000 people were poised to get health care coverage, and they didn't get it," De Marco said.

A leading opponent of the HMO tax, Ellen Valentino, state director for the National Federation of Independent Business, said that small employers already have a tough time paying for coverage for their workers. Adding a tax on top of that would put further pressure on the employer-financed system, Valentino said.

"The issue of how to deal with the uninsured has to be wrestled with, but the financing of the proposal can't depend on asking people who can barely pay now to pay more," she said.

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