The Maryland House and Senate were preparing to pass a bill early this morning to keep malpractice insurance costs for doctors in check, defying Gov. Robert L. Ehrlich Jr.'s pledge to veto the complex agreement.
Legislative negotiators struck a compromise on the second day of a rare General Assembly special session yesterday that would limit doctors' insurance increases at 5 percent in the coming year, instead of the 33 percent increase that they face Jan. 1. Other agreed-to reforms would make patients safer, discipline negligent doctors and change the way courts award damages for injuries and improper care.
Ehrlich called the effort "relatively minor" and "a wasted opportunity" to create more meaningful reforms. "It's a shame," he said. But the governor vowed to reintroduce legislation with stricter limits on lawsuits, as he originally proposed, when the General Assembly reconvenes in two weeks.
"It appears the net result of this experience is a tax bill which is regressive and is legal-reform light," Ehrlich said last night after receiving a briefing on the results of the negotiations, "which is not what the people of Maryland wanted."
Eager to wrap up a holiday-week special session called by the governor, lawmakers decided to stay well past midnight while the final version of a 100-page bill was printed. Legislators grew giddy as the hours passed. While some drank coffee, others retired to local inns or found secluded rooms for card games. Del. Salima S. Marriott napped on a couch in the House lounge.
With Ehrlich promising to follow through with a veto, some lawmakers were unsure whether they had wasted their time. But others maintained that something of substance had been accomplished.
"The juice was worth the squeeze to come down here, and do what we did," said Del. Joseph F. Vallario Jr., a Prince George's County Democrat and one of the House negotiators.
Vallario and others said there were sufficient votes in both chambers to override a gubernatorial veto, a vote that could come as early as Jan. 11. That's when lawmakers are scheduled to take up a series of veto overrides, a day before the start of the 90-day regular session.
Health providers had mixed reaction to summaries of the legislature's plan.
"We have a lot of docs on the edge, and this is a great step in the short term," said Dr. Stephen L. Diehl, a Hagerstown radiologist who has been lobbying for reform as part of the Save Our Doctors Protect Our Patients Coalition. "A long-term solution involves mostly tort reform, but we got some significant tort reform as a first stage."
But Del. Dan K. Morhaim, a Baltimore County Democrat who is also an emergency room physician, said he thought the conference bill was "seriously watered-down tort reform," and blamed the Senate for not considering more sweeping changes. He said he would support it reluctantly, because "it does keep a number of doctors in practice for a year."
Representatives of the state medical society and hospital association said they would need to study the bill before commenting.
Ehrlich and the Assembly remain locked in a standoff over which public funds should be used to help doctors defray their soaring costs. The Democrat-controlled legislature wants to remove a decades-old tax exemption applied to health maintenance organizations, making them subject to the same 2 percent premium tax paid by other insurers.
Ehrlich, a Republican, has repeatedly called such a tax "regressive," and his veto of the bill is virtually guaranteed. Instead, the governor wants to use a corporate tax windfall to create a stopgap fund for doctors who say the insurance increases are forcing them to curtail care and even quit.
Legislative leaders insisted they were proud of their work over the past three days to balance the desires of trial attorneys, hospitals, doctors and patient victims.
"I'd like to think the governor will have time to reflect on this bill and see the good it does for the people of Maryland," said Senate President Thomas V. Mike Miller. He called the agreement "almost miraculous."
Likewise, House Speaker Michael E. Busch said Ehrlich should be pleased with the limits on jury awards and expert witnesses contained in the final plan, because it includes many of the legal reforms Republicans have long championed.
Sen. Brian E. Frosh, a Montgomery County Democrat and key negotiator of the compromise, called the consensus package "a comprehensive approach to the problem - balanced, effective and fair." He said it would reduce future litigation costs more than the version offered last week by the governor.
Del. John Adams Hurson, the chairman of the House Health and Government Operations Committee said it included "major pieces of tort reform," and stronger patient safety and insurance reform measures than the governor's bill.
Key provisions of the bill include: