Measure to broaden access to health insurance easily passes House panel Limits on doctors' fees up for discussion STATE HOUSE REPORT


A House committee voted overwhelmingly yesterday for legislation designed to make health insurance more available to Marylanders. And it signaled that it might consider limits on how much doctors can charge for their services to make health care more affordable as well.

The Economics Matters Committee's 25-1 vote sends House Bill 1359 to the full House for debate this week and a possible final vote next week. Chairman Casper R. Taylor, an Allegany County Democrat, said he hopes to get the complicated legislation to the Senate as fast as possible so both houses will have time to meld competing approaches.

The House measure is an attempt to make health insurance available to businesses that employ two to 50 workers, firms which now can find insurance either too expensive or unavailable at any price.

Mr. Taylor acknowledged that for some people who are already insured, the result of such a change could actually be higher insurance premiums -- a trade-off his committee is willing to make to broaden access to health insurance to the estimated 570,000 Marylanders now without it.

The bill also would reform the way health insurance is offered to all other Marylanders, but only if enough state residents agreed to participate in such a program. It would require insurers to set hTC premiums by spreading their risk among all whom they insure (a method called community rating) rather than basing premiums on how often people were sick or injured in the past.

One probable effect of such a law would be to decrease the number of small insurance companies that offer policies in the state. That, in turn, would give the remaining large insurers more clout to encourage doctors and health care providers to control costs, backers of the bill say.

Most large employers, however, are self-insured and under federal law cannot be required to join such a program. They probably would be lured into joining only if they believed their insurance costs would actually go down.

Finally, the bill would set up a seven-member Medical Care Data Review Commission to develop a comprehensive standard benefits package that all health insurers in the state would be required to offer. The panel also would collect and analyze data on doctors' fees, procedures and medical equipment.

Though proponents say the commission would be the first step toward collecting information that could help bring health costs down, Mr. Taylor conceded the bill may have to go further if it is to appease the Senate -- or the public.

"I know that the biggest criticism of the bill is, 'Where's the beef? Where is the cost containment?'" he said. He then proposed an amendment that would have given the new commission authority to set a fee schedule for physicians and prohibit them from charging above whatever limits the commission set.

Almost as quickly, he withdrew it, explaining afterward that he just wanted to put everyone on notice that he and his committee are actively considering such cost control measures.

"If we don't find a way to prevent more and more dollars from getting into the system, we won't reform anything," he said.

The bill, backed by House leaders, is expected to clear the House, but its future in the Senate is uncertain. Sen. Thomas P. O'Reilly, the Prince George's County Democrat who chairs the Finance Committee, is developing his own health care bill which is expected to incorporate strong cost containment measures.

The difficulty both committees face in enacting such controls, however, was evident yesterday when the state medical society and other physicians testified in force before the Finance Committee against a Senate proposal to limit doctors' fees.

"Fees are not known to be a problem in Maryland," said Dr. Joseph Fastow, an emergency room physician from Calvert Memorial Hospital and spokesman for the Medical and Chirurgical Faculty of Maryland, the state medical society.

Former Gov. Marvin Mandel, the medical society's lobbyist, told the committee that if there is any evidence of fee gouging, the society's disciplinary board wants to know about it.

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