Legislature urged to act on health care before Congress does Control of reform could be at stake


The General Assembly's two presiding officers and a top Schaefer administration official yesterday urged a Senate committee to enact health care reform this legislative session, saying Maryland should not wait for Washington to act.

Senate President Thomas V. Mike Miller Jr., D-Prince George's, said he recently attended a meeting at the White House where President Clinton urged state legislators to move forward with their own health reform initiatives.

House Speaker R. Clayton Mitchell Jr., D-Kent, said the bill the House passed last week, which is designed to make health insurance more available and affordable for many state residents, "would be a great economic tool to bring businesses into Maryland."

And Nelson J. Sabatini, the state health secretary, told the Senate Finance Committee that Maryland has "a window of opportunity this year to do something."

The timing is right, he said, because the legislative session is drawing to a close and because whatever the state does is likely to mesh with what is being considered by the Clinton administration and Congress. If it doesn't, he said, the state would probably be "grandfathered in" when the federal government acts.

"You have a much better chance of us being masters of our own destiny if we go out and do it now," Mr. Sabatini said.

The Finance Committee focused most of its attention yesterday on two approaches.

One, pushed by Sens. American Joe Miedusiewski, D-Baltimore, and Paula C. Hollinger, D-Baltimore County, would use the 250,000 people covered under the state government's health insurance program -- most of them state workers and their families -- as a starting point for creating a program of coverage that would spread the insurance risk among as many people as possible.

The other was House Bill 1359, the major House health insurance reform initiative. That bill -- like the Senate proposals -- embraces a concept of pricing health insurance known as "community rating," or spreading the risk.

The House bill would begin by requiring insurers to offer policies to companies employing two to 50 workers, small businesses which now often cannot get or cannot afford health insurance for their employees.

For those policies, the bill would prohibit insurers from setting premiums based on how often the employees have been sick or injured in the past. It also would gradually eliminate the practice of denying insurance to people because of pre-existing medical conditions, such as diabetes or cancer. The policies would have to be issued to anyone who wants them and renewed upon demand.

Coverage under those terms would be available to nearly all Marylanders if more than a third of those under 65 who have health insurance agree to participate.

To control costs, the bill would permit limits on physician fees and insurance company profits.

Unmentioned through hours of debate on these proposals, however, was still another approach that is being quietly developed by Finance Committee Chairman Thomas P. O'Reilly, Prince George's. So secretive has Mr. O'Reilly been that his proposal has been jokingly dubbed the "Stealth Health" bill.

Given Mr. O'Reilly's position as committee chairman, his plan is likely to be the foundation for whatever final bill the Senate approves.

In an interview, Mr. O'Reilly said his proposal likely will contain these broad provisions:

* A much heavier emphasis on moving employees of smaller companies into health maintenance organizations. Mr. O'Reilly, an unabashed fan of the "managed care" approach to medicine, believes HMOs provide cradle-to-grave care in the most cost-effective way.

Instead of focusing on companies employing up to 50 workers, Mr. O'Reilly would attempt to force companies with as many as 250 employees to use HMOs rather than self-insurance.

His bill would set up an HMO commission -- one of at least three separate commissions his bill would create -- to develop a benefit plan, hire a plan administrator, divide the state into four regions and offer consumers both cost and quality-of-care comparisons for competing HMOs.

* Mr. O'Reilly also would set up a separate health care commission to adopt a global budget for health care costs in the state. Much like House Bill 1359 and the Miedusiewski-Hollinger proposal, the plan would require the commission to collect data on medical costs.

Proponents say only by collecting information on how much health care providers charge and what services they perform can costs ultimately be controlled.

Under Mr. O'Reilly's plan, health care providers would be required to keep statistics, but to turn them over to the commission only when asked. A cap on doctors' fees would be possible, but only after other efforts have failed.

* In an effort to control costs, Mr. O'Reilly's plan also would create a "practice protocols" commission in which doctors would develop guidelines for what medical procedures their profession should follow.

The idea is that by establishing uniform practice protocols, excessive, unnecessary or costly procedures could be avoided, medical malpractice costs reduced, and appropriate clinical care assured.

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