Maryland officials are discovering what President Clinton and Congress are about to learn: that it is a tortuous task to develop a comprehensive health care plan that is both affordable and free of political controversy.
The state's health care reform effort, though modest in comparison with Mr. Clinton's, became law earlier this year and is nearing completion of its first phase: the development of a minimum package of health benefits that insurers must offer small companies beginning next summer.
The law was designed to make insurance more affordable for small businesses, where many of Maryland's more than 600,000 uninsured hold jobs. But the task force charged with developing the plan is finding that the cost of the benefits it would like to offer is too high.
That means that before it recommends a final plan to the state's new Health Care Access and Cost Commission by next week's deadline, the task force will have to trim back its proposal.
Apart from the cost issues, one proposed benefit -- insurance cover age for abortions -- has become the most troubling, igniting anew the fight between abortion opponents and those who support abortion rights for women.
The controversy over that provision is threatening to overshadow the many other difficult decisions the task force has made -- or is about to make -- that will affect hospitalization, psychiatric services, home health care, laboratory work, prescription drugs and other insurance benefits that thousands of Maryland workers may soon depend on.
Last Saturday, the Standard Benefits Task Force preliminarily approved a long list of benefits, including a 7-2 vote in favor of covering "all medically necessary abortions." Medical necessity would be determined solely by the patient and her health care provider.
But at a public hearing tonight, groups opposed to abortions intend to ask the task force to repeal that provision. Others will argue that companies should be given the option of purchasing abortion coverage only as an add-on, or "rider," to the standard insurance policy.
"The Catholic community doesn't think abortion coverage should considered as health care," said J. Kevin Appleby, associate director of social concerns for the Maryland Catholic Conference. "We shouldn't force employers who are opposed to abortion to make a choice of either buying into this package or not covering their employees. Also, employees who object to this on moral grounds shouldn't be subjected to this."
Bebe Verdery, director of public affairs for Planned Parenthood of Maryland, said her organization strongly opposes any effort to exclude abortion coverage from the basic health care package. Most insurance policies cover the costs of abortions, she said.
"For them to allow it to be put in as a rider . . . allows employers to determine if the women in their firms should get abortions," she said. "We haven't wanted legislators or politicians to make this decision, and we don't want employers to make this decision either."
Another option is to change the wording that describes the benefit, possibly modeling it after the Clinton plan, which covers abortions but never mentions the word. The president's plan merely refers to "family planning services and services for pregnant women," although administration officials have orally assured abortion rights groups that abortions would be covered.
The Standard Benefits Task Force is expected to make its final decisions this week and report its recommendations to the full seven-member health care commission by Nov. 4. Ultimately, the commission must approve the final ingredients of the standard benefits package, and insurers must begin offering the new policies July 1 to all Maryland companies that employ between two and 50 workers.
A major goal of the Maryland plan is to provide coverage for small companies that now cannot afford insurance for their workers. The new law, however, says the value of the basic policies that must be offered cannot exceed 12 percent of wages.
Based on projected 1994 wages, the task force has concluded that the value of benefits in the policies cannot add up to more than $3,519. But because health insurance premiums are expected to rise faster than wages in coming years, the task force set a goal of keeping the value of the policies below $3,034.