As the drummer for a band called the Kensington Jazz Commission, Steven B. Larsen is used to the spotlight.

But now, in his day job as Maryland's insurance commissioner, Larsen has never had the spotlight shine on him more brightly.

Larsen must decide whether it's in the public interest to allow the state's largest nonprofit health insurer, CareFirst BlueCross BlueShield, to be sold. The deal involves hundreds of millions of dollars and the health coverage of about 2 million Marylanders.

That makes Larsen the key figure at the center of Maryland's highest-profile insurance issue in years. He is to issue a ruling early next year on whether the deal should go forward and, if so, what conditions should be imposed.

A favorable recommendation might be the only thing that can persuade a skeptical legislature to allow the sale to go forward, political insiders say.

"Of all the insurance commissioners I've known in the last 30 years, he's the one who has the absolute confidence of the legislature," said Joseph A. Schwartz 3rd, who lobbies for the state medical society.

Del. Michael E. Busch, chairman of the House Economic Matters Committee, says that with CareFirst as a huge insurance issue, Larsen is "the right man at the right place at the right time."

Larsen's influence in Annapolis is such that "if he's not on your side, you're dead," said Elizabeth Sammis, senior director of government programs for health insurer Mid Atlantic Medical Services Inc. (MAMSI).

Larsen doesn't mind the CareFirst spotlight and relishes the complicated case.

"It's challenging, but that makes it fun," he said. "There are a lot of complex new issues. It's a big policy decision, which makes it interesting."

He finds, however, it is consuming a good chunk of his life.

Much of his spare time, Larsen said, is taken up with the activities of his sons, ages 7 and 8 - soccer, baseball, Cub Scouts, piano.

He jogs 3 miles twice a week, or "about as much as I have time for," he said.

Occasionally, he thinks about what he'd like to do when his term ends in June but has yet to come to any conclusions.

"I would never say never," he said, "but I'd say the odds are that I wouldn't ask the next governor for another term."

Larsen the musician had abandoned his drumming for several busy years but was thinking about getting back to it, when his wife gave him a drum set for his 40th birthday three years ago.

He soon began playing with others - all professional musicians - in his Kensington neighborhood in the Washington suburbs, leading to the formation of his band, called the Kensington Jazz Commission.

They play perhaps a dozen times a year, Larsen said, sometimes at community events, sometimes at private parties, sometimes at political functions. He finds the music offers a good psychological release and change of pace.

"It's such a divergence from our everyday government work," said Stephen M. Ports, another regulator/musician who has, on occasion, jammed with Larsen. "People see us as uptight government workers."

During the day, Ports is principal deputy director of the Health Services Cost Review Commission. But musically, he's a folk-rock keyboard player.

But government work can call the tune for regulator/musicians.

Ports recalls how this year on the last day of the legislative session, Larsen and his band were playing on the front porch of lobbyist Gary Alexander's office. "Mike Busch runs from the State House," calling Larsen to a final conference on an important bill.

"He finished the song," said Ports, "then turned to the band and said, 'I think we're done.' "

'A player'

Larsen became a player - politically - in Annapolis after nearly a decade as a legislative staff member and as a lobbyist for two governors.

Larsen, who grew up outside of Boston and graduated from Gettysburg College, came to Maryland government more or less by accident.

He decided on law school after college. "I knew I liked the law," he said. "I liked the intellectual rigor." While in law school at Rutgers University, he enrolled in a joint program that also gave him a master's degree in public policy.

He practiced with a large firm in New Jersey for a year and half until the middle of 1988 when his wife-to-be, Gail Robinson, was offered a job with a law firm in Washington. Before moving to the district, they spent eight weeks driving across country.

After looking for work unsuccessfully on Capitol Hill, Larsen spotted an advertisement from the Maryland legislature looking for bill drafters and applied. "It so happened my resume got there the day someone quit," Larsen recalled.

When he started work at the end of 1988, "I didn't know where the Eastern Shore was. I had never picked up the Maryland Code," Larsen said. He was assigned to the House Economic Matters Committee.

Lots of insurance bills came through the committee, and Larsen began to get intrigued with the subject.

"You get a lot of interesting facts, and you get a lot of interesting law. It's highly regulated. From a lawyer's point of view, it's fertile ground," he said. "Also, there's a human aspect to it. People made claims that were denied. The fact patterns involved people with problems you could identify with."

He also began developing a careful style of operation. Sammis, who worked with Larsen as a member of the legislative staff, said the young lawyer learned to follow a model set by Casper R. Taylor Jr., then Economic Matters chairman and now House speaker.

"Casper shaped all of us who worked in that committee," Sammis said. "Casper would come and pose the big questions, and we would set out to get information from other states and third parties. We would watch ... [Taylor] take the information and solve the problem."

After three legislative sessions, Larsen moved to the legislative office of Gov. William Donald Schaefer for two sessions, then did a brief turn inside the insurance industry, becoming a counsel at USF&G; Corp.

Larsen said he enjoyed the USF&G; experience and learned a lot. "[But] projects you work on in the public sector often are a little more interesting. Also, there's the sense that you're working toward - I don't know how to put it - some public good."

Glendening recruit

After Larsen had been at USF&G; for about a year and half, Gov. Parris N. Glendening, who was coming into office after the 1994 elections, recruited him to become the No. 2 person in his legislative office, with the prospect of moving up to No. 1.

When they discussed the legislative job, the governor recalled, Larsen told him, "My first love is insurance, and I'd like to be considered as insurance commissioner" if the job opened up.

Larsen did become the governor's chief legislative aide and then, in 1997, moved to his current job.

His style of operation, honed in his Annapolis years, moved with him.

Those who have worked with (and sometimes against) him describe him as "lawyerly," "thorough" and "methodical." He not only talks at length about the "savings clause" of the federal Employee Retirement Income Security Act, but also seems to enjoy doing so.

At the same time, he has an ability to explain abstruse issues in digestible chunks.

"He can articulate his position in terms everyone can understand," said Busch. "Sometimes regulators make your eyes glaze over."

Larsen views that as part of his work: "Understanding not just the legislative process, but understanding how to fashion and deliver a message - to the legislature, to the press, to the public, to the companies - is tremendously important for an insurance commissioner."

Larsen consults with the interest groups involved in an issue, said Schwartz, the lobbyist for the medical society. For example, Schwartz said, Larsen recently held a meeting to discuss when doctors can bill a patient for more than what an HMO pays, an issue likely to come up at the next session of the legislature.

"The HMOs, the doctors, the hospitals, we were all sitting at the table," Schwartz said. "It's very typical of the way he works."

Following a methodical process allows Larsen to build support, refine arguments and gauge opposition, said Sean Cavanaugh, now a New York-based consultant. "It slows him down, but he gets more done in the end."

As principal deputy director of the Health Services Cost Review Commission, Cavanaugh worked with Larsen on a number of related issues.

Larsen took office at a time of heavy consumer backlash against HMOs for allegedly denying needed care to their members.

'Starting to melt down'

"When I became commissioner, that's when things were really starting to melt down," Larsen said. "It was clear the department needed a focus on consumer protection."

In his first year, he helped steer through a bill - killed the previous year - that gave his department authority to judge disputes involving patients who were denied care by their HMOs. Larsen also reorganized the department to create a consumer complaint unit and stepped up "market conduct" reviews of insurers.

Last year, for example, he slapped Aetna, the largest U.S. health insurer, with a record $850,000 in fines for late and incorrect payments to physical therapists and podiatrists.

Glendening said he's received occasional "low-key" complaints from insurers that Larsen is too tough on them. For example, the governor said, "I did hear some grumbling from CareFirst" about Larsen's demands for detailed financial data and his questions about CareFirst's role as a nonprofit.

But when the legislature turned hostile toward CareFirst, the company's chief executive, William L. Jews, began to argue that, rather than kill the deal outright, lawmakers should allow Larsen to continue his review process.

"Bill's had his battles with Steve," said Busch. "Right now, Steve's their inner tube."

If Larsen were to approve the CareFirst deal, Sammis said, it might be the only thing that could persuade a highly skeptical legislature to allow the insurer to become a for-profit company.

"Would it rule the day? I don't know," she said. "But he's probably the only person who could make that case."

Said Glendening: "Right now, you have almost a stampede [to block the deal]. If someone of [Larsen's] stature were to say there were some purposes to allow it, at least you'd get a dialogue."

Besides his standing in Annapolis, Larsen generally gets approval from the various interest groups that often clash over health insurance issues.

"The HMO lobbyists like him and the provider lobbyists like him, so that should tell you something," said Schwartz.

Larsen is seen more critically by the property and casualty (known in the trade as "p and c") insurers, those that write auto and homeowners and commercial policies.

'Overly protective'

"He and his office tend to be overly protective of consumers, without giving adequate consideration to the needs of insurers to function in a difficult market," said John Andryszak, who lobbies for the American Insurance Association, a trade group of commercial insurers.

In this year's legislative session, for example, Larsen clashed with the p and c industry over "credit scoring," an industry practice of using consumers' credit rating in determining whether to issue a policy and how much to charge for it.

Although the industry argued that Larsen's approach would increase costs for many consumers, the lawmakers and governor eventually followed his advice and passed a measure severely limiting the practice.

Until a few months ago, Thomas L. Bromwell was chairman of the Senate Finance Committee, and worked closely with Larsen.

Now Bromwell heads a regulated insurer; he is the president and chief executive officer of the Injured Workers' Insurance Fund.

Joking about the different views of Larsen held by lawmakers and the property and casualty insurers, Bromwell said, "When I was a senator, he was a great guy."