Prescription for more than malpractice insurance

THE BALTIMORE SUN

A LOT OF Republican black ink splattered trial lawyers in the aftermath of Maryland's malpractice crisis. They're worse than "greedy": They're "rapacious," one inflamed legislator declared.

Luckily, Democrats thought the problem was a little more complex, needed more than demonizing.

The bill they passed over Gov. Robert L. Ehrlich Jr.'s opposition did a number of important things - all or most of which would have been delayed or killed by his veto.

The law's reduction of the insurance rate increase from 33 percent to 5 percent will go beyond financial relief. It should help rural areas of the state that are already underserved medically. If a doctor decides to retire or abandon a specialty, it's a bigger deal if he or she is one of only a few offering that service.

Radiologists who do mammograms get relief in the law from what are called discriminatory practices imposed on them by insurers.

Reimbursement for various services, unchanged for years, will be raised eventually by the law's 2 percent tax on HMOs.

These advances were in the comprehensive bill that Mr. Ehrlich refused to sign, though he had supported some of them. Republican legislators, many of whom represent medically underserved areas, should have voted for the bill. Under pressure to support their governor, they voted to sustain Mr. Ehrlich's veto.

A few political insiders suggest Mr. Ehrlich actually wanted to be overridden so he could roast Democrats for raising taxes. Probably a fallback option at best: It's seldom good to be the loser.

Mr. Ehrlich says he opposed the bill because he found its reform provisions weak and he opposed the legislature's decision to put the tax on HMOs. But other insurers already pay the tax, so why not the HMOs?

He called the tax regressive, meaning - if true - that it would fall most heavily on poor and low-income families. But fiscal analysts say HMO subscribers, most of whom are not poor, would pay only pennies more a month. Moreover, they say, corporations are likely to absorb the costs because they're in a competitive environment.

The General Assembly's bill addresses insurance practices that threaten to force doctors out of certain aspects of their work. Those who spent 30 percent of their time in nursing homes faced higher premiums, for example. If they work in the emergency rooms, where they may be more vulnerable to lawsuits, they face a substantial increase in insurance rates. Though Maryland has one of the best trauma services in the nation, insurance practices could leave the state with insufficient emergency room backups.

The bill's financial assistance to obstetricians addresses a kind of whiplash effect: Reimbursement for deliveries of babies and associated care have been static while the costs of providing those services are up. Medicaid reimbursement rates are a major problem because a third of births in Maryland involve Medicaid. Doctors have tried to account for the shortfall by taking more commercially insured patients. The 33 percent premium increase was the coup de grace.

Experts tell legislators the spiking rates represent a cyclical problem caused by a number of market forces. It's not just the lawyers. The cycle is playing out in other states. Maryland will emerge from the rate spike too - at which time, under this bill, the HMO tax revenue will go into the reimbursement rate structure. If the crisis wanes, Mr. Ehrlich may reason, pressure to get the greedy will slip away.

Some saw inconsistency in his opposition to the General Assembly bill. He called its premium relief a "superfund for lawyers." And yet his own bill called for a similar fund with a different revenue source.

There were many legislators who thought more reform would have been better, but on balance they supported the bill as a decent compromise. The entire veto exercise illustrates once again how the political dynamic has changed in Annapolis. It's the politics of demonization. It's party unity over problem-solving. Some Republican legislators have supported an HMO tax in the past and might have this time given what their constituents will get in return.

Must mean some in the GOP thought the bill would do some good. Too bad they had to oppose it.

C. Fraser Smith is news director for WYPR-FM. His column appears Sundays.

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