- The Washington Times - Monday, December 27, 2004

ANNAPOLIS — Significant disagreements over medical malpractice insurance reform continued to divide Gov. Robert L. Ehrlich Jr. and key legislators yesterday as they prepared for a special session of the General Assembly called by the governor to deal with what he calls a crisis that threatens health care for all Marylanders.

Mr. Ehrlich was subjected to skeptical questioning from some lawmakers when he appeared at Senate and House committee hearings seeking support for his bill to rein in major increases in malpractice insurance premiums.

Democratic leaders plan to introduce their own bills when the House of Delegates and Senate meet today. Although all three plans have areas of agreement, they also have differences that House Speaker Michael E. Busch, Anne Arundel Democrat, and Senate President Thomas V. Mike Miller Jr., Prince George’s Democrat, said will be difficult to resolve.

Mr. Ehrlich, a Republican, told senators that his bill is a good package that will help reduce the cost of malpractice lawsuits while protecting the rights of patients who are victimized by bad doctors.

“It is balanced. It is not left or right,” he said.

Mr. Ehrlich said Dec. 17 when he issued a proclamation for the special session that he, Mr. Busch and Mr. Miller were in substantial agreement on what should be in the bill. He said the legislature should be able to approve his bill quickly, getting the contentious issue out of the way before the 2005 legislative session begins Jan. 12.

But the three leaders have given differing views on their agreements, and Mr. Miller and Mr. Busch question the need for calling lawmakers back to Annapolis at a cost of about $45,000 a day just two weeks before their regular session opens.

“This whole thing is a mess. Being here is a mess,” Mr. Busch said. He said legislators are being asked to approve the most comprehensive change in health care policy in many years, even though they are just getting their first look at the legislation proposed by the governor.

Doctors were hit with average premium increases of 28 percent this year and 33 percent for 2005, and white-coated physicians showed up for the hearing to press their demands for quick action to hold the line on rate increases that they say are forcing them to curtail their practices, move out of state or retire early.

Dr. John Caruso, a neurological surgeon from Hagerstown, said he will have to cut back on his practice unless something is done to curtail big increases in his insurance premiums, and warned that young people will not be entering the medical field unless something is done to increase reimbursements and reduce rates.

“I have four kids, and I wouldn’t let a single one of them become a doctor,” Dr. Caruso said.

The major dispute between the governor and legislative leaders remains how to pay for a fund that will be created in all three bills to increase payments to doctors for some Medicaid services and temporarily freeze insurance premiums.

In his testimony at the Senate hearing, Mr. Ehrlich repeated his threat to veto the health care legislation if Democratic leaders persist in their plan to raise the money by requiring health maintenance organizations (HMOs) to pay the 2 percent tax on premiums that is paid by all other insurers.

Passage of a tax “would be bad policy and, parenthetically, bad politics,” Mr. Ehrlich said. “We don’t need the dollars.” He is proposing using $30 million from existing tax sources instead of making HMOs pay the premium tax to hold the line on premium increases. He also proposes to increase Medicaid payments by $12 million a year.

But Democratic senators said the governor will have to cut spending by $400 million to balance the budget, and the state can’t afford an additional $30 million in cuts.

Mr. Busch and Mr. Miller plan to continue their push for the premium tax, which they said would provide equal treatment for all insurance companies.

“There’s going to be an HMO tax in any bill that passes the House and Senate,” Mr. Miller said. “I’m confident that reason will prevail, and [Mr. Ehrlich] will recognize that we need these revenues.

“We’re not going to write bad checks like they do on Capitol Hill. This is the only fiscally responsible thing to do.”

Mr. Busch said the House version of the legislation will be close to Mr. Ehrlich’s, except for the HMO tax. The differences are more substantial between the governor’s bill and the proposal in the Senate, where there is more resistance to restricting the ability of patients to sue doctors.

On the eve of the special session, there was no guarantee that a bill would be approved by the legislature or that Mr. Ehrlich would sign it, especially if it included an HMO tax.

Although Mr. Busch questioned the need for a special session, he said the legislature “has to make a good-faith effort” to pass a bill that will provide relief from premium increases.

“These are difficult circumstances. We’ll do the best we can,” he said.

Mr. Miller said it would take at least three days to wrap up the special session. Mr. Busch held out hope that work could be completed more quickly.

He said if the House doesn’t finish work on its bill today, “it becomes more and more likely that it will unravel.”

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