On the Record Sauerbrey and Glendening are running against each other for a second time. (File Photo)

By Avram Goldstein and Scott Wilson
Washington Post Staff Writers
Saturday, October 10, 1998; Page B01

Maryland Republican gubernatorial candidate Ellen R. Sauerbrey is quietly promoting a collection of free-market health policies that have brought her a spurt of campaign contributions from doctors while other health care interests are lining up solidly behind her Democratic opponent, Gov. Parris N. Glendening, who leans more toward a managed-care approach.

At stake for Maryland residents is how they choose health care and the price they pay for it. Although the two candidates agree on many health care issues, Sauerbrey generally favors an approach in which patients would be able to shop around for doctors but would probably pay higher medical bills as a result. Glendening favors insuring more people through managed care, a change that in some cases could provide them with fewer choices while saving money for taxpayers.

Despite the importance of the dispute, neither candidate has spent much time describing these differences publicly. Instead, they are spelling out their plans in mostly private meetings with potential contributors from Maryland's fractious, $15 billion-a-year health care industry – one of the state's most lucrative sources for campaign donations.

In private fund-raisers and in small gatherings, Sauerbrey is promising to give physicians more power to challenge HMO decisions and possibly more pay for treating poor patients. The proposals, drafted by a kitchen cabinet of conservative doctors, would probably give medical professionals, rather than health plans, more authority over patient care but also raise medical costs and run counter to a decade of industry trends.

Glendening, meanwhile, championed a "patient's bill of rights" in July that would require state HMOs to pay for necessary prescription drugs and give clients more freedom in picking doctors, among other measures to make health plans more responsive. Since then, however, he has talked little about it as he has collected at least $197,000 in recent months from health care interests, according to a Washington Post analysis of the campaigns' largest contributions.

Contributions to both candidates come from across the spectrum of the health industry, including doctors who believe the governor's gun-control and anti-smoking policies have been beneficial to public health. In sharp contrast to Sauerbrey, Glendening has received more than $30,000 in recent months from HMOs, hospitals and nursing homes that could be hurt financially by some of her proposals.

Sauerbrey has collected a fraction of that amount from the same industry groups, according to a review of her largest contributors. But she has collected at least $44,000 from doctors and dentists, much of it during private fund-raisers during which she has pitched specific ideas to give them more power over HMOs.

"She has promised that she will be good for us," said Habib Bhutta, a Laurel general surgeon who has given more than $3,000 to Sauerbrey.

Ronald Dworkin, a Baltimore anesthesiologist, heads the Sauerbrey campaign's health care task force and has held two fund-raisers on her behalf. During those events, Dworkin and other doctors said, Sauerbrey promised to make HMO medical directors who wrongly deny care subject to disciplinary sanctions by the state medical licensing board. Such decisions are now regulated by the insurance commissioner, and HMOs vigorously oppose having doctors review their decisions on whether to pay for specific patient care.

"It says that if you make a medical decision, then you are held to a medical standard," said Andrew P. Harris, a Baltimore doctor who has given $1,100 to Sauerbrey and who is running for state Senate. "I know she has addressed groups and fund-raisers that include physicians and has received a warm reception each time."

Dworkin said Sauerbrey's other proposals, which he has been instrumental in drafting, include granting doctors the right to appeal their removal from HMO plans. Current rules permit HMOs to dismiss doctors from their roster of participating physicians for any reason, depriving expelled physicians of significant income.

He said Sauerbrey also has vowed to fix the state's cumbersome Medicaid reimbursement process and possibly raise the fees doctors can charge for treating more than 100,000 Medicaid recipients who are not enrolled in HMOs. About 300,000 Medicaid recipients are in HMOs.

"There's overpayments, underpayments, and physicians in particular are not being paid properly," Dworkin said. "She's very much into raising the reimbursement rate . . . but she wants to know what's going on."

With the exception of public health initiatives and Glendening's clear support for requiring HMOs to pay more benefits for specific illnesses, the two candidates have relatively few clear-cut differences on health issues. Both want some deregulation of hospitals and have expressed support for patients' rights measures for HMO members. In some cases, Sauerbrey is demanding increases in funding for programs that already are being expanded.

One key difference comes in the area of litigation. Both Sauerbrey and Glendening favor making HMO medical directors accountable to the agency that disciplines doctors. But Glendening would subject those doctors to civil lawsuits for their errors; Sauerbrey is opposed to opening the door to more lawsuits.

"I think that health care for the next administration is going to be one of the most important issues that has to be addressed," Sauerbrey said in an interview yesterday. "It's not an issue I have tried to make headlines on. I have been quietly working."

Sauerbrey has portrayed Glendening as friendly toward the managed-care industry, which she says she fears has grown too powerful. Maryland has one of the highest rates of HMO membership in the nation, and last year the state assigned more than 300,000 Medicaid recipients to HMOs as a way to save money and improve care.

Health plans are underpaying doctors and hospitals and harming patients by denying needed services, and that leads legislators to pass laws mandating specific medical benefits, all of which raise the cost of insurance beyond the means of more and more Marylanders, Sauerbrey said.

The governor dismissed Sauerbrey's objection to mandates.

"You can't say that you're against HMOs and then don't support the mandates that protect patients," Glendening said in an interview yesterday. "She's talking out of both sides of her mouth."

Glendening said he is committed to proposing legislation next year requiring HMOs to cover as much as 48 hours of hospitalization after a patient has undergone a mastectomy or testicular cancer surgery. HMOs should not be allowed to treat both surgeries as outpatient procedures, he said.

Maryland health officials are working on a plan to extend managed-care controls to long-term care programs for Medicaid recipients. Sauerbrey says senior citizens feel threatened by the prospect of such organizations determining when and whether they are placed in nursing homes.

In meetings with senior citizens, Sauerbrey said, she has promoted more long-term care options for the elderly. She wants Medicaid to devote more money to sending health professionals to elderly Medicaid recipients' homes as a way to delay sending them to a nursing home, or to expand the availability of assisted-living facilities that would be covered by Medicaid.

Maryland Medicaid officials yesterday said they already are working on plans to regulate the burgeoning assisted-living industry, which would then enable Medicaid to cover it as an alternative to nursing home care for patients who are not too frail, and to expand services to elderly recipients who need only housekeeping assistance to remain independent.

Metro Resource Directors Bridget Roeber and Margot Williams contributed to this report.