The Maryland House of Delegates, without a word of debate, decisively approved today seven bills sponsored by Gov. Harry Hughes designed to slow the growth of health care costs and purge the state's hospitals of expensive excess beds.
The package of health care cost-containment measures, which together constitute one of Hughes' highest legislative priorities this session, sailed through its final House test in a fashion that was a tribute to the political muscle of Speaker Benjamin L. Cardin (D-Baltimore).
Once the bills emerged 10 days ago from a House subcommittee that changed the tone if not the substance of many of the bills and killed one major concept outright, they were treated as sacrosanct despite predictions early in the session that the bills would generate controversy. Under persistent urging by Cardin, who this week personally lobbied every county delegation to support the bills, the House gave final approval by lopsided margins today. The closest vote on any of them was 103 to 23.
The House bill would impose an immediate moratorium on hospital construction projects until October, give the governor the authority to impose future bans on hospital expansions, give the state the authority to close hospitals if they do not voluntarily merge or consolidate, and require doctors to get state approval before buying equipment worth more than $600,000.
The health care package is encountering rougher sledding in the less-disciplined Senate, where the Finance Committee has altered significantly many of the recommended changes in the state's health care regulatory system that grew out of a gubernatorial commission's work last fall.
The Finance Committee, which is nearing final votes on the measures, is ready to strip or re-cast a number of the changes sought by Hughes. Like its counterpart in the House, the panel has rejected an overall revenue cap on Maryland's 59 hospitals, a provision that was touted early on by members of the task force as the most significant piece of the package and one desperately needed to convince Washington to continue the state's exemption from federal Medicare rates.
Cardin, for example, called the cap "the key bill of the session" in late December and said it represented the state's only chance of saving the Medicare exemption.
Other changes that the Finance Committee has informally agreed on would:
* Mandate six exemptions to an emergency measure placing an immediate moratorium on hospital construction projects through October. The House merely established a relatively weak mechanism under which state health regulators could approve the exemptions.
* Remove the governor's authority to impose future moratoriums as is proposed in the administration legislation.
"We see no need at this point to give the governor that additional power," said committee chairman Dennis Rasmussen (D-Baltimore County), arguing that if extraordinary circumstances later require another moratorium, the General Assembly could approve it then. The House has agreed to the moratorium authority, while limiting the length and circumstances under which the governor could exercise it.
* Give the state less rather than more original authority to regulate the purchase of expensive medical equipment by physicians. The Hughes administration had sought to force physicians to go through the state's certificate of need process as hospitals already do, but the Finance Committee is on the verge of removing medical equipment purchases from the certificate procedure altogether. In its place, the committee may set up a streamlined licensing procedure for both doctors and hospitals, and spot-check for abuses by regular audits. Health regulators could then rescind the licenses of any individuals or institutions that used the sophisticated equipment unnecessarily.
Andy Wigglesworth, the governor's aide who has been shepherding the measures through the legislature, said, "So far, I don't think they've done major damage. We'll be looking to fix some of this in conference committee."