The state Senate overwhelmingly approved today Gov. Harry Hughes' initiatives to restrain medical care cost increases in Maryland, but the package of bills differs radically from the governor's proposals and the measures passed by the House of Delegates a week ago.
The gulf separating the House and Senate on four of the seven bills in the health care package will be tackled by a conference committee next week, a task that Senate Finance Committee Chairman Dennis Rasmussen (D-Baltimore County) predicted "will be as difficult as going through the original bills."
"At this point there are major philosophical differences between the two versions," said Rasmussen.
Today's votes in the Senate, which approved five of the bills unanimously, marked one of the final steps in a process begun in August by a commission appointed by Hughes. That panel explored ways to trim health care costs and dispose of an estimated 4,100 excess hospital beds in the state.
The commission's nearly three dozen recommendations were distilled into the seven bills intended to give state health regulators, who already enjoy considerable power, more authority over hospitals and physicians.
Included in the package are bills that would: immediately freeze all hospital building projects until October empower the governor to impose future construction moratoriums; cap overall hospital revenues; regulate the purchase of expensive technology by physicians; encourage and, if necessary, force hospitals to merge and even close; regulate health insurance plans that direct consumers to low-cost hospitals; and require hospitals to set up "utilization review" programs to cut down on unnecessary medical procedures.
House and Senate committees spent the past month dissecting the bills, with the House staying considerably closer to the Hughes' administration's original proposal.
The bills passed by the Senate today differ in four major respects from the companion measures adopted by the House:
* The Senate mandated six exemptions to the proposed emergency moratorium on hospital building projects. The exemptions would allow some hospitals to continue the process of qualifying for certificates of need from state officials for building projects while the ban is in effect through October. The House approved a relatively weak mechanism under which state regulators could authorize the exemptions if they choose to.
* The governor's permanent authority to impose construction moratoriums in the future was stripped from the Senate version, while it was left in the House bill, in a somewhat restricted form.
* The Senate bill would not require either doctors or hospitals to obtain certificates of need for expensive equipment. Currently only hospitals are required to go through that process when purchasing the new equipment. Rather, the Senate bill sets up a new, streamlined licensing procedure under which the state would audit the use of such equipment periodically and would have the power to take licenses away from any provider who uses such equipment unnecessarily. The House version includes many of the governor's proposals in this area.
* The Senate has stripped from the health insurance bill provisions to protect teaching and inner-city hospitals from being excluded from insurance plans that offer reduced rates if beneficiaries use low-cost hospitals. The House version retains that concept, which is a major concern of House Speaker Benjamin L. Cardin (D-Baltimore).
In addition, both the House and the Senate summarily rejected the proposed revenue cap on the state's 59 hospitals, which had been touted by Cardin and the administration as a key component of the package.
House and administration officials are expected to make a spirited effort to get the confernce committee next week to approve bills close to the governor's original proposals. Asked today to predict the outcome, Cardin said, "If reason and logic prevail, the House will win."