A package of bills designed to reduce the cost of health care in Maryland -- the centerpiece of Gov. Harry Hughes' legislative program -- appears to be in serious trouble in the General Assembly, where a key Senate committee is poised to kill or dilute much of the legislation.
The mounting resistance to several of the health care measures comes despite an intensive lobbying effort by the Hughes administration, including a personal appeal by the governor to 50 hospital trustees in two meetings over the last 10 days.
Senate President Melvin A. Steinberg (D-Baltimore County) said yesterday he opposes the most important of the administration's bills, a measure that would set an overall revenue cap for the state's 59 hospitals.
His support also is waning, he said, for a bill that would impose an emergency moratorium on hospital expansions until October. He wants the bill amended to exempt some hospitals in rural areas.
Senate Finance Committee Chairman Dennis F. Rasmussen (D-Baltimore County), who has been holding hearings on the legislation this week, characterized the health care initiatives today as "ailing."
"The committee just doesn't believe there is adequate justification to support many of the proposals at this time," Rasmussen said. "We would like to do something meaningful to control health care costs, but Maryland is doing a fairly good job already compared to the nation."
In addition to rejecting the revenue cap and amending the moratorium bill, Rasmussen predicted that his committee would kill or substantially alter other bills that would give the governor the permanent authority to declare future moratoriums on hospital projects; regulate health insurance plans, and require state approval for doctors to buy expensive equipment.
Steinberg said one key legislative concern is that the bills delegate excessively broad authority to the state health bureaucracy.
Moreover, he said, the bills deal more with concepts than specifics. The Hughes administration had only a few weeks to shape the bills based on recommendations of a gubernatorial task force, which included Steinberg and other legislators as well as representatives of the health industry and consumers.
"I think a number of these issues will be sent to summer study," Steinberg said.
Hughes aide Andy Wigglesworth, the administration's chief spokesman before House and Senate committees, acknowledged today that the bills are encountering heavy weather in the Senate, but predicted the legislation would emerge relatively unscathed.
"There are definitely serious concerns being expressed by the senators, and rightfully so," Wigglesworth said. "They've been hit with a comprehensive package on a complex issue. They have to learn the issues. It's going to work out."
Though opposition is less intense in the House, where a 10-member subcommittee of the Environmental Matters Committee began reviewing the legislation this week, the revenue cap bill is regarded as moribund there as well.
Environmental Matters Committee Chairman Larry Young (D-Baltimore), though more favorable toward the health care initiatives than his Senate counterpart, nonetheless is opposed to yet another key component of the administration package, which would give the state secretary of health the authority to close hospitals.
"I'm trying to find language that would guarantee that is a last resort," said Young, whose legislative district includes several of the state's most underused hospitals.
Other members of the Finance Committee have been singularly unimpressed with the administration's presentation of the bills, despite an array of witnesses that has included the secretary of health, the chairman of the task force and the directors of the two agencies that regulate hospitals.
Those spokesmen have failed to convince some senators that the legislation is critical to preserving Maryland's exemption from federal Medicare rates, which serves as the underpinning for the state's pioneering rate-setting system.
Saving that exemption, said Rasmussen, "will be a political decision by federal authorities and will have very little to do with whether the legislature adopts this package."
"Generally speaking the health department hasn't done its homework," said Sen. Howard A. Denis (R-Montgomery). "We're getting charts and rhetoric but no substance. They haven't made their case."
Though health industry lobbyists have been fighting some of the legislation for weeks, legislators said that has had less to do with their resistance to the package than the administration's failure to document its case.
Indeed, James J. Doyle Jr., who represents the Maryland Hospitals Association, said, "I haven't had to do a lot of lobbying."