ANNAPOLIS – Both houses of Maryland’s General Assembly have been busy this session telling health insurers how to run their businesses.
Lawmakers have introduced bills that would force health maintenance organizations to cover the cost of everything from prescription contraceptives to wigs for chemotherapy patients.
Such proposals are nothing new to industry representatives. Debra Garner-Williams, a spokeswoman for the Maryland Association of HMOs, said Maryland mandates more specific health care coverage than any state in the nation.
D. Robert Enten, a lobbyist for the Maryland Association of HMOS, said that while the mandates benefit a small number of patients, they drive up the costs for all HMO customers.
“Decisions are being made on medicine and science with very little information as to what the cost will be, and we just can’t support that,” Enten said.
But Sen. Arthur Dorman, D-Prince George’s, said HMOs are risking their own bottom lines as well as their clients’ health by opposing what he sees as common-sense preventive measures.
By his own estimation, Dorman has introduced nearly 90 such bills in his 33-year legislative career, a record that he said has earned him the nickname, “Mr. Mandate.”
This year alone, Dorman is sponsoring bills that would mandate coverage for prescription contraceptives and breast prostheses for women who have had mastectomies. He has also filed a bill that would make it easier for clients of HMOs to get dermatological care.
He said the HMOs could benefit from such mandates, which would allow customers to choose options that are preventive or cheaper in the long run.
But even Dorman said he has doubts about a bill that would require insurers to pay for cancer patients’ wigs, or hair prostheses as they are called in the bill.
“How do you draw the line?” Dorman asked.
That brought a testy response from supporters of the wig bill, which is sponsored by Del. Mary Conroy, D-Prince George’s, and Del. Mary Ann Love, D-Anne Arundel. Supporters noted that the bill limits coverage to wigs prescribed by oncologists and it caps the payment for the devices at $300.
“It’s hard enough to undergo the trauma of chemotherapy,” without being forced to go bald in public, said Conroy’s aide, Pat Bruce.
A wig can keep a cancer patient from sinking into depression, she said, noting that insurers will pay to counsel cancer victims but not for the wigs that might prevent the need for therapy.
While some of the bills may seem frivolous on the surface, they engender serious debate.
Planned Parenthood and the National Organization for Women supported the contraception coverage at Thursday’s Senate Finance Committee hearing, for example, while the Maryland Catholic Conference was on hand to oppose it.
To some, the issues are more personal than ideological.
Kelly Kwedar, 21, a senior at the University of Maryland Baltimore County, said her insurer recently boosted the co-pay for her birth control pills from $6 a month to $25. She could not afford that higher cost, she said, and has turned to Planned Parenthood, where she pays $10 a month.
“If they don’t want us to have abortions, then they should provide us with contraception,” said Kwedar.
Enten said it’s hard to argue against emotional appeals from ailing patients. But somebody still has to pay for the coverage they are demanding, he said.
Industry officials are pushing for a bill sponsored by Sen. Thomas Bromwell, D-Baltimore County, that would set up an panel of insurance and medical experts to review mandated coverage proposals in the future.
That would take lawmakers out of the process and help prevent what Enten called “legislating by body part.”