ANNAPOLIS Gov. Parris N. Glendening and GOP nominee Ellen R. Sauerbrey agree that Maryland needs affordable, quality health care.
But they differ on the specifics: if residents should have the right to sue an HMO; if state agencies overseeing health care should be consolidated; and if restrictions should be loosened on individual savings accounts for medical care.
Glendening has supported efforts to set standards for health insurers, and he recently endorsed a bill that would let some Marylanders sue their HMOs for denying needed care.
Sauerbrey says “right-to-sue” laws and other state mandates force insurers to raise prices and cut services; she promotes a freer market and fewer restrictions on tax-free medical savings accounts.
Affordable health care is a significant issue in Maryland, where more than 700,000 people – about 14 percent of the residents – don’t have medical insurance.
“People are afraid,” said Joseph Morton, the treasurer of the nonprofit Maryland Patient Advocacy Group. “This system is imploding.”
The debate often centers on managed care: HMOs enjoy a large share of the state’s health care market, with nearly 37 percent of Marylanders enrolled in such programs.
HMOs and other managed care companies lump hospitals, doctors and administrators under a single umbrella. By sharing resources, the company cuts its costs.
And Maryland has saved millions of dollars since it began funneling Medicaid and other health-aid recipients into managed care in 1996, said Joseph Millstone, director of the Medical Care Policy Administration, which oversees the state’s Medicaid programs.
One of the biggest concerns about managed care is accountability. Patients have not been able to sue HMO medical directors, the people who approve or deny procedures, for refusing needed care.
The General Assembly this year established an appeals process before the state’s insurance commissioner. But Glendening has thrown his weight behind a proposal that would allow some patients to challenge HMOs in court.
“We have to put patients’ rights above corporate profits,” the Democratic governor said. “Being accountable to patients is good for managed care and good for consumers of health care.”
Sauerbrey says she wants to hold medical directors responsible for their decisions, but she fears frivolous lawsuits would make health care more expensive.
“If this type of system were brought to Maryland, doctors would end up paying huge liability claims,” said Sauerbrey spokeswoman Carol Hirschburg. “HMOs would pass that onto the consumer. It would put health insurance out of the reach of those who can now afford it.”
Even if the right-to-sue bill passed, it would only cover about half of Marylanders enrolled in HMOs, said state Sen. Paula C. Hollinger, D-Pikesville, who has supported similar measures.
Why? Because a 1974 federal law prevents the 40 million Americans covered by “third-party administrators” usually HMOs overseeing corporate health plans – from collecting damages for refused care.
Both candidates have raised concerns about the large number of Marylanders who can’t afford health insurance.
“The biggest uninsurance is among working families who work for small firms,” said Robert Moffit, a director at the Heritage Foundation, a conservative think tank. “They don’t have access to group insurance and individual plans are prohibitively expensive.”
To help these Marylanders, Sauerbrey has proposed lifting the state’s deposit requirements on medical savings accounts, designed to help self-employed workers and small-business men put away money for health care. The federal government sets the annual amount that can be saved tax free.
Maryland requires that about 33 percent of that amount come from monthly deposits, a requirement Sauerbrey would eliminate.
Glendening says reliance on these plans isn’t the answer: Many families can’t afford to save enough in individual plans.
“When you’re a working family and you’re struggling from one paycheck to the next, you do not have the money to set aside in these medical accounts,” he said. “Most of them are saying, `What can I afford this week?’ ”
Sauerbrey also has proposed consolidating some of the programs and staff at the five regulatory arms overseeing health care: the Department of Health and Mental Hygiene, the Health Care Access and Cost Commission, the Health Resources Planning Commission, the Health Services Cost Review Commission and the Maryland Insurance Administration, plus an assortment of advisory boards and panels.
“People in these agencies must start looking beyond their own turf at the bigger picture,” said Ronald Dworkin, Sauerbrey’s health policy advisor.
Glendening spokesmen declined to comment about the efficiency of Maryland’s regulatory arms. But, said Glendening spokesman Len Foxwell, “If the issue is whether or not consumer access and consumer options have improved in Maryland, the Glendening-Townsend record speaks for itself.”
Sauerbrey says she does not plan to tear down Glendening’s programs, just remodel some of them. “All of this is about options,” Dworkin said. “Ellen doesn’t want people being forced into an HMO if they don’t want it.”
But Glendening and Millstone say managed care companies are the best at preventing illness. “Managed care organizations basically make money by keeping people healthy,” Millstone said. “You buy prevention, instead of waiting until you get sick and then getting treatment.” -30-