Donoghue health care bill passes crucial test

February 24, 1998|By GUY FLETCHER

Donoghue health care bill passes crucial test

ANNAPOLIS - Del. John P. Donoghue's legislation aimed at easing the burden on health care customers passed a critical test Tuesday when it was tentatively approved in the Maryland House of Delegates.

But some lawmakers raised questions about the bill's effectiveness and suggested it could expose the state to possible lawsuits.

The legislation would require health care insurers and health maintenance organizations to establish internal grievance procedures for members and would authorize the Maryland Insurance Administration to investigate complaints if a carrier refuses to pay for treatment.

The administration could then make decisions on a question of medical necessity after consulting health care professionals.

The bill was approved by voice vote Tuesday, setting the stage for a final vote in the House of Delegates, possibly later this week. If approved, the bill would go to the Senate.


Donoghue, D-Washington, said the legislation is a response to complaints he has heard from people who were denied coverage for bone-marrow transplants, cancer treatments and other medical procedures.

"Right now, if you get an adverse decision, they call it a day," he said.

Del. Michael E. Busch, D-Anne Arundel, chairman of the House Economic Matters Committee, said, "I believe it's good legislation. I believe it reflects the best interests of the consumers of the state of Maryland."

Del. Leon Billings, D-Montgomery, argued that the legislation could cause further anguish for patients if they have to hire a lawyer and lose time from work to fight their case against large insurance companies.

Donoghue responded that patients can always seek relief for lost wages, expenses and other damages in court. Of Billings' claim, he said, "That's absolute nonsense."

Donoghue also disagreed with a claim made by some lawmakers that enforcement of the legislation could be inconsistent because the bill says only the state insurance commissioner "may" penalize violators.

"We don't want the file sitting on some desk with nothing happening," said Del. Gilbert J. Genn, D-Montgomery.

Del. Kenneth C. Montague Jr., D-Baltimore, said inconsistencies could lead to allegations that the state is giving "discretionary authority" to the insurance commissioner.

"What, in my mind, this does is put the state in the position of being sued," Montague said.

But Donoghue said the insurance commissioner needs flexibility in enforcing the law, especially in the most severe cases.

"He wants to be able to slap a $100,000 fine if he wants to," he said.

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