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It's a shame final congressional passage of a law expanding health insurance coverage didn't end some of the most deplorable political posturing and demagoguery heard in a long time.

We witnessed a sickening display of name-calling (and worse) on Capitol Hill followed by angry chest-pounding from conservatives in search of publicity and a renewal of ancient battles over states' rights and nullification.

What flamboyant nonsense. The disputed law won't destroy democracy as we know it. It will not take the country down the road to communism. Nor will it end America's health care deficiencies. The event might not even be the "big f------ deal" that Vice President Joe Biden (D) says it is.

All the law does is give 32 million Americans an opportunity to get health insurance five years from now.

While this colorful political circus was entertaining us in Washington, officials in state capitals were left wondering: What does this massive health insurance expansion mean for us? How will it change the status quo?

For the majority of Americans, it could turn out to be much ado about very little.

The new law contains a long fuse. Little happens right away. Indeed, the biggest reforms won't occur until 2014. A lot can — and will — change by then.

The first impact will be felt by insurance companies that must alter the way they handle applicants with prior health conditions.

The rest of us will be disappointed, especially if we thought this law represented the end of life as we know it — for good or evil.

Yet some of the long-term implications of this law could create a major earthquake in Maryland.

As a result of this law, the growing scarcity of physicians in parts of the state could spread. Financially pinched hospitals could see their predicaments worsen. The state's unique rate-setting system for hospitals, established 40 years ago, might have to be junked or modernized.

Maryland's medical system could find itself ill-equipped to absorb an additional 600,000 patients who previously lacked coverage.

So far, the governor and legislators have managed to avoid confronting that issue. But pressures are building on hospitals in Maryland, thanks in no small measure to the willingness of state regulators in recent years to favor insurers over medical centers.

Under Maryland's novel rate-setting law, the state Health Services Cost Review Commission determines how much a hospital charges for a medical procedure or an overnight stay. Everyone pays the same rate, including the federal government, which has sanctioned Maryland's system — as long as the state's annual rate increases are cheaper than national Medicare charges.

In recent years, state regulators have ratcheted down hospital requests for higher charges in an attempt to create a big cushion between the Medicare rate and what hospitals bill patients.

While that sounds good in theory, it doesn't work so well when hospitals are hit at the same time by fierce recessionary pressures.

Hospital reserve accounts aren't yielding any interest to help support health programs. Philanthropic gifts are way down. Yet, the demand for costly emergency room services and inpatient admissions are surging, particularly among the recently unemployed who lack insurance.

This situation might deteriorate under the new health reform law, which mandates $500 billion in Medicare cuts to doctors and hospitals over the next decade.

Sharp reimbursement reductions might persuade more practicing physicians to retire early, switch careers or refuse to take Medicare and Medicaid patients — just what we don't need with a tidal wave of newly insured patients about to flood waiting rooms.

As for Maryland hospitals, they could face a double-whammy: State regulators not only will implement painful Medicare rate reductions, they will go further and cut hospital charges even more dramatically to maintain the state's status.

It might become untenable for local hospitals. Red ink could flow from most centers. That would force them to end community health programs, cancel equipment purchases, lay off workers and shutter all but essential services.

Two Maryland hospitals already are on state-supplied life support — Prince George's Hospital and Bon Secours in Baltimore. Many others are treading water. The last thing they need is a series of steep clamp-downs on hospital charges.

True, hospitals will benefit as the number of uninsured patients shrinks and paying patients rises. But that positive could be erased if state regulators make sharp rate reductions.

It's a complicated issue with fierce lobbying from insurers and health care advocates. An institutionalized rate-setting bureaucracy fighting for its very existence doesn't help matters, either.

There's no simple solution.

More than in any other state, Maryland will be impacted by the federal health care reforms. The results may not be positive, either.

This week, the governor announced formation of a new Health Care Reform Coordinating Council. It has the job of recognizing the extent of the problem in Maryland and coming up with answers that avert a full-fledged crisis.

That, in turn, will require tough action by the governor and state lawmakers to implement changes. Indeed, they may have to come up with a totally different health care template that fits Maryland's unique needs in the second decade of the 21st century.

Barry Rascovar is a State House columnist and a communications consultant. He can be reached at brascovar@hotmail.com.