Health insurance requirements could take a radical turn if a health care reform bill ever lands on President Barack Obama’s desk, and that could mean costly changes for Maryland businesses.

The House and Senate versions of the bill vary in several key areas, but both call for some sort of employer mandate, requiring certain business owners to provide health insurance to full-time employees, and would require individuals to have health insurance. Businesses and individuals that don’t follow the rules would pay fines for not having coverage.

“For many, many businesses, the employer mandate is going to mean new costs on the business, whether they take the fine or comply,” said Kenneth R. Huber, senior vice president of the employee benefit group for PSA Insurance & Financial Services in Hunt Valley.

“I look at the economy, and a lot of businesses have already trimmed their expenses, including employees. … They’re going to look at a new cost the same way all employers look at a new cost. They’re going to have to figure out how to deal with it,” said Huber, who advises small to medium-sized businesses.

Under the House bill, which passed in November, companies with annual payrolls of $500,000 or more would be required to offer employees health care coverage. Sanctions would begin at 2 percent of payroll expenses and ramp up to 8 percent if the business has a payroll of $750,000 or more.

Under the Senate bill, which has not been debated yet, employers would not have to provide coverage. However, if any employee received government assistance to buy an insurance plan, the company would have to pay a $750 penalty for each of its employees. Companies with fewer than 50 employees would be exempt.

Out of more than 119,000 businesses in Maryland, 74 percent have fewer than 50 full-time employees. But only 44 percent of those businesses offered health benefits in 2008, according to the Department of Health and Human Services.

About 56,000 small businesses in Maryland could qualify for tax credits of up to 50 percent of a health insurance premium under health reform. Reform would expand on Maryland’s Health Insurance Partnership, which gives businesses with two to nine full-time employees the same subsidy if they have not offered insurance in the last year and their employees make less than $50,000 on average. Under reform, a business that employs up to 25 people, with average salaries of $40,000, would qualify for credits.

Reform would also provide coverage for people with pre-existing conditions. But the small-group plans offered in Maryland — for companies with 2 to 50 employees — already do that.

“Our concern is that Maryland already imposes more mandates on the small-group insurance,” said Kathleen Snyder, president and CEO of the Maryland Chamber of Commerce, which opposes the House health care bill.

“We’re concerned that Maryland will come back and add on to a very rich federal government plan, which will add up the costs to insurers [and] to employers,” she said.

Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, said he is hopeful that health care reform will become a reality. His group has pushed for universal health care in Maryland through a 2 percent payroll tax on businesses.

“We would like to do our proposal the way the House did, which is to require all businesses provide health care and charge them an assessment if they don’t,” he said.

“If something like that passes, that would make it unnecessary for us to do many of the things we were going to do,” DeMarco said. “We’re ready to adapt our proposal to theirs to finish the job here in Maryland.”

He said that requiring all businesses to provide health care would decrease the hidden costs in premiums that cover the uninsured. But both Huber and Snyder said they are unsure if health care reform would actually bring costs down.

“At the end of the day, both of these bills are primarily health insurance reforms and expanding coverage, and there isn’t a lot that I believe will meaningfully have any impact on bending the cost curve,” Huber said. “Nor is there anything in either of these bills that will meaningfully improve care.”