Maryland would spend millions of dollars to fight smoking-related heart and lung disease and send new state aid to suburban Washington hospitals under a plan approved by two House committees in Annapolis yesterday.

The committees' plan for distributing Maryland's share of the national tobacco settlement is substantially different from the approach favored by Senate leaders -- assuring a showdown between the two chambers in the remaining three weeks of the legislative session. The Senate plan, approved by a key committee Friday, would direct much of the money to cancer prevention, treatment and research. It is much closer to Gov. Parris N. Glendening's proposal for allocating Maryland's tobacco windfall -- an estimated $4.2 billion over 25 years. Del. Howard P. Rawlings, the Baltimore Democrat who chairs the House Appropriations Committee, has insisted that some of the money be spent on research and treatment of noncancer tobacco-related diseases. The University of Maryland Medical System would receive $11 million for such efforts over the next two years under the plan approved yesterday, 44-2, by the Appropriations and Environmental Matters committees. "Cardiovascular and pulmonary diseases need to be at the table -- not just cancer alone," Rawlings said. The House committees did adopt language that calls for the creation of new local programs to screen and treat people for cancer, which is similar to the Glendening and Senate proposals. The House plan "is moving closer toward the governor's original version," said Dr. Georges C. Benjamin, the state health secretary. He added, however, "We still very much favor the Senate bill. The governor wants to focus more on cancer, and the Senate version does that for us." Other differences involve how much money is targeted to go to certain hospitals in the state. The House bill would direct $2 million to unnamed hospitals in Prince George's and Montgomery counties. The money would be used to enhance the capacity for cancer treatment at the hospitals, which would be required to work with the University of Maryland Medical System or Johns Hopkins Hospital. Under another provision, $1.5 million would go to an unnamed hospital that treats a high number of cancer patients and uninsured patients. That generally is viewed as a provision to benefit Sinai Hospital in Baltimore. The House bill also directs that $5 million be spent to subsidize the federal Medicare program in an effort to entice HMOs back to rural areas. Without them, many senior citizens have been left without coverage for prescription drug costs. Another difference is the duration of the programs proposed by the tobacco bill. The Senate version would allow the programs to remain in place through the expected 25-year life of the settlement funds. Under the House bill, the programs would expire in 2004. "The differences are reasonable and can be addressed in the conference committee," said Del. Samuel I. Rosenberg, a Baltimore Democrat who sits on the House Appropriations Committee.

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