His office announced the death. Mr. Busch underwent a liver transplant in 2017 for a condition he described as an adverse reaction to skin cancer medication. He said he had been diagnosed with liver disease from nonalcoholic steatohepatitis, a condition he attributed to the medication. He received a donated organ from a sister. Last year, he had heart-bypass surgery. In recent weeks, he was back in the hospital with pneumonia after a follow-up procedure for his liver transplant.

Mr. Busch, an Anne Arundel County Democrat, was a low-key but highly influential fixture in the Maryland State House until his death. He was regarded as a respected dealmaker, known for a folksy style that leaned heavily on consensus-building. He skillfully managed his party and his chamber, with all its egos.

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Only the governor and the garrulous Senate President Thomas V. Mike Miller Jr. (D-Calvert), who has been in his position since 1987, held as much clout over the fate of legislation. Matthew Crenson, a professor emeritus of political science at Johns Hopkins University, called Mr. Busch a “great compromiser and negotiator, a legislative peacemaker and a solid policymaker.”

Mr. Busch made perhaps his greatest impact on health care, championing Maryland’s “all-payer” hospital system, in which all insurers pay a hospital the same rate for the same service or procedure. He also was a leader on broadening mandates for insurers well before the Affordable Care Act was signed into law in 2010.

He helped promote African Americans and women to leadership posts. Anthony G. Brown, a former delegate representing Prince George’s County, served under him as majority whip — a level of visibility that led to his later selection as lieutenant governor and election to the U.S. House. Mr. Busch also supported Del. Adrienne A. Jones ­(D-Baltimore County) in her successful bid to become the first black woman to serve as speaker pro tem.

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Mr. Busch’s prowess on the football field — at St. Mary’s High School in Annapolis and then at Temple University in Philadelphia — made him a professional prospect until he suffered a sidelining knee injury. After college, the burly 6-foot-1 athlete returned to Maryland and began a teaching and coaching career at his high school alma mater.

He was elected to the House of Delegates in 1986, joking that he owed his triumph to votes from every kid he “taught, coached, refereed or tossed out of the swimming pool . . . in Annapolis between 1972 and 1979.”

In 1994, he was named chairman of the Economic Matters Committee, overseeing bills on health care, insurance, corporate law and technology. He proved his diligence most vividly in the early 2000s when the state’s largest health insurer, CareFirst BlueCross BlueShield, proposed converting into a for-profit company with the intent of selling itself to the California-based conglomerate WellPoint Health Networks.

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Mr. Busch was at the forefront of the successful effort to scuttle the deal, raising the objection that the company, with more than 3 million customers in the Mid-Atlantic, had an estimated value of more than $1 billion and that executives stood to gain windfall bonuses from the sale.

Sensing an opportunity

In 2002, one of his mentors, state House Speaker Casper R. Taylor Jr. (D-Allegany), was dislodged from his Western Maryland seat in an election with heavy Republican turnout. Mr. Busch, dismayed but sensing an opportunity, aggressively pursued the speakership and was elected in January 2003 without opposition.

Mr. Busch and Miller stood on opposing sides during the legislature’s long and tortured debate over gambling in Maryland — which the speaker vociferously opposed and the president enthusiastically favored. The slot machines that had once proliferated on the Eastern Shore and in Southern Maryland were banned in 1968, and ever since, there had been efforts to reinstate them.

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Mr. Busch initially prevailed in the early 2000s when Gov. Robert L. Ehrlich Jr. (R) vowed to bring gambling back to the state to help avoid raising taxes. Among other concerns, Mr. Busch raised the suspicion of “impropriety or unjust enrichment” among those most ardently pushing for gambling: the state’s horse-track owners, who would be the most likely to gain profits as state gambling licenses were awarded.

The speaker also revealed to The Washington Post that his father had descended into gambling addiction and personal ruin.

“People are going to say, ‘No wonder Busch is against this, it’s just because it’s a personal family issue.’ But that’s not it,” he said in 2003. “I understand more about gambling than most people, more than I should probably admit to.”

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But four years later, at the urging of Gov. Martin O’Malley and with the grudging deference of Mr. Busch to his newly elected Democratic gubernatorial colleague, the House approved legislation that paved the way for a referendum on legalizing slot machines. The voters overwhelmingly approved the measure, which was presented as a way to close a $1.5 billion budget shortfall.

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Mr. Busch continued to express a dark view of gambling and its ability to alleviate budget woes. By 2012, still under the O’Malley administration, a gaping budget hole remained. There was also an impasse between Mr. Busch and Miller over the expansion of gambling to include casinos, including one likely to be located in Prince George’s County (a part of which is in Miller’s district).

Miller sought to link budget talks to the matter of gambling expansion. Mr. Busch wanted the budget settled first, and he held firm.

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“O’Malley was constantly off to New York or downtown Washington to build a national profile on TV for his presidential run,” said Todd Eberly, a political scientist at St. Mary’s College of Maryland. “Miller was obsessed with gambling, and that’s all he wanted. Busch was the adult in the room, saying we have to settle the budget because it’s the one thing by law we have to do.

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“Miller was playing chicken,” Eberly continued, “but Busch didn’t blink. There were two special sessions, first on the budget and then on gambling because Busch wasn’t willing to equate the two.”

In the end, gambling proponents prevailed, but Eberly said Mr. Busch’s predictions about gambling revenue not closing the budget gap or serving as a gold mine for funding-starved schools “has been proven right repeatedly. . . . It can be said without hesitation that Busch understood that was what was going to happen.”

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The other major issue Mr. Busch confronted was same-sex marriage. Until 2011, Mr. Busch — then 64 and the product of a Catholic education in a state with a strong Catholic tradition — had publicly sided with the state law defining marriage as a union between a man and a woman.

He had a very public conversion on the issue, concluding that even a middle course of civil unions was inadequate. He attributed his change of heart in part to then-Del. Keiffer Mitchell Jr. (D-Baltimore), whose family was prominent in Maryland civil rights advocacy and who likened civil unions to “separate but equal” public facilities during the pre-civil rights era.

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“I thought to myself, ‘They’re right,’ ” Mr. Busch told The Post. “People have always put barriers in front of people who are different.”

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Mr. Busch announced his support for same-sex marriage rights just before a 2011 vote on the matter died in the House. In February 2012, the legislature passed a same-sex marriage bill, but a coalition of conservatives successfully petitioned to put the question to voters in a November referendum. The public affirmed the legislature’s vote.

“In the leadership of the state, Busch was the person high up saying it was something we should do,” said Eberly, who added that the speaker had argued in favor of marriage equality before his fellow Catholic O’Malley, and that Miller, also a Catholic, stood largely on the sidelines.

Mr. Busch also had a leading role in the 2010-2011 redistricting process, which has become the subject of a continuing legal battle over gerrymandering. He denied having manipulated geographic lines to favor his party, although many were skeptical.

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“When he redrew the districts, he made his seat safer,” Eberly said. “He’s a survivor and used the process to his advantage.”

Turf and service

Michael Erin Busch was born in Baltimore on Jan. 4, 1947. His football career at St. Mary’s was so outstanding — he once rushed 280 yards in a game — that the U.S. Naval Academy’s head football coach, Bill Elias, began grooming him for a team led by quarterback and future NFL Hall of Famer Roger Staubach.

Mr. Busch lacked the grades for the service academy, and Elias steered him to Temple, where he received a football scholarship. He dazzled crowds by breaking the college’s single-game rushing record. Other intricate plays, requiring finesse and brute force, won him the attention of professional scouts. But a knee injury during his junior year derailed his hopes.

Not long afterward, his father abruptly left his Glen Burnie, Md., law practice and the family, which included three younger girls, and struck out for Las Vegas. “I’m 50 years old. I want to live the rest of my life and not worry about anything,” Mr. Busch recalled his father saying.

He refused to pay child support and drank and gambled his way to oblivion, dying in a flophouse.

“It’s a mystery that no one will ever know the answer to,” Mr. Busch told The Post. “He never saw my mother again. He never saw any of my sisters. I tell you, I have a real tough time talking about it.” (Mr. Busch made attempts at reconciliation, but they were fruitless.)

He received a history degree from Temple in 1970 and returned to St. Mary’s, where he became head coach of the basketball and football teams. He later spent decades overseeing the youth athletics program in the Anne Arundel County parks and recreation department, a job that supplemented his income when the legislature was not in session. He retired in 2018.

An early marriage ended in divorce. Survivors include his wife, Cynthia Abbott “Cindy” Busch, and their two daughters, Erin Busch and Megan Busch; and three sisters.

Mr. Busch was known for a harmonious style of leadership, but he was not above employing a gruff style of motivation, either on grassy turf or in marbled corridors. During one 1978 game when his football team was tied, The Post reported, he gave a half-time pep talk that was more tough than love.

“Fellas, let me tell you this: I don’t care if I go to jail, I don’t care what happens, but if we lose this game, none of you are riding home on the bus,” Mr. Busch recalled saying. He then threw a bunch of coins against the wall. “I said, ‘You better go over there and get a quarter so you have something to call your parents with, because you will not ride home with me if we lose this game.’ ”

St. Mary’s won.

John Wagner contributed to this report.