Op-Ed: Hogan’s worst nightmare is Trumpcare by Barry Rascovar

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Maryland Gov. Larry Hogan’s worst nightmare is starting to come true. Trumpcare has passed the U.S. House of Representatives. If the Senate finds a way to give President Trump what he wants, it could spell a heap of trouble for Hogan in 2018’s general election.

The Republican Party’s mania with obliterating Barack Obama’s massive health insurance law has led the majority party in Washington to ignore common sense.

“Repeal and replace” is a GOP obsession – though an estimated 24 million people could lose their insurance, tens of millions more could be out of luck due to pre-existing conditions and medical programs for the poor could be cut 25%.

It also would damage the nation’s economy. That’s especially true in Maryland, where healthcare is one of the state’s biggest employers.

It is almost certain to be the No. 1 issue in the 2018 mid-term elections, even if the Senate approves a diluted Trumpcare bill.

What a devastating state of affairs for Republican Hogan. Until the House vote last week, he appeared in excellent shape to win a second term.

Now he has to figure out how to tiptoe around this explosive issue that already is proving highly unpopular.

Unfavorable poll numbers

A Washington Post-ABC poll last month found 61% of Americans opposed Trumpcare. A Quinnipiac poll the month before found Trumpcare support stood at just 17%.

Most Americans, it appears, would rather stick with the existing – though seriously flawed – Obamacare medical insurance program and fix parts that aren’t working well (“keep and improve” as opposed to the GOP’s “repeal and replace”).

Wait until the Congressional Budget Office issues its cost and impact analysis of the House-passed version of Trumpcare. It could expose the bill’s soft underbelly. Public resistance could grow louder.

For Hogan, House passage of Trumpcare might be the beginning of bad news.

He could be trapped in a nearly untenable position: A Republican who might have to disavow his own party leaders in Washington to survive.

Hogan won election in 2014 by promising “no new taxes.” Does that mean he will let Trumpcare’s 25% cut in federal Medicaid funds lay waste to Maryland’s health programs for the poor and near-poor? Where would he find hundreds of millions in state dollars to cover those unfunded programs?

How does he run for reelection with Trumpcare hanging over his head?

Justifying the Republican plan

How does Hogan justify to voters his party’s plan to let insurance companies charge outrageously high premiums – or deny coverage entirely – for people with “pre-existing conditions”? This could be anyone with acne, anxiety, depression, diabetes, obesity, cancer, pulmonary problems, asthma or even allergies.

How does he tell older working Marylanders that under his party’s plan their insurance premiums could jump an unaffordable 500%?

How does he explain a cut of $600 billion in taxes that supported Obamacare – a massive windfall for wealthy Americans, insurance companies and medical device companies?

How does he justify $880 billion in healthcare cuts to Medical Assistance for the poor?

Hogan & Company should be praying that the Senate junks the House bill and takes a few years to figure out what to do next.

Otherwise, the GOP across the country – including here in Maryland – could take a shellacking for its all-out effort to appease its conservative base.

Gift to Democrats

There’s no doubt Democratic candidates for Maryland governor will tie Hogan to Trumpcare.

Every candidate will be running ads with tales of how middle-class and working-class Marylanders would be hurt, how lives hang in the balance.

It is a gift from heaven for Democrats.

One Republican pollster called the GOP’s insistent quest to wipe out Obamacare “political malpractice.”

Until recently the notion of Democrats regaining control of the House by picking up 24-plus seats next year appeared wishful thinking. Thanks to House Speaker Paul Ryan’s determination to pass a draconian Trumpcare bill, that’s no longer the case.

Little wonder Democratic House leader Nancy Pelosi – the former Nancy D’Alesandro from Baltimore’s Little Italy – was practically giddy.

Every Republican will be vulnerable, unless he or she disowns the GOP’s No. 1 issue and risks losing support from Trump’s supporters. “This vote will be tattooed to them,” Pelosi vowed.

That includes Republican Hogan, who has made an extensive effort to distance himself from Donald Trump and his controversial comments and proposals.

That may not be enough to give him immunity from this highly contagious political disease.

When virtually every healthcare group – from the American Medical Association to the American Hospital Association to AARP – as well as virtually every insurance group vehemently opposes the Republicans’ “repeal and replace” crusade, smart politicians should pay attention.

Failure by the GOP to “listen and learn” could prove fatal come November 2018 – both in Maryland and nationwide.

Barry Rascovar’s blog is www.politicalmaryland.com. He can be contacted at brascovar@hotmail.com.

It’s a Wrap: Hogan, Busch, Miller “Proud” of Annapolis Legislative Session

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“It was a great session,” Gov. Larry Hogan said about the just closed 90-day meeting of the Maryland General Assembly. “This is the way government is supposed to work…. This was all about compromise.”

“It was a session we can all be proud of,” House Speaker Michael Busch, sitting next to Hogan at a bill signing ceremony Tuesday morning. “This year your staff did a great job.”

House Minority Leader Nicholaus Kipke, R-Anne Arundel, told Capital News service that “despite the partisan efforts to kind of drag us into the D.C. post-election theater, we were able to pass some meaningful bills.”

Despite its many battles, Kipke said the 2017 session was the “most bipartisan” he has seen since he took office. Hogan concurred, telling reporters that 2017 was an “incredible, bipartisan session.”

It was so bipartisan that as Republican delegates talked the clock out on a bill expanding medical marijuana licenses, it was Kipke who made the motion to “adjourn sine die” at midnight, a role typically reserved for the House Democratic majority leader. This partially reflected bipartisan distaste for how the bill was written and forced on them by the Senate.

“We got everything done that needed to get done in terms of the legislation,” said Senate President Mike Miller. “We dealt with health care, we dealt with education, we dealt with environment and we dealt with public safety. So I think it was a very good year quite frankly.”

The two parties came together on several significant issues, most notably job creation, opioid abuse, anti-fraud measures, education, and environmental issues.

And in very Democratic Maryland, Republican Hogan continues to be the second most popular governor in Maryland, according to a Morning Consult poll released Tuesday based on an online survey over the last three months.

MANUFACTURING JOBS: The More Jobs for Marylanders Act (SB317) passed with strong bipartisan support. The law is designed to bolster manufacturing jobs in Maryland by offering tax incentives to companies that create jobs in high-unemployment areas and job training programs. Hogan considered the law a core piece of his 2017 agenda and signed it into law Tuesday.

Sen. Rich Madaleno, D-Montgomery County, often critical of Hogan, described a bipartisan process of senators who worked on the bill with administration representatives.

Mike Galiazzo, president of the Regional Manufacturing Institute, said the bill represented a good signal to manufacturers that Maryland was interested in promoting their businesses, which hadn’t gotten any tax breaks in 15 years.

The lone senator to vote against the bill, Sen. Roger Manno, D-Montgomery, had worked on his own version of tax incentives for manufacturers for three years.

Manno called the bill that was signed “a steak dinner for big business and a chicken box for the workers.”

OPIOID ABUSE: Maryland passed restrictions on the quantity of opioid painkillers that can be doled out by doctors in a single visit (HB1432); measures to increase the availability of naloxone — a drug that can counteract the effects of overdose (part of the HOPE act); and introduced steep penalties for people who distribute opioids that later cause the death of another person. The legislature passed a Hogan administration bill setting new penalties for distributing Fentanyl — an extremely potent synthetic opioid that has a high rate of lethal overdoses (SB539).

CRISIS TREATMENT: (UPDATED) The Heroin and Opioid Prevention Effort and Treatment Act of 2017 (or HOPE Act, HB1329), which passed late Monday with only one dissenting vote, is a broad response to the state’s opioid crisis. A key provision will increase reimbursement rates for community-based behavioral health providers over the next three years. Community behavioral health providers will receive reimbursement rate increases of 3.5% annually in the next two years and a 3% increase in the third year. This reimbursement increase was the key goal of the Keep the Door Open campaign.

PROTECTING TAXPAYERS: The Taxpayer Protection Act (SB304), a Hogan priority, makes it easier for the state to prosecute fraudulent filers for tax refunds and gives the comptroller’s office greater latitude to investigate tax fraud and identity theft. Comptroller Peter Franchot pushed hard for the legislation, holding conferences and events around the state to drum up support for the bill. It passed this year with unanimous support in the Senate and in the House of Delegates.

CLEAN CARS, WATER: Hogan administration environmental legislation included the Clean Cars Act (HB406), which increases the state’s budget for tax credits for electric vehicles, and the Clean Water Commerce Act, which expands the scope of the Chesapeake Bay Restoration fund to include sediment reduction, but does not include any new funding (SB314). Both had strong support from both Democrats and Republicans.

As always, a majority of proposed bills died, including some with significant support.

MEDICAL MARIJUANA: Tops among the failed bills was legislation that would expand the number of growing licenses for the state’s medical marijuana industry (HB1443) in an effort to increase diversity in business ownership. Sen. Joan Carter Conway, D-Baltimore, said she was “devastated” the House didn’t pass the bill before the midnight deadline. “We have a multi-billion industry with no minorities participating,” Conway said. “…I’m almost speechless.”

SANCTUARY STATUS: Latino delegates were outraged after the Maryland Law Enforcement and Governmental Trust Act (SB835) died in the Senate. The bill would have essentially made Maryland a sanctuary state by restricting the involvement of law enforcement agencies in Maryland with federal immigration efforts, banning state government agents from asking crime victims or suspects about their immigration or citizenship status.

Members of the Latino caucus walked off the floor at 4 p.m. Monday to demonstrate their displeasure that the Senate Judicial Proceedings Committee and Miller were blocking the bill.

Del. Jocelyn Peña-Melnyk, D-Prince George’s, shouted that Miller and committee chair Bobby Zirkin, D-Baltimore County, were “Democrats in name only” (DINOs). “Shame on you” she said of Zirkin. “I hope your district takes you out.”

Hogan was opposed to the bill as well.

The Capital News Service contributed to this article.

 

Annapolis: Generic Drug Price Gouging could be Penalized In Bill Sent to Hogan

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A prohibition on generic drug price gouging now heads to Gov. Larry Hogan’s desk for signature after the House concurred in Senate amendments Monday morning.

The House voted 137-2 for the bill, HB631, and the Senate approved it on Friday 38-7 with a handful of Republicans joining the Democratic majority. All but a few GOP delegates supported the measure.

The legislation would be the first of its kind in the country to hold drug makers accountable for drastic spikes in prices that can’t be justified. Under the new law, the state Medicaid program will notify the attorney general of a spike in drug prices, who can seek civil penalties of up to $10,000 per violation.

“Generic prescription drugs prices have been like the ‘wild’ west for many Americans” said Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, moments before Friday’s vote. “There’s a new sheriff in town and his name is Attorney General Brian Frosh, who will protect Marylanders from price gouging, and this will also allow future AG’s to protect Marylanders.”

“Frosh will be able to take legal action to stop unconscionable price increases that hurt people without justification when there’s no competition in the market,” DeMarco said.

Subjective judgment

In floor debate Friday, Sen. Robert Cassilly, R-Harford, said the proper way to deal with price controls would be to set up a commission rather than allow the attorney general to make a “subjective” determination on what constitutes price gouging.

“If the state of Maryland wants to establish their own version of the FDA and engage in price controls we ought to do in the proper manner,” Cassilly said. “The proper manner would be set up some proper board or commission…or have it come under some aspect of our state bureaucracy.”

Senate Republican Whip Sen. Stephen Hershey. R-Queen Anne’s, said the law could actually harm competition.

“Generic drugs are one of the only indicators in the delivery of health care where prices are actually going down,” Hershey said prior to passage of the bill. “This bill is going to have a negative effect that could potentially eliminate some of the competition that is in Maryland and that is driving these costs down.”

The legislation was rolled out at a Jan. 10 rally in Annapolis three weeks after Maryland joined 19 other states in a lawsuit against six generic drug makers for market manipulation and anti-competitive behavior.

Frosh said a 2014 survey of pharmacists revealed that 25 “off patent” generic drugs saw price increases of 600% to 2000%.

He said normally prices “plummet” when patents expire and competition becomes “robust.” He said generic drugs have consistently run about 20% of the original patented price.

“What we allege is these companies conspired to fix prices.” Frosh said at the rally.

by Dan Menefee

Annapolis: Paid Sick Leave Bill Sent to Hogan, Who has Pledged a Veto

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Five years in the making, the Maryland General Assembly on Wednesday passed a widely supported but controversial paid sick leave bill, HB1, which Gov. Larry Hogan has vowed to veto.

Democratic lawmakers are promising an override at the start of the 2018 session, saying they will defend the rights of 700,000 Marylanders to take paid sick leave without fear of losing their jobs.

As the votes went up on the tally board , the bill’s lead sponsor, Del. Luke Clippinger, a Baltimore City Democrat, lauded the efforts of fellow delegates and called on Gov. Hogan to sign the bill. A broad coalition of unions and progressive groups supported the bill.

“This has been five years… a lot of people have worked very hard to come to the day when nearly 700,000 Marylanders will be able determine they can take the day off to get better as opposed to losing their jobs…I certainly call on this governor to sign this bill when it comes to his desk.”

Veto-proof majorities

The bill cleared the House of Delegates by a veto proof majority, 87-53, concurring with Senate amendments and avoiding the need for a conference committee so close to the end of session – which Clippinger wanted to avoid. There were no votes to spare in case of a veto when the Senate passed the measure 29-18 Monday.

With the 90-day session over next Monday, the legislature cannot send it to Hogan for action, as it did with 27 other bills last week.

If successfully overridden in 2018, the sick leave bill requires companies with 15 or more workers to offer 40 hours of annual paid sick leave. Part-time employees working only twelve hours a week would accrue paid sick leave under the mandate.

The bill originally had offered seven sick days. Any business that currently offers five days of flexible paid leave, whether vacation or sick, complies with the bill.

A job killer, business groups say

The bill saw strong opposition from business interests during the session as a “job killer” and a “debilitating mandate” on small businesses struggling to stay afloat.

Mike O’Halloran, Maryland’s director of the National Federation of Independent Business, said the Democratic majority had failed to consider bipartisan input.

“If implemented this bill would cost thousands of jobs, a majority of which would disappear from small businesses,” O’Halloran said soon after the House vote. “[More] than a dozen reasonable and responsible amendments were offered to lawmakers to help Maryland small businesses mitigate the impact of this mandate. Unfortunately, although these changes were supported in a bipartisan manner, the legislature chose not to listen to the pleas from Maryland’s job creators.”

Clippinger’s bill overshadowed a competing bill offered by Hogan at the beginning of the session that would require companies with 50 or more employees to provide 40 hours of annual paid sick leave, as most already do.

Hogan’s plan also budgeted $60 million in tax incentives for smaller companies with 50 or less employees that offered paid leave.

But even support among Republicans was tepid at the start of the session because of mandates on businesses.

Three Democrats opposed

While passage was mostly along party lines, several Democrats voted against the bill because of the impact on small businesses.

“I was concerned this bill was going to hurt the businesses in my district,” said Del. Ned Carey, D-Anne Arundel. “I heard from many that they may have to close their doors or lay people off to get below 15 employees…this could mean the loss of jobs.”

“Many of the businesses in my district are just scraping by and there are times business owners go without a paycheck,” Carey said.

“I don’t have a lot of big businesses in my district, most are mom and pop businesses that can’t afford to offer paid sick leave,” Carey said in interview. “Businesses with 15 or 16 employees will be forced to rethink their staff levels and consider letting some people go.”

Eric Bromwell, D-Baltimore County, grew up in the restaurant businesses working alongside his brothers and mother at The Bromwell Inn in Overlea. He said the family originally lived above the restaurant and “put everything they made back into it.”

“Small business is a part of who I am and how I grew up,” he said. He said his mother very much wanted to offer paid sick leave and health insurance but could never afford it. “It’s a very delicate balance between helping the employees or hurting the business.”

He said this was especially true for family owned restaurants, which would have trouble staffing shifts during the holidays.

“If you have people who’ve accrued sick leave throughout the year it will become a lot harder than it already is to cover shifts during the holidays,” he said.

Del. C.T. Wilson, D-Charles, also voted against the bill, as did four Senate Democrats. Sen. Ed DeGrange, Anne Arundel and three from Baltimore County, Jim Brochin, Kathy Klausmeier and Bobby Zirkin.

Some businesses support it

Not all small businesses opposed the bill.

Clifton Broumand, founder and CEO of Man & Machine, a company that produces waterproof computer keyboards, said the talk of onerous regulations was “a side issue.”

As a small business job creator, he said his biggest asset was his employees.

“If my employees can’t take care of themselves, they can’t be efficient for me,” he said in testimony before the Senate Finance Committee on Feb. 10.

“The main issue here is providing paid sick leave,” he said. “There can be a way, and all of you have the opportunity to figure out a way that everyone can have paid sick leave in Maryland.”

Broumand said he provides 15 days of leave annually for his employees, and the week off between Christmas and New Year’s Day.

He said passage of the bill would level the playing field.

“The concept of a level playing field is an honorable thing for everybody,” he said. “If I’m doing this, everyone else should have to.”

by Dan Menefee

Annapolis: School Scoring Bill sent to Hogan, who Promises Veto

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Democrats in the Maryland General Assembly on Tuesday passed legislation establishing parameters for school evaluations that the state school board strongly opposes and Gov. Larry Hogan has promised to veto.

The House went along with Senate amendments, and sent the bill to Hogan, who called it “an utter disgrace.”

If the bill is delivered to Hogan’s office by Monday, he has six days to act on it, giving the legislature the chance to override a veto before it adjourns April 10. It is one of several bills Democratic leaders hope to send to Hogan in time to override promised vetoes.

The Protect Our Schools Act would set standards for a plan to improve student outcomes that the state must submit to the U.S. Department of Education under the 2015 Every Student Succeeds Act (ESSA).

The sticking point for Hogan and GOP lawmakers is that the bill does not sufficiently weigh academic achievement when assessing schools. In that case the state could lose nearly $250 million in federal funding, a legislative analyst suggested.

Advocates for the teachers union scoffed at the notion the Trump Department of Education would reject any state plan, since ESSA gives much wider latitude for the states to set policy than under No Child Left Behind, the federal law it replaced.

The bill also restricts the state Department of Education’s ability to intervene in failing schools, which opponents worry is intended to limit the creation of charter schools and voucher systems.

Academic indicators raised

The bill specifies which measures could be considered when determining a school’s quality and prohibits student testing from being one of them. As introduced, the academic indicators amounted to 55% of the total score for a school, but the Senate raised that to 65% Tuesday and the House accepted the amendment.

“Members of the legislature just voted to trap thousands of our kids in failing schools and jeopardize over a billion dollars in education funding over the next five years – all to protect the teachers unions and preserve the unacceptable status quo,” Hogan said in a press release. “It’s an utter disgrace and one of the most irresponsible moves our legislature has ever made.”

Republicans opposed the bill largely on the grounds that it undermines school choice and makes it more difficult for students in struggling schools to get an effective education.

Several Republicans expressed concern that the bill would prevent the state from improving struggling schools for several years. Senate GOP leader J.B. Jennings attempted a filibuster, but the Democratic majority limited debate after about 15 minutes.

Concern about charter schools and privatizing
Sen. Paul Pinsky, D-Prince George’s, defended the bill, saying emphatically that it “does not remove charter schools” and that it only prevents the state board of education from approving charter schools without local input. However, he also said that part of the motivation for the bill is a concern that some leaders in the state department of education want to privatize schools, introduce vouchers, and “destroy our public school system.”

The State Board of Education, now dominated by Hogan appointees, held an emergency meeting last week to reinforce its earlier opposition to the legislation, which preempts its role in setting policies to implement ESSA that it has been working on for over a year.

Sen. Steven Hershey, R-Upper Shore, described the bill as part of a “battle between the school board and the teachers’ union” and said he was “not convinced that this entire body knows what it’s doing.”

He proposed an amendment that would have delayed the effects of the bill until five other specific states with highly ranked education systems come forward with similar plans; the amendment was rejected. This amendment was modeled on a Democratic redistricting reform measure that also required action by five states, which Republicans had derided as an excuse to do nothing about gerrymandering.

Sen. Rich Madaleno, D-Montgomery, insisted “this is not a partisan issue, this is not about who is president or who is governor.”

“This is our one chance to in fact be a national leader to set up the most comprehensive set of standards to determine how schools succeed and how they don’t,” Madaleno said.

Baltimore City schools were repeatedly cited as examples of places where students would benefit from being able to move out of struggling public schools and into charter schools or, through a voucher, pay down the cost of a private school.

Sen. Nathaniel McFadden, D-Baltimore, a former school administrator, defended the Baltimore public school system, saying that “they may not have succeeded to the extent that some would like to see but our efforts are strong.”

Reporting also done by the Capital News Service

Annapolis: Legislature Braces for ACA Repeal despite Congress’s Failure

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The Maryland House of Delegates on Friday adopted its version and a Senate version of the Maryland Health Insurance Coverage Protection Act to plan for the potential loss of $4 billion in annual Medicare and Medicaid dollars that flow to the state annually, should the Republican-controlled Congress succeed in repealing the Affordable Care Act.

The loss of funding could result in 400,000 Marylanders losing their health coverage, according to analysis from the Maryland Department of Legislative Services released in January to assess the impact of repeal.

But during floor debate on Friday morning, Warren Miller, R-Howard, asked if the measure could be delayed pending the outcome of a scheduled 3:30 vote in Congress on the American Health Care Act, the GOP’s replacement to the ACA.

“There is a very good possibility there could be no repeal,” Miller.

Miller’s comments were correct and several hours later U.S. House Speaker Paul Ryan announced there would be no vote and conceded that the AHCA failed to win the support of GOP majority.

“Obamacare is the law of the land and will remain the law of the land until it is replaced,” Ryan said at an afternoon press conference announcing his decision to cancel a vote on his plan. “We’re going to be living with Obamacare for the foreseeable future…I don’t know how long it’s going to take to replace this law.”

Congressman Andy Harris, Maryland’s only Republican in Congress, originally lauded the Ryan plan as a way to reduce costs for patients while increasing the quality of health care, but by Friday Harris pulled his support.

Democratic leaders in Annapolis and Washington fear the GOP Congress will continue attempts at repeal before the end of Trump’s first term.

“Today, tens of millions of Americans can breathe a small sigh of relief as President Trump, Speaker Ryan, and House Republicans failed to eliminate their healthcare coverage—at least for now,” said Rep. Elijah Cummings of Maryland’s 7th District in a statement.

Being prepared

Del. Bonnie Cullison, chair of the health insurance subcommittee, said regardless of what happened Friday the state should be prepared for potential changes. She said the state needed to brace for repeal or drastic changes that could result in loss of coverage or a spike in premiums and other costs.

“We need to be prepared and we’re going to have to look at some other ways to deliver [health care] services,” She said.

She said options may be limited to bringing back high-risk pools like the Maryland Health Insurance Plan (MHIP), a public health plan established by the legislature in 2002, the Health Insurance Safety Net Act, to cover individuals who could not get coverage due to pre-existing conditions or who were deemed uninsurable. The program established 41 medical conditions that automatically qualified individuals for enrollment.

Coverage under MHIP was supported by premiums, a 1% assessment of hospital rates and federal grant funds. The plan was phased out in January 2014 when coverage became available under the ACA. Those who could still not afford coverage qualified under the Medicaid expansion if their incomes were 133% of the poverty level or less.

“But we’re not looking favorably on any of our options right now,” Cullison said. ‘We’re going to have to look at some other ways of delivering the service.”

“There may be very high premiums but it would cover the people who absolutely need health care and don’t have it,” she said. She said it could be a stopgap against medical bankruptcy and would hopefully include a prohibition against lifetime limits on coverage.

“These are out there as options but we are not looking favorably on any of our options right now,” Cullison said.

Minor amendments were adopted on Friday to make the bills identical and final passage is expected next week. The Senate passed its version March 18 in a party-line vote, 33-14.

by Dan Menefee

Maryland Commission would Monitor Health Care Coverage as Congress Replaces ACA

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The Maryland Senate on Friday adopted the Maryland Health Insurance Coverage Protection Act to monitor congressional plans to repeal and replace the Affordable Care Act that could cost the state billions to maintain current coverage.

The intent of the bill, SB571, offered by Sen. Thomas “Mac” Middleton and 31 other Democratic co-sponsors, is to study ways to prevent 400,000 Marylanders from losing health insurance and plan for a potential loss of $4 billion in federal Medicaid and Medicare dollars that flow to the state each year.

Sen. Jim Brochin, D-Baltimore County, was the only Democrat not to sign on as a co-sponsor.

Sen. Thomas “Mac” Middleton

A plan released by U.S. House Speaker Paul Ryan March 6 cuts $880 billion from the Medicaid program and $673 billion in premium subsidies to those who purchased insurance through the exchanges, according to Congressional Budget Office report released last week, page 6.

Under Ryan’s plan, the American Health Care Act, the CBO estimated that 24 million Americans would become uninsured by 2026 from the loss of Medicaid funding and the eventual loss of federal subsidies available to those with incomes between 133% and 400% of the federal poverty rate.

Middleton’s bill is expected to pass in a final vote this week. A cross-filed bill in the House is co-sponsored by all 91 Democrats and six Republicans but there’s been no action on the bill since its hearing on March 10.

The Act would set up an 11-member commission, including the Maryland attorney general, to complete a study on the potential impact to Marylanders and devise plans to mitigate the loss of Medicaid and Medicare funding.

The commission would be authorized to convene workgroups over the next three years and report back to governor and legislature.

Big federal subsidies

The federal government currently subsidize 95% for Marylanders who became insured under the Medicaid expansion when the state fully implemented the ACA. This brings about $2.8 billion in annual Medicaid support in 2017 and the state’s share is just $70 million.

The state also stands to lose its Medicare waiver, which is the only program of its kind in the country that allows hospitals to charge Medicaid and Medicare the same commercial rates charged to insurance companies, normally much higher than what Medicaid and Medicare reimburses in other states. The waiver also allows the state, not the federal government, to set the rates.

The waiver brings around $2.3 billion in additional funding to Maryland hospitals annually.

ACA decreased number of uninsured

When Maryland fully implemented the Affordable Care Act in 2013 the unprecedented expansion of Medicaid added 291,000 Marylanders to the Medicaid rolls by 2016, according to analysis by the Maryland Department of Legislative Services.

This was accomplished by raising the income eligibility to 138% of the federal poverty rate for all individuals under 65 who were enrolled beginning January 1, 2014. Previously Medicaid eligibility had been restricted to low-income parents with children, the elderly and the disabled, and the reimbursement rate was a 50-50 cost sharing arrangement with the federal government.

Under the expansion, the federal government kicked in 100% of the cost of new Medicaid enrollees from 2014 through 2016. But that was scheduled to get a gradual trim to 90% by 2020 and remain in effect indefinitely. The state would pick up the other 10%.

Maryland’s share to cover the Medicaid expansion in 2017 is around $140 million and the federal government will kick in around $2.8 billion, 95% of the total costs.

The state costs were expected to grow to $350 million by 2021, with the federal match rising to $3.5 billion.

Ryan cuts

But the Ryan plan would reduce federal government participation for new Medicaid enrollees beginning 2020 and set the cost sharing at 50-50, the traditional cost sharing split that existed before the expansion.

If a 50-50 split were in effect the state’s Medicaid obligation this year would be $1.3 billion.

Middleton said in floor debate Friday that “there’s a reasonable certainty the feds will…hand back 50% of the costs.”

The Ryan plan would also affect the 143,000 Marylanders who qualified for subsidized premiums through the Maryland Health Benefit Exchange. The Ryan plan ends those subsidies, saving $673 billion in federal spending through 2026, according to the CBO report.

Maryland’s exchange has received $137 million in state funding and $425 million in federal funds since 2011. The exchange has 67 employees with annual salaries approaching $8 million.

by Dan Menefee

Op-ed: Marijuana legalization Shouldn’t be Held Hostage to Drugged Driving Concerns by Paul Armentano

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Maryland lawmakers are once again considering legislation to regulate the adult use and sale of marijuana to those age 21 or older. Nearly six in 10 residents support this reform, according to a February Goucher poll. But opponents charge that doing so could pose a risk to traffic safety.

Such concerns are not all together unfounded, but deserve to be placed in proper context.

First, it should be stressed that driving under the influence of marijuana is already a criminal offense in Maryland. Nothing in the language of Maryland’s proposed adult use laws changes this reality.

Second, scientific studies consistently find that marijuana-positive drivers possess a comparatively nominal accident risk, particularly when compared with alcohol-positive drivers. In fact, the largest ever controlled trial assessing marijuana use and motor vehicle accidents, published in 2015 by the U.S. National Highway Traffic Safety Administration, reports that marijuana positive drivers possess virtually no statistically significant crash risk compared to drug-free drivers after controlling for age and gender.

By contrast, drivers with detectable levels of alcohol in their blood at legal limits possess nearly a four-fold risk of accident, even after adjusting for age and gender.

This finding is consistent with prior meta-analyses of crash risk data. For example, a review of 66 separate crash culpability studies published in the journal Accident Analysis and Prevention reported that THC-positive drivers possessed a crash risk on par with drivers testing positive for penicillin (Odds Ratio: 1.10 for cannabis versus Odds Ratio: 1.12 for penicillin) This risk is far below that associated with driving with two or more passengers (OR=2.2) and is comparable to the difference between driving during the day versus driving at night.

Further, data from states that have liberalized marijuana’s legal status show no uptick in motor vehicle crashes. Writing in December in the American Journal of Public Health, investigators at Columbia University reported, “[O]n average, medical marijuana law states had lower traffic fatality rates than non-MML states. …. Medical marijuana laws are associated with reductions in traffic fatalities, particularly pronounced among those aged 25 to 44 years. … It is possible that this is related to lower alcohol-impaired driving behavior in MML-states.”

A review of federal FARS data (Fatal Analysis Reporting Systems) further finds that trends in motor vehicle accidents in Colorado and Washington post-legalization are no different than crash trends in non-legalization states over this same period of time.

Nevertheless, the use of marijuana prior to driving ought to be discouraged and better efforts ought to be made to identify drivers who may be under the its influence. These include greater funding for the training of Drug Recognition Evaluators, the use of modified roadside field sobriety tests, and potentially the provisional use of roadside marijuana-sensitive detection technology, such as saliva test or breath test technology.

These efforts should not include the imposition of per se thresholds for THC or its metabolites, as such limits are not scientifically correlated with driver impairment.

Efforts should also be made to better educate the public with regard to the existing traffic safety laws, as well as to the evidence surrounding marijuana’s potential influence on driving. In particular, this messaging should stress that combining marijuana and alcohol greatly impacts driving behavior and is associated with far greater risk of accident than the use of either substance alone.

Such an educational campaign was implemented nationwide in Canada by the Canadian Public Health Association and could readily be replicated in the United States and promoted by groups like the American Automobile Association.

In addition to increasing public safety, implementing these steps would help assuage concerns that regulating the adult use of marijuana could potentially lead to an increase in incidences of drugged driving or limit the state’s ability to successfully identify and prosecute such behavior.

Adults’ consumption of and demand for marijuana is here to stay. It is time for Maryland lawmakers to acknowledge this reality. It is time to stop ceding control of the marijuana market to untaxed criminal enterprises and to regulate its adult use and sale accordingly.

Paul Armentano is the deputy director of the National Organization for the Reform of Marijuana Laws (NORML) and is the co-author of the book “Marijuana Is Safer: So Why Are We Driving People to Drink.”

Annapolis: New Septic Bill Struggles in the Senate

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A bill to require Best Available Technology (BAT) for all new construction on septic everywhere in Maryland is struggling to survive in the Senate.

The bill, SB266, sponsored by Sen. Joan Carter Conway, D-Baltimore City, would establish a 2012 regulation issued under former Gov. Martin O’Malley into law that required BAT systems for all new construction on septic, even beyond the critical areas.

Gov. Larry Hogan killed the O’Malley-era regulation last summer and limited BAT system requirements to the critical areas only. Hogan told the Maryland Association of Counties that the regulation “created a cost-prohibitive burden for Maryland homeowners and businesses” outside the critical area. BAT systems can cost up to $7,500 or more per home than conventional septic systems.

Critical areas are considered to be within 1,000 feet of the Bay or coastal areas.

Vote falls short

On Thursday a 22-23 vote fell short of advancing the bill, but it was brought back to life moments later when Sen. Ulysses Currie, D-Prince George’s, asked to reconsider the vote, although he did not change his vote.

Currie’s motion to reconsider cleared the way for Sen. Thomas “Mac” Middleton on Friday to offer floor amendments that would prioritize BAT requirements based on available funding in the Bay Restoration Fund. The amendment would have allowed conventional septic systems outside the critical areas if funding was unavailable.

The amendments failed 20-26.

Shortly after Middleton’s amendment failed, Sen. Edward Reilly, R-Anne Arundel, offered amendments to revert back to requiring BAT systems in the critical areas only. Those amendments were laid over until this week.

“It makes no sense to put an enhanced nutrient removal system in the middle of a farmland 25 miles from any critical area in the state and require [homeowners] to pay any more than necessary,” Reilly said. “This focuses the efforts and the money on the most important parts of the state.”

Senate President Mike Miller originally voted against the bill on Thursday but had a change of heart Friday after Reilly’s amendments were laid over. He asked the body to reach a compromise.

“Let’s pass the bill,” Miller said.

Flush tax money

The measure, if passed, would provide funding, if available, from the Bay Restoration Fund — where the “flush tax” goes — to subsidize the cost difference between conventional and BAT systems, currently estimated at $7,500, according to a legislative analysis.

An $8,000 fine would be levied for any home not using a BAT systems where required.

O’Malley put the regulation in place just weeks after signing the controversial Sustainable Growth and Agricultural Preservation Act of 2012, which put tighter limits on septic in subdivisions but preserved some local control over septic use.

Rural lawmakers and local governments reeled at the time and said it would put too many restrictions on development and was an affront to property rights of farmers and landowners.

The Act established the size and scale of major developments using septic systems as a way to encourage development closer to priority funding areas that could be served by sewage treatment plants.

by Dan Menefee