With tight purse strings in Annapolis, health care advocates push for improved access to care, lower drug prices
- January 23, 2024
In what is shaping up to be a financially difficult year for the Maryland General Assembly, community health and hospital advocates hope state lawmakers consider bills that would improve access to care for low-income Marylanders, help reduce high-cost drug prices and reform prior authorization practices.
Maryland Gov. Wes Moore has labeled the next few months “a season of discipline” as the state faces a projected $761 million budget deficit that is expected to grow in the coming years. And lawmakers have plenty of other priorities to balance, from funding the state’s education system through the Blueprint for Maryland’s Future to expanding mass transit via the Red Line.
Still, health care advocates like Gene Ransom, CEO of MedChi, the Maryland State Medical Society, are hopeful about what they’ll be able to accomplish — even, for Ransom, in light of recent cuts to Medicare payments to physicians and hospitals.
“You don’t have to be the most connected lobbyist in Annapolis to know that money is tight down there,” Ransom said. “But again, all we’re asking for is to keep us where we are today. We’re not asking for anything crazy. We just want to make sure that some of the cuts that we’ve seen implemented in D.C. are not passed down to Maryland.”
Improving access to care
While Ransom said MedChi tends to keep an eye on all health care bills during the legislative session, the organization — which advocates for and represents physicians — has two key priorities this year.
In November, Medicare administrators announced a 3.37% Medicare physician pay cut, which took effect Jan. 1 on top of last year’s 2% pay cut. Pay for Medicare physicians have fallen by 26% since 2001, according to the American Medical Association, the professional and lobbying group for physicians and medical students.
As Medicare reimbursement rates drop, Ransom said, it’s also vital to keep rates stable for Medicaid, which serves more than one of every four state residents.
“When you lower Medicaid rates, you obviously end up having more physicians leave the network,” Ransom said. “When more physicians leave the network, it means it’s harder for Medicaid patients to get access to their practitioners.”
MedChi is also pushing to reform prior authorization, a health plan cost-control process that requires physicians and other care providers to get approval from insurance companies before delivering certain medications, tests and services. Decisions about care should be determined by doctors and their patients — not insurance companies, Ransom said. As the practice currently stands, it restricts access to care and eats away at physicians’ limited time, he said.
Lawmakers this session also will revisit the End-of-Life Option Act, a bill already filed that would release a doctor from liability if they prescribed fatal drugs that a patient with a terminal illness took themselves.
Senate President Bill Ferguson has described aid-in-dying bills as the hardest to debate in the legislature, as they deal more with lawmakers’ personal experiences than with politics. However, he’s said he anticipates the End-of-Life Option Act will pass out of the Senate this year. Moore also indicated he would sign the bill if it reaches his desk.
Lowering drug prices
Another group that will be pushing for improved access to health care is the Maryland Health Care for All! Coalition, led by longtime advocate Vincent DeMarco.
In September, DeMarco said the organization would be lobbying for legislation to expand the authority of the still-young Prescription Drug Affordability Board. If passed, the bill would allow the five-member board to use upper payment limits to make high-cost medications more affordable for all Marylanders — not just those who work for state and local governments.
Previously, DeMarco has pointed to polling conducted for the coalition by an Annapolis-based firm, which demonstrated strong support for the prospective bill. During the session, he also plans to cite a report published Tuesday by Public Citizen — a progressive consumer rights advocacy group — that showed the manufacturers of 10 high-cost drugs spent $22 billion more on advertising and self-enriching expenditures than research and development.
The report’s authors claimed that the finding counters common arguments from pharmaceutical companies — that regulating drug prices will reduce industry profits and capacity to invest in the research and development of new medicines.
And, DeMarco added, “These really wonderful drugs aren’t doing people any good if they can’t afford them.”
DeMarco’s coalition also plans to support the Access to Care Act, a bill championed by CASA last year that would allow undocumented immigrants to purchase health coverage through the Maryland Health Benefits Exchange.
“We’re going to fight very hard for whatever legislation is introduced,” DeMarco said.
Priorities for hospitals
This year, the Maryland Hospital Association — which represents 62 nonprofit hospitals and health systems in Maryland and Washington, D.C. — will push to improve transitions between levels of care for patients, strengthen the state’s health care and hospital workforce, and protect the state’s liability climate, said Erin Dorrien, the organization’s vice president of policy.
The organization plans to support legislation that would create a pathway for courts to make expedited decisions about guardianship for patients whose release from the hospital hinges upon that ruling.
“We think that this will help move patients through, get patients to the level of care that they need and move patients from an emergency department into those beds,” Dorrien said. “Right now, we have people waiting in hospital beds for months and up to a year, waiting for a guardianship decision.”
Maryland consistently has ranked last in the nation in terms of the time patients spend waiting in emergency departments before they are discharged or admitted.
The Maryland Hospital Association also intends to work to ensure there is funding for the loan assistance repayment program, which helps physicians and physician assistants who work for two years in a medically underserved area or an area with a shortage of health professionals.
And, Dorrien said, the organization will be supporting the Access to Care Act, as well.
Funding rape crisis centers
Last legislative session, the Moore administration allocated $1 million in new general funding to community-based rape crisis centers.
This year, the Maryland Coalition Against Sexual Assault is pushing for a continuation of that funding to face an increase in demand for crisis services following the pandemic and keep up with workforce challenges, said Lisae Jordan, executive director and counsel for the organization.
The organization, which represents the state’s 17 rape crisis centers and other professional, programs and advocates committed to ending sexual violence, also supports a bill that would create a statutory definition of consent and “make it clear that people have the right to control who touches their body in a sexual manner,” according to its legislative agenda.
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