Health care legislation preview: Maryland advocates want to focus on access, patients in 2024 session

Health care-focused organizations across the state are hopeful that the 2024 legislative session will be a year that reins in health costs and allows patients to have greater access to the care they need.

“We really want to talk about the patient,” said Gene Ransom, CEO of MedChi, The Maryland State Medical Society, discussing the organization’s priorities for the upcoming session.

“This year, I’m hoping will be the year that we talk about access and patients, and that will be the thing we focus on,” he said.

There will likely be several health-focused bills considered during the 2024 legislative session. But in a fiscally constrained budget year, Gov. Wes Moore (D) has said that he and the legislature will have to make “tough choices” regarding funding initiatives.

The 446th session of the General Assembly convenes Wednesday.

While MedChi plans to offer support for many bills in 2024, the organization is pushing for two main legislative efforts. One is to ensure that low-income patients have access to physicians across the state, and the other is to ensure that there are not bureaucratic hurdles for patients to receive the care and screenings they need.

The group wants to put restrictions on what’s called “prior authorization,” which is when certain procedures need approval from an insurance company before they can be provided to a patient, Ransom explained.

“And that is incredibly frustrating because, what happens is usually those types of things are complicated to fill out, it’s extra paperwork. It’s time,” Ransom said. When insurance companies deny coverage for certain medications, procedures or screenings, the patient and doctor may look to other methods that would be covered but might not be the most effective treatment.

“We believe that the physician and the patient relationship is sacrosanct, and the physician and the patient should decide what the treatment is and it should be provided. It doesn’t make sense for the insurance company to put barriers in between that relationship,” he added.

MedChi also wants to ensure that physicians are provided appropriate reimbursement rates for seeing patients who are enrolled in Medicaid, the federal health care plan available for people who fall below a certain income level.

Low-income patients can experience health issues that are unique because of their economic needs, Ransom explained, so some physicians may not want to take on Medicaid patients without appropriate reimbursement.

“We want to make sure that doctors and practitioners who are in Maryland are in the Medicaid network, and are seeing poor people and helping them out,” he said.

For the upcoming session, some issues that were at the forefront of legislative priorities in 2023 might not be as high of a priority, such as expanding abortion protections.

In 2023, Gov. Moore approved several bills on abortion, such as protecting the medical privacy of those seeking an abortion in Maryland and giving Marylanders the opportunity to vote on whether to add reproductive freedom to the state’s constitution, among other measures.

“We did so much last year,” said Sharon Blugis, executive director for Reproductive Justice Maryland. “I don’t think we’ll have a whole lot this year. I think the advocates are pretty worn out,” Blugis said, though the organization will likely still be involved during session.

There is also renewed interest in passing a controversial “medical aid-in-dying” bill that would allow terminally ill patients to determine when and how they die with the help of a physician. While supporters of aid-in-dying bills say it would give patients more control over their final moments, many in opposition argue that the procedures could be abused and misused against disabled and terminally ill patients.

Expansion of drug affordability board

Maryland’s Prescription Drug Affordability Board is tasked with finding ways to reduce the costs of medication for employees on the state’s health care plan. But the Maryland Health Care for All Coalition wants to help pass legislation to expand the authority of the board, so that cost reduction efforts might also impact all Marylanders.

Vincent DeMarco, president of the coalition, told Maryland Matters that the legislation will be filed later this month. DeMarco told Maryland Matters that the expected sponsors of the bill will be Del. Bonnie Cullison (D-Montgomery) and Del. Jennifer White Holland (D-Baltimore County) in the House and Sen. Dawn Gile (D-Anne Arundel) and Sen. Brian Feldman (D-Montgomery) in the Senate.

The proposed legislation has earned the support of House Speaker Adrienne A. Jones (D-Baltimore County) who said lawmakers “need to consider all the opportunities and options available to us” in order to make prescription drugs more affordable.

“I think it has a good shot,” DeMarco told Maryland Matters.

The board has been slow to begin operating and has not yet implemented measures to bring down drug costs, due in part to a veto from former Gov. Larry Hogan (R) amid pandemic-induced economic uncertainty in 2020.

Over the past few months, the board has approved rules outlining the initial procedures to identify which drugs may be eligible for price reduction efforts. The state board expects to be able to identify the first set of medications for consideration in January, if not shortly after.

Despite the slow beginning, DeMarco still thinks it’s an appropriate time to expand the authority of the board so that more Marylanders can see savings from prescription drug costs, should the board be successful.

“The board has done a lot of legwork that would allow them to quickly move forward,” DeMarco said. “I think the legislature and the [Moore] administration has a lot of faith in the board to do the right thing. We shouldn’t tie their hands.”

Insuring undocumented Marylanders

One of the taller orders for the 2024 legislative session is an effort to expand health care access for Maryland’s undocumented population.

In November, the immigrants’ rights group CASA announced that they will be pushing for the General Assembly to pass legislation to create accessible health care for all Marylanders, regardless of citizenship or employment status.

In the 2023 legislative session, a billed called the Access to Care Act would have done just that. While the legislation was approved in the House of Delegates, the it was not voted on in the Senate.

The House Health and Government Operations Committee recently reviewed a study projecting how much it might cost the state to provide full or partial health care coverage to the undocumented community, which could costs millions to a billion dollars for the state, depending on the magnitude of a proposed health care expansion.

Groups like Health Care for All and MedChi are also in support of providing health care coverage to undocumented Marylanders, in order to reduce the state’s uninsurance rate and insure as many people as possible have access to health care.

But in a constrained fiscal year for the state, efforts such as providing health care access to undocumented residents may struggle to reach the finish line and become law.

“One of the challenges with that is we have to be realistic with what’s going on the budget,” Ransom continued. “And the numbers are tough. Some of those items might have fiscal notes to make them hard. This session might not be about health care. It might be more about money.”

Editor’s Note: This story has been updated to correct the title of the group “Health Care for All” in one reference.

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