submitted  by Nora Miller Smith 

The COVID-19 pandemic has reinforced one of the fundamental principles of public health: “No one is safe until everyone is safe.” 

The LWVMD believes that healthcare is a human right. ALL Marylanders need accessible, equitable, affordable, comprehensive, quality health care, which includes disease prevention and health education, primary care, reproductive health care, acute care, long-term care, and mental health care. 

Marylanders’ access to equitable health care was improved last year with the passage of important legislation including: Healthy Babies Equity Act, Abortion Access Act, Dental Coverage for Adults on Medicaid, Consumer Health Information Act, Insulin Cost Reduction Act, and Small Business and Nonprofit Health Insurance Subsidies Program Workgroup. But more work needs to be done.

The Maryland Legislature’s Issue Papers 2023 Legislative Session references the Commonwealth Fund’s 2022 Scorecard on State Health System Performance for Maryland. While Maryland did well in terms of adult smoking (ranking fourth out of the 50 states and D.C.) and suicide deaths (ranking sixth), its state ranking was 27th for infant mortality, 45th for drug overdose deaths, and 46th for adults with mental illness reporting unmet need. “Disparity indicators” such as uninsured adults (23rd), uninsured children (28th), adults who went without care because of cost in the past year (39th), or children without all recommended vaccines (41st) illustrates the severity of too many Marylanders’ unmet health care needs. 

Racial and ethnic health equity disparities were evident in the report as well. Twelve percent of U.S. adults age 19-64 are uninsured. But in Maryland, while only 4% of White residents are uninsured, 29% of Latinx residents have no health insurance coverage. The Issue Paper notes that “Maryland’s health outcomes are considered lower than expected given that the State has one of the highest median household incomes in the U.S.” 

It is expected that multiple bills will be introduced this year to expand health care access and equity. Some initiatives that the League will support include:

-Increasing health insurance coverage for more Marylanders. Approximately 6% of Marylanders have no health insurance, which includes 225,000-275,000 undocumented immigrants who are not eligible for insurance through the marketplace or Medicaid. Increasing subsidies and changing the regulations so that more Marylanders, including undocumented immigrants, can purchase coverage through the marketplace will help reduce that number, as will expanding eligibility for coverage under Medicaid. 

-Increasing behavioral health services, including home, community, and school-based resources for adults and children, especially in underserved communities

-Protecting access to reproductive health care. Last year’s Abortion Access law expanded the types of medical providers able to provide abortion care, and required health insurers and Medicaid to cover abortion services without cost sharing. This year the legislature is expected to reintroduce the proposal to add an amendment to the State constitution establishing “the fundamental right to reproductive liberty.” This is more important than ever due to the Supreme Court’s overturn of Roe v Wade last year.

-Shielding medical providers from prosecution when caring for pregnant people needing abortions who travel to Maryland from states with abortion bans.  

-Expanding Medicaid coverage for gender-affirming care. Many private insurances cover a wide variety of medically necessary and life-saving treatments for Marylanders with gender dysphoria. Medicaid coverage for low-income Marylanders, however is very restricted. This is discriminatory, and is counter to both Maryland and federal law. 

-Decreasing food insecurity by supporting efforts to simplify the application process for SNAP benefits, and to improve the operation of the program.

-Reducing the number of Marylanders saddled with medical debt, and ensuring that those low-income patients who had been eligible for free hospital care but who had incorrectly been billed- and had paid those bills- will be reimbursed.

-Increasing transparency in medical billing and strengthening patient rights.

-Strengthening school vision services, so that children who fail vision screenings are able to obtain comprehensive care, including eyes exams and, if needed, glasses. 

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