What is the greatest health care challenge facing Maryland today, and how do you plan to address it?
I believe the greatest imminent challenge is addressing behavioral health, which includes mental health and substance abuse disorders, which have been made greatly worse as a result of the pandemic. As the former chair of the Health and Human Services Subcommittee of Appropriations, I have advocated for years for complete parity between physical and mental health in terms of services and insurance coverage. The state lacks enough psychiatrists and related healthcare professionals, psychiatric beds, and crisis support. Additionally, there is a growing crisis in the affordability of prescription drugs, as recognized by the creation of the Prescription Drug Affordability Board by the Maryland General Assembly, which must be fully supported with the necessary resources so it can identify practical and effective solutions to lowering drug prices.
Maryland’s hospitals operate under a unique contract with the federal government that promotes community, equity, and value. It also contributes significantly to Maryland's economy. How do you plan to support the continued success of the Maryland Model?
As I mentioned, I chaired the appropriations subcommittee of the Health Committee in 2014, when the Maryland All-Payer System and the CMA waiver were in jeopardy. We worked closely with the Health Committee and all the stakeholders to modernize our system so Maryland could continue with its unique healthcare approach, which allows for healthcare innovation, economic stability, and improved outcomes for patients. Since 2014, Maryland has moved to an even more global and holistic approach to providing efficient, high-quality healthcare by including not only hospitals, but also doctors, home healthcare providers, skilled nursing facilities and others to encourage more coordination, establish incentives, and focus on the unique needs of our communities. By adding incentives to reduce hospital visits with our rate setting and global budgeting system, Maryland hospitals are now investing in community health and advanced primary care to successfully keep patients out of their doors and reduce healthcare spending. I believe lawmakers must champion our system when it is next up for review in 2023.
Maryland is experiencing a shortage of health care practitioners, especially nurses, that we project will worsen in the years ahead. How do you plan to address the immediate crisis and what will you do to make sure we have a robust and sustainable health care workforce pipeline?
To remedy this, I support a number of measures including promoting nursing as a career to high school students, and perhaps even earlier to students. Additionally, we need to reduce the obstacles to pursuing a nursing career, such as offering alternative financing options for pursuing a nursing degree. There also needs to be more professional support and opportunities to curb dropout rates in nursing programs and increase nursing educational resources. Finally, to address the immediate shortage, I support maximizing licensure reciprocity, recruiting more nursing teachers, and considering leveraging assessments as an alternative to some licensing requirements.
How would you increase availability of and access to health care for Marylanders?
You need a multi-pronged approach, including adequate funding for the Children's Health Insurance Program, continuing strategies to increase the Medicaid expansion, and supporting ACA reforms to reach more people. We also need to invest in a diverse healthcare workforce that is culturally competent to help reduce disparities and to ensure better screening to identify health-related social needs and work with patients to address these. I also think clinicians can do more in local school districts and health departments to increase primary care and dental services for children and families and help to reduce ER visits. Finally, we need to leverage virtual care in appropriate medical situations to improve access to care, remote monitoring, and to reduce the burden of traveling for medical care.
What policies will you pursue to improve health for all Marylanders? Please also consider the social determinants of health?
Western medicine is great at producing the most advanced drugs, therapeutics, diagnostics, and successful, complex surgeries. But where we have fallen down is in preventative care and screening, which has only recently started receiving the attention and resources it deserves. More often than not, most of the doctors I visit do not delve into my lifestyle, including sleep, diet, exercise, and stress, to name a few. And far too many people do not realize how important these factors are to their underlying and long-term health. Just for example, obesity is one of the leading causes of poor health in this country, and it has only gotten worse. Thus, I support a strong partnership and intersectional approach to educating people, with a big emphasis in medical education, that these lifestyles and behavioral issues are fundamental and must permeate all aspects of health and healthcare. As the question suggests, there are also social issues that can have a great effect on health, including poverty, social and family support, the caliber of public K-12 education, employment, and housing. And these factors can make it harder to make improvements in lifestyle. There needs to be more recognition of these factors, especially by primary health care professionals and a comprehensive approach to compassionately and empathetically addressing these issues with patience and the larger community.
How do you plan to address consumers' growing exposure to health care costs, such as high deductible health plans and rising prescription drug prices in Maryland?
In addition to supporting the renewal of the Maryland Cost of Care model, I support the newly-created Prescription Drug Affordability Board. That Board must fully evaluate why U.S. drug prices are so high (and higher than other countries) and what can be done to bring prices down. This is a complex subject and there are many trade-offs that need to be transparently explained to our citizens. I am aware that higher drug prices come from our world-class research and development, the high risk of bringing a drug to market, and the need for high levels of investment and patent protections to help incentivize that investment. But the U.S. has created a monopoly for drug companies, and economics teaches us that monopolies create excesses, and the only way to address monopolies is through regulations, yet the U.S. does not allow for (except for the VA) the regulation of drug prices typically conducted through negotiations. Progress in lowering drug prices must include changing the status quo.
Maryland’s worsening medical liability climate, as noted in a recent independent report, threatens access to, and affordability of, health care services in Maryland. Plaintiffs’ attorneys typically take 40% of a medical malpractice judgment. Do you support limiting attorneys’ fees so that the affected individuals can receive more of their settlement or judgment? What additional reforms would you support that balance supporting individuals and families harmed by medical malpractice with ensuring continued access to services in a community?
I would look to the more comprehensive report by the Health Services Cause Review Commission (HSCRC) in addressing the worsening medical liability climate in Maryland. This report not only discusses capping attorney’s fees, but also using a sliding scale to tie these fees to the amount of the reward. Additionally, Maryland should look at what other states are doing to determine if these efforts would improve the liability issues in our state, such as birth injury, patient compensation, and/or excess liability funds, which seem to be borrowing from the concept behind workers compensation and no-fault insurance. Additionally, the state should revisit its ever-increasing cap on non-economic damages and other tort reform measures listed in the HSCRC report. Just by way of background, my law school senior thesis in 1986 involved drafting Maryland’s first punitive damage cap legislation, which former State Senator Julian Lapides introduced on my behalf. Although the bill did not make it out of committee, a nearly identical bill was passed several years later.
What are your priorities should you be elected, not confined to health care?
Looking at issues at the state level, I am committed to supporting the full implementation of the Blueprint for Maryland’s Future landmark education bill, expanding Maryland’s land preservation programs, and providing more funding and strategies to make it affordable for seniors to age in place, rather than going to institutional care.
Locally, Harford County is a great place to live, work, and raise a family. We care deeply about our quality of life, having decent well-paying jobs, stable, safe communities, and high-quality public K-12 education. None of this happens by accident, but rather by our communities being supported with strong advocacy for their concerns and values by results coming out of Annapolis. This will be my mission.