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General Assembly 2019: What needs to happen this year and what can wait

From The Baltimore Sun

By The Baltimore Sun Editorial Board

January 9, 2019

EXCERPT:

The General Assembly reconvened today at noon with lots of fresh faces in both the Senate and House of Delegates. That means lots of energy, enthusiasm and ambition but not necessarily much experience in getting things done in Annapolis. The first year of a new term is rarely the most productive, but the 188 men and women who will be sworn in today will face pressure to act on a host of major issues in education, health care, the environment, public safety and much more. Some are unresolved business from the last four years, and others are new territory even for veteran lawmakers. Realistically, legislators won’t be able to get everything done this year that they and advocates would like.

Some triage is in order. Here’s our take on the issues the General Assembly can and should address this year and the ones that can wait.

Must do

Health care: Maryland had great success last year in shoring up its Affordable Care Act insurance exchange, which saw substantial decreases in premiums for 2019 and, consequently, an increase in enrollment at a time when other states experienced sharp drops. But the work isn’t done. The top priority is enacting a state-level requirement for most individuals to have health insurance, which will help ensure that more young, healthy people stay in the risk pool, thus constraining premium costs for everyone. Health advocates’ proposal to structure the mandate in such a way that the uninsured could use their tax penalties as a down payment on a qualifying insurance plan is a substantial improvement over the ACA’s initial concept.

This year’s decrease in premiums was the result of a new state reinsurance fund, which effectively covers the cost of the most expensive patients and thus improves the composition of the risk pool. It was funded by enacting a one-year health insurance premium tax, which replaced a federal one that Congress suspended for a year. The money will cover the reinsurance program at some level for three years, but after that, its fate is uncertain. At a minimum, the General Assembly should make the state-level premium tax automatic in any year in which Congress suspends it, which has happened on several occasions.

Finally, a major driver of health care costs is the rising expense of prescription drugs. Health care advocates have worked for years to lay the groundwork for a proposed prescription drug price review panel that could serve as a check on egregious and unjustified price increases. It’s a more comprehensive approach than a generic drug price gouging bill that passed during the last term (and whose fate is now in the hands of the courts), and we believe this is the year it should pass.