Our values: Health, health security, safety, protection, quality of life
Our vision: Every American should be able to get the health care they need, when they need it, at a price they can afford. But for years, insurance companies charged too much, their policies were full of holes, and coverage was easily denied or revoked. The Affordable Care Act changed that, providing families with a new and greater measure of health security. There remains much to be done: (1) guarantee coverage to every American as a matter of right; (2) encourage healthy behavior and protect others from unhealthy behaviors; and (3) allow people to make their own health care choices.
The Trump Administration weakened the Affordable Care Act (ACA), which made it necessary for each state and locality to expand health care. One step, already employed by Maryland, is to create a study commission to recommend policies to help people become or remain insured, and to control costs. Those may include a reinsurance program, fair share disclosure, and a series of measures to lower prescription drug prices.
Preventable behaviors such as tobacco use, poor diet and physical inactivity, and alcohol or other drug use are the underlying cause of half of deaths in the United States. A progressive government encourages healthy behaviors while leaving ultimate decisions to the individual. The biggest preventable killer remains tobacco, which claims more than 480,000 victims every year. Jurisdictions can discourage smoking by raising the tobacco tax, implementing workplace smoking and e-cigarette bans, increasing the minimum age to purchase tobacco, and offering smoking cessation programs. States, localities and school boards can improve nutrition and physical fitness programs available in schools and also increase opportunities for athletics, walking and biking in communities. States and localities can raise alcohol taxes, crack down on sales to minors, and rethink whether their drug laws and enforcement systems are an efficient way to discourage the use of dangerous drugs.
Too often, people who are sick or dying are not given choices that should be theirs to make. If a doctor thinks that a patient with glaucoma, multiple sclerosis, nausea from chemotherapy or chronic pain would benefit from medical marijuana, the patient should have that choice. If patients would benefit from palliative care, they should be told. And if a terminally ill person wants to have some control over the time of his or her own death, that should be their decision, not the government’s.
FEATURED POLICIES FOR 2021
Americans are struggling to afford the prescription drugs they need, often having to choose between their medication and other necessities, like rent and groceries. States can respond by creating a Prescription Drug Affordability Board, an independent body with the authority to evaluate high cost drugs and set a reasonable upper payment limit that applies to all purchasers and payer reimbursements.
In an average state, at least tens of thousands of residents qualify for free or reduced-cost health coverage but are not currently enrolled. Where there is a state income tax, residents can be automatically enrolled in heath programs based on the income they report. Maryland has led the way with such an “easy enrollment” program.
Health disparities exist in urban, suburban, and rural communities, and communities where significant health disparities exist also often face shortages in the primary health care workforce, including nurses. The Health Enterprise Zones Act enables localities and nonprofits to propose plans for underserved geographic areas where health care practitioners may receive incentives to improve access to and quality of health care.
Smoking is the leading cause of preventable deaths in our nation, killing more than 480,000 Americans each year. More than 90 percent of smokers start as teenagers and, therefore, young people are heavily targeted for advertising by the tobacco industry. The Protecting Young People from Tobacco Act would raise the tobacco age to 21, cut the number of people who start smoking, and reduce deaths, disease and health care costs caused by tobacco use. Six states (CA, HI, MA, ME, NJ and OR) as well as at least 350 localities (including Boston, Chicago, Cleveland, Kansas City and New York City) have raised the age for tobacco sales from 18 to 21.
Conduct an affordable care assessment
States and localities can follow the state of Maryland by creating a commission to recommend policies that strengthen coverage and lower healthcare costs.
Create a reinsurance program to lower costs
A few states have successfully stabilized health plan premium increases on their exchanges for individual plans by implementing a reinsurance program. Such a program, created by the Healthcare Reinsurance Act, pays catastrophic claims but requires a 1332 waiver from the federal government. Most recently, Maryland’s waiver was approved in August 2018.
Ban flavored tobacco and vape products
Massachusetts has enacted the most comprehensive ban on the sales of flavored tobacco products, including mint and menthol cigarettes and dozens of vape products. As the American Heart Association explains: “The tobacco industry uses [flavored products] to start kids on tobacco and addict them to nicotine. In fact…97 percent of youth e-cigarette users prefer flavored products.” A ban on flavored tobacco and vape products saves children’s lives.
Stop prescription drug price gouging
Prescription drug prices rose about ten percent each of the past five years and drug costs are the fastest-growing component of health care in most jurisdictions. So, it is not surprising that the overwhelming consensus among Americans is that pharmaceutical companies are charging too much. In 2017, Maryland enacted first-of-its-kind legislation to directly address high drug prices. The Prohibition on Price Gouging for Essential Generic Drugs Act allows the state Attorney General to go to court to stop unconscionable price increases for certain medicines.
End gag rules on pharmacists
Pharmacy benefits managers (PBMs), on behalf of health insurance companies, often prohibit pharmacists from informing their customers about less expensive ways to pay for their medicines. Such contract provisions are unfair to both pharmacists and their patients. The No Gag Rule on Pharmacists Act prohibits health insurance companies and PBMs from using contracts to prevent pharmacists from telling their customers about cheaper ways to buy prescription drugs.
E-cigarettes are battery-powered devices that mimic cigarettes. A heating element vaporizes a nicotine liquid, which is inhaled by the user. Both the benefits and risks of e-cigarettes are rather uncertain, but nicotine is certainly an addictive substance and some teenagers who were otherwise nonsmokers are using e-cigarettes. Nine states and more than 500 localities have specifically applied workplace smoking bans to e-cigarettes, in part because their safety is not established and because their use causes confusion as to where smoking is allowed.
End-of-life palliative care
All too often, terminally ill people are not provided adequate information about their physical condition or counseling about palliative care and end-of-life options. Too often they feel abandoned by the healthcare system and suffer unnecessary physical or psychological pain. People have a right to know when treatments offer only a tiny chance of prolonging their lives for a few weeks or months. And they have a right to know about palliative therapies which could make them feel a lot better for their remaining time. A few states now require healthcare providers to address the needs of the terminally ill. In New York, for example, when a disease is terminal and patients are unlikely to survive six months, doctors must inform them of this, and advise them of available medicines and treatments that comfort rather than cure. Palliative treatment can ease anxiety and pain, and can be administered at home, a hospice, or a specialized hospital unit. A good law also encourages the creation of interdisciplinary palliative care teams to provide medical, spiritual, psychological and practical support to patients and their families. And just incidentally, by eliminating medical procedures that patients don’t want, it also saves many millions of dollars.