Category Archives: health care

Speaker Adrienne Jones and Senate President Mike Miller have appointed Van Mitchell, one of the most experienced and trusted Marylanders on health care policy, to the Prescription Drug Affordability Board. Unfortunately, Mitchell also has conflicts of interest that would give most pause before making the appointment.

Van Mitchell is awash in valuable experience for his new position on the Prescription Drug Affordability Board. A former Democratic legislator from Charles County, Mitchell served on the appropriations committee and understands the importance of health care in balancing the state budget. Known as a bipartisan, straight shooter, Mitchell also served as principal deputy health secretary under Gov. Bob Ehrlich and later as secretary of health during the first two years of Gov. Larry Hogan’s first term.

But Mitchell worked as a lobbyist between his two stints at the Department of Health. He joined Cornerstone Government Affairs shortly after leaving the Hogan administration. Records reveal that Mitchell represented Pfizer, a major pharmaceutical manufacturer, in 2014 and 2015.

Though Mitchell is not currently representing drug companies, one of his colleagues at Cornerstone, former Montgomery Sen. P.J. Hogan, does. Hogan currently represents AstraZenaca, Biotechnology Innovation Organization, and Johnson & Johnson. As a result, Mitchell is part of a firm that has a financial interest in pro-pharma outcomes.

None of this means that Mitchell might not be an outstanding member of the Board. He has direct political, administrative and legislative knowledge on this issue. He is also seen by a variety of different actors as someone who is trustworthy and tells it like it is.

At the same time, these are the sort of conflicts that normally raise red flags. No doubt it is exactly these sorts of connections that make progressives suspicious about the health care industry’s tentacles in health care public policy. Nevertheless, Mitchell made the right noises about drug prices in Jones and Miller’s press release.

Some might make the case that these sorts of problems plague anyone who has been deeply involved with an issue for decades. Many would argue that this shows why these officials should be prohibited from lobbying but others would contend that these limits drive people out of public service.

Except that not everyone becomes a lobbyist for the industry they used to oversee after they leave the legislature or administration. While Mitchell knows a lot and is trusted by Democrats and Republicans alike, Democrats would go banana cakes, to borrow one of Adam Pagnucco’s favorite expressions, if Republican Gov. Hogan appointed someone with these conflicts.

health care, Larry Hogan

Hogan Raises Taxes by $380 Million to Save Obamacare

March 17, 2018 David Lublin

The Washington Post reports that Gov. Larry Hogan has collaborated with the General Assembly to raise taxes in order to protect Maryland’s individual insurance market:

Gov. Larry Hogan (R) and Maryland’s Democratic legislative leaders have reached agreement on a one-year plan to stabilize skyrocketing individual health insurance premiums by taxing insurance companies and using the money to pay the biggest claims.

Legislation that won initial approval in the state Senate on Friday would levy a surcharge of about $380 million on insurance companies that do business in Maryland, which are paying about that much less in federal taxes this year because of a one-time exemption provided by the recent overhaul of the U.S. tax code.

Using that money for a “reinsurance fund” will lower premiums for everyone in the individual insurance market, officials and advocates said, heading off a potential crisis stemming from anticipated increases in premiums of between 30 and 50 percent and the possible departure of CareFirst, Maryland’s only statewide insurer for the estimated 154,000 individuals who buy their own plans rather than get coverage through an employer or government program.

In this way, the Governor is working directly against efforts by Trump and congressional Republicans to kill off the Affordable Care Act through executive actions and ending the individual mandate. In short, Hogan is working with Democrats to achieve their goal of protecting health care for all Marylanders.

Of course, it’s only a stopgap solution. If reelected, Hogan will have to extend the tax increase in one form or another in order to continue the reinsurance fund, or reestablish the individual mandate within the State of Maryland. No one can seriously believe that this is a one-time move.

It’s completely the right thing to do but destroys the narrative that Hogan has reduced taxes. As the most powerful governor in the nation, Hogan could have stopped the tax increase. However, the Republican base has little choice to stick with Hogan but cannot be pleased or motivated by this decision.

health care, unions

Standing Up for Quality Care at Holy Cross Hospital

August 16, 2017 David Lublin

Today, Seventh State is pleased to present a guest blog by Suzanne Mintz, a registered nurse working in the Neonatal Intensive Care Unit at Holy Cross Hospital and a leader of nurses’ effort to organize with National Nurses United.

It was a sweeping victory. A National Labor Relations Board Administrative Law Judge ruled decisively in July that the registered nurses (RNs) at Holy Cross Hospital (HCH) in Silver Spring had been unlawfully harassed, intimidated, surveilled, and retaliated against by the managers of the hospital [ed. note: decision posted at bottom of post]. On countless occasions, management illegally interfered with our important efforts to organize a union to protect our patients and improve working conditions.

I love the work I do as a neonatal intensive care (NICU) nurse. My fellow nurses and I care for the most vulnerable patients – premature and/or critically ill babies. Together we help struggling infants survive, grow, and thrive, and we are dedicated to giving each of them the best start in life we possibly can. Unfortunately, conditions in the hospital can make it unnecessarily difficult to do so.

It wasn’t long after I started working at the hospital almost six years ago that I began to notice problems that put patient care at risk: significant and regular under-staffing of nurses, shortages of supplies, and dirty spaces. Every parent expects the best care, support and setting for their vulnerable babies, often fighting for their lives, and every child deserves a high level of care.

Consider this: How does an individual RN properly monitor and care for multiple babies when she is also responsible for a baby born at 23 weeks, is the size of your hand, with skin that comes off with the slightest touch, requires six different medications plus daily blood and platelet transfusions? If you are the parent of that 23-weeker, wouldn’t you be upset if you found out that your baby’s nurse is not able to dedicate 100% of her time to your precious child? And what about this: As a parent wouldn’t you be shocked to hear that the reason the NICU floors are filthy and the trash is overflowing because the hospital has cut back on their housekeeping staff? Yes. That’s right. At a hospital.

That’s why registered nurses decided to organize at Holy Cross Hospital with the National Nurses Organizing Committee/National Nurses United. Starting with the NICU, and then moving throughout the hospital, we galvanized hundreds of nurses to advocate for patient safety and improved working conditions for nurses. Every step of the way we have been attacked, followed, and intimidated by senior administrators, unit managers, and hospital security. The hospital has spent hundreds of thousands of dollars on outside union busters who have targeted pro-union nurses. RNs have left employment at the hospital in big numbers for reasons that include the hospital’s lack of attention to patient safety and unfair working conditions, and others have buckled under the anti-union campaign of management and its huge parent corporation, Trinity Health.

Despite this pressure, many nurses have stood strong for our patients and our rights, and were attacked for it. Just ask Edith, an oncology RN at HCH who has been helping patients fight cancer for 13 years. Edith was a leader in the nurses’ effort to improve patient safety and care, so she was targeted in management’s union busting. Hospital management fired Edith for no defensible reason – a fact which became obvious when we pushed back and the hospital management was forced to re-hire her and provide 14 weeks of back pay and other compensation. A major life disruption for Edith is only one of many caused by unfair hospital management practices that have at times prevented HCH nurses from advocating for our patients.

Instead of working with us to improve patient care, hospital management did everything it could to stop us from exercising our rights. The judge agreed with nurses that management was acting unfairly. “Credible”, “unrefuted”, “undisputed”– these are some of the terms the judge used to describe nurses’ testimony about the unfair labor practices of management at the May hearing. And the judge told management to stop violating our rights and required the posting of notices around the hospital about labor law and how it had been violated.

Nurses have been vindicated by the decision. Despite the challenges posed by the administrators and managers, we continue to work to protect our patients and to organize a union to improve care and conditions at the hospital. All because we care deeply about our patients and providing the care they deserve.

HCH RNs have been deeply touched by the outpouring of support from the community for our patients and our effort to organize to protect them. In February, more than 100 people came out in the cold to stand with us for quality care, including community members, religious leaders, elected officials, and patients. Four area members of Congress, six of the nine Montgomery County Council members, and three quarters of Maryland legislators representing Montgomery County have urged Holy Cross Hospital management to listen to nurses concerns, respect our rights as workers, and stop their attacks on us. Nurses are proud to stand with our community, faith, and elected leaders.

We have continued our efforts to organize a union at the hospital so that we can be effective in our patient advocacy, and can protect ourselves and those we care for. We urge Holy Cross Hospital management to take this opportunity to stop its unlawful behavior, focus on patient care, and recognize and respect our rights.

Learn more about nurses’ unionization and patient advocacy efforts at www.Facebook.com/HCHNurses.

ALJ Decision Holy Cross by David Lublin on Scribd

health care

Democratic Statements on Hogan’s Veto of Earned Sick Leave

May 25, 2017 David Lublin

Bill Sponsor Del. Luke Clippinger (D-46)
Video Courtesy of Bryan P. Sears, The Daily Record.

Sen. Rich Madaleno:

Today the people of Maryland saw the Hogan Hype Machine at it again. Hiding behind the empty promise he offered in January, Governor Hogan vetoed real progress for the working families of Maryland.

Sadly, Hogan sat on the sidelines for while Democrats in the legislature did the hard work. If Governor Hogan truly cared about providing sick leave to more working Marylanders, he would have signed this compromise legislation today.

Republicans in Congress are working to dismantle our healthcare system and Hogan’s actions today denies 750,000 Marylanders the ability to see their doctor or care for a sick family member. We need a Governor who will stand with working Marylanders.

State Party Chair Kathleen Matthews:

Hard work should pay off, and working Marylanders shouldn’t have to decide between a paycheck and taking care of themselves and their families.

Democrats brought all sides of the table together to extend earned sick leave to more than 700,000 Marylanders.

Instead of heeding the calls of working Marylanders, Governor Larry Hogan dismissed them.

Voters will remember in next year’s election that Governor Larry Hogan put his own agenda ahead of the health of working Marylanders and their families.

Adam Pagnucco, health care, Larry Hogan

Hogan’s Point Man on Health Care Wants to Destroy the Affordable Care Act

May 25, 2017 Adam Pagnucco

By Adam Pagnucco.

Governor Larry Hogan may be silent on the efforts by President Donald Trump and congressional Republicans to gut health care, but his newly appointed Chair of the Maryland Health Care Commission has been anything but silent. To the contrary, Hogan’s new point man on health care has openly advocated for the destruction of the Affordable Care Act.

Robert E. Moffit, whom Hogan appointed Chair of the Maryland Health Care Commission on May 9, will now be playing a critical role in administering Maryland’s health care system. The commission is an independent agency with broad regulatory powers over health care providers in areas including IT, data reporting, performance evaluations, certificates of need authorizing new hospitals and expansions and much more. Moffit’s appointment would normally be confirmed by the Maryland State Senate, but since they do not return to Annapolis until next year, Moffit will have plenty of time to make his mark on the state’s health care system.

And that could be quite a mark. During his tenure as Senior Fellow at the Heritage Foundation, Moffit was a leading critic of the ACA, which provides health coverage to more than 400,000 Marylanders, and called for it to be repealed as soon as possible. Consider his views.

1. In one of many screeds against the ACA, Moffit said it was experiencing “multi-organ failure” and that “central planning is the disease.” One wonders what he thinks about other “centrally planned” health care systems like Medicare and the Veterans Health Administration.

2. Moffit wrote that Congress “should kill the employer mandate entirely,” thus leaving employees to fend for themselves in health care as they did before the ACA was passed.

3. Moffit enthusiastically endorsed the GOP’s plan to issue waivers to states so that they could excuse insurers from having to cover pre-existing conditions. In an article entitled “House Health Care Bill Moving in the Right Direction,” he wrote, “President Barack Obama and his allies in Congress should never have imposed centralized federal control over diverse state health insurance markets in the first place. While the best solution would be to repeal that federal overreach, the proposed waiver is a significant improvement over current law. Its practical effect is to achieve a devolution of health insurance rulemaking back to the states.”

4. Just weeks after Hogan appointed him, Moffit cheered on Trump’s budget, which called for $800 billion in cuts to Medicaid and converting it into a block grant program. Moffit wrote: “By putting Medicaid on a budget—either through a fixed allotment to the states in the form of a block grant or a per capita cap—the Trump budget would give state officials much needed flexibility in managing the program and better target services to the poorest and most vulnerable of our citizens.”

5. Last November, when criticizing the ACA’s poll numbers, Moffit wrote, “What ‘progressive’ politicians want, and their academic and media cheerleaders like, most Americans don’t want or like.” According to Gallup, the ACA’s approval rating went from 42% at the time Moffit wrote his article to 55% in April. Apparently, Americans want to have health care after all.

6. Moffit called the Republican House bill replacing the ACA “a major improvement over current law.” Yesterday, the Congressional Budget Office found that the House bill would increase the number of Americans without health coverage by 23 million by 2026. The office said, “Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums.”

In selecting Moffit, Governor Hogan has broken his silence on the Affordable Care Act. Moffit’s views are longstanding, well developed and very public. If Hogan had major disagreements with him on the ACA, why would he appoint him to one of the most powerful health care positions in Maryland? Actions speak louder than words, and this action speaks volumes.

Adam Pagnucco, health care, Larry Hogan

Will Hogan Stand By as Republicans Destroy Health Care in Maryland?

January 16, 2017 Adam Pagnucco

By Adam Pagnucco.

President-Elect Donald Trump and the new Republican-controlled Congress are proceeding rapidly to dismantle the Affordable Care Act (ACA). The law, a complicated amalgam of policy and funding requirements, has helped 20 million Americans gain health care coverage and has cut uninsured rates dramatically across many racial and ethnic groups. Its repeal threatens to throw millions of Americans out of health care coverage, including hundreds of thousands of Marylanders. And so far, Governor Larry Hogan is standing by silently and letting it happen.

The ACA has expanded health insurance coverage in two primary ways: setting up government-run health care exchanges and expanding Medicaid, the federal/state health insurance program for low-income people. In Maryland, 146,808 people are currently enrolled for coverage through the state’s exchange, Maryland Health Connection. The latter entity reports that roughly 278,000 more people are covered by the ACA’s expansion of Medicaid. All told, more than 420,000 Marylanders have obtained health coverage through the ACA and two more weeks remain in the enrollment period.

Marylanders in every county are enrolled in the state’s health exchange.

Under the ACA, the federal government has invested a lot of money in increasing enrollment. Maryland Health Connection reports that Maryland health care exchange participants receive about $225 million in annual federal tax credits to subsidize their individual health insurance premiums. The Kaiser Family Foundation estimates that the federal government spent $5.7 billion on Medicaid in Maryland in Fiscal Year 2015. These funding sources are now at risk.

Since it is a federal law, some changes to the ACA must pass a 60-vote hurdle to overcome filibusters in the U.S. Senate, where the GOP has just 52 seats. But budget items are not subject to filibusters. That means part or all of the above federal funding to support ACA enrollment could be eliminated in a budget passed solely with Republican votes and signed by President Trump. If that happens, millions of Americans and possibly hundreds of thousands of Marylanders could lose their health coverage.

That’s not all. The federal tax credits and Medicaid funding under the ACA support lots of jobs and income in the health care industry, and through the multiplier effect, the broader economy as well. A new study from George Washington University estimates that if the ACA’s tax credits and Medicaid funding are repealed, Maryland will lose 52,000 jobs by 2019. The study projects that Maryland will also lose $49 billion in business output and $982 million in state and local tax revenues from 2019 to 2023. All of this would be on top of any federal agency cuts that Trump and the Republican Congress might include in their next budget.

Any Governor would be expected to jump up and down about the prospect of losing tens of thousands of jobs and hundreds of millions in tax revenues as well as having hundreds of thousands of constituents lose health care coverage. But not Larry Hogan. He has stayed silent as Donald Trump and his Republican colleagues in Washington plan to destroy health care in Maryland. Hogan bristles at questions from reporters about anything going on in Washington, telling one of them that he was tired of “stupid questions about the Trump administration.” And yet, the Trump administration’s actions will have gigantic negative impacts on his state that he declines to oppose.

All of this begs the question. Is Larry Hogan with Donald Trump and anti-health care zealots in the Republican Party? Or is he with the rest of us?

Anthony Brown, Doug Gansler, health care, Heather Mizeur

More Health Exchange Troubles for Brown

February 27, 2014 David Lublin

The Washington Post has the story:

A single flaw in Maryland’s troubled online health insurance system will cost the state an estimated $30.5 million in excess Medicaid payments over the next 18 months because the system cannot accurately identify recipients who should be removed from the rolls, a report by state budget officials said.

The State has fired the contractor for its health exchange website but this problem just does not seem to want to go away. If anything, the increased functionality of the federal website just heightens the glare of Maryland’s continuing problems. Not a good news day for Lt. Gov. Brown who would like the focus to turn elsewhere.

Anthony Brown, Doug Gansler, health care, Heather Mizeur, polls

Marylanders Like Obamacare

February 19, 2014 David Lublin

The Washington Post reports that Marylanders approve of Obamacare by a 55-40 margin. The poll also says few attach blame to LG Brown but instead to state and federal administrators. One suspects that the share of Democratic primary voters who blame Brown is even lower.

I suspect that this aspect of the poll is more vulnerable to the answer choices provided. It is also unclear or whether voters deem the issue important or have fixed opinions. Campaigns also have the capacity to raise the salience of issues and to frame them in ways that opinions shift (i.e. who oversees those administrators blamed by the voters). However, the poll suggests that has yet to occur despite efforts by both AG Gansler and Del. Mizeur.

Seventh State