We’ve led a number of successful initiatives during our 20 years in Annapolis. Here is a brief look at some of our bigger wins over the past two sessions.
2013 Highlights
Gas Tax Increase – We worked with two clients on this initiative.  Working with 1000 Friends of Maryland and a large coalition, we helped enact the first gasoline tax increase in Maryland since 1992 and ensured that a good portion of the money will go toward mass transportation projects, including the Purple Line and Baltimore’s Red Line.  On behalf of the Chesapeake Bay Foundation, we secured nearly $500 million in the legislation for stormwater upgrades on State Highway Administration roadways. This legislation didn’t poll very well and there was a host of opposition in Annapolis throughout session. But we worked to educate legislators about the quality of life issues that arise when a state’s transportation system is allowed to decay and crumble.  Commutes get longer and longer. Businesses can’t transport their goods quickly or safely. Lives are even at risk if bridges or roadways collapse from severe long-term neglect.  Clients – 1000 Friends of Maryland and Chesapeake Bay Foundation

Biotechnology Investment Tax Credit – A coalition of biotechnology investment firms, led by 20/20 Gene Sciences, Inc., hired us to extend the period during which a biotech firm can receive the state biotechnology investment tax credit. Under previous law, a company would age out of eligibility for the investor tax credit after the company was 10 years old, even if the firm was started well before the credit was in existence. The new law states that a company ages out 10 years after it first receives a tax credit from the state, levelling the playing field among eligible companies.  Client – 20/20 Gene Systems, Inc.

Baltimore City Public Schools Construction and Revitalization Act – This legislation will yield approximately $1 billion to replace and upgrade Baltimore City’s dilapidated public schools. Funding will come from State Lottery proceeds and existing Baltimore City revenues.  Client – Advocates for Children and Youth.

Record funding for Chesapeake Bay Restoration Programs – Despite the state’s ongoing fiscal difficulties, we secured another round of record funding for Chesapeake Bay restoration, staving off proposed cuts in the Chesapeake and Atlantic Coastal Bays 2010 Fund, securing additional funding for 2010 Fund projects in the capital budget and reversing cuts to Program Open Space that were adopted in the Senate’s first passage of the capital budget.  Clients – Chesapeake Bay Foundation, Citizens Campaign for the Environment and Partners for Open Space.

Medicaid Coverage for Emergency Room Telemedicine – Modern technology allows hospitals and clinics to take advantage of advanced medical expertise through high-speed visual communication between their facilities and medical experts located at home, their office or other facilities. This is especially helpful in the emergency room setting where time is of the essence and the ability to link patients with specialists in real time can save lives, prevent suffering and even save money. In 2012 the American Heart Association worked with a coalition of health advocates and enacted legislation requiring private insurers to cover telemedicine in most cases. We went back in 2013 to require the same coverage in Medicaid. State health officials were sympathetic to the issue and agreed that properly designed coverage would provide savings in the long run. They were concerned that in the short-term the coverage would inflate state Medicaid expenditures and bust the budget, and because of that opposed the bill in its original form.

We worked with DHMH Secretary Josh Sharfstein and his staff to craft the Medicaid coverage to be more narrow than the private insurance mandate. Coverage was limited to treatment of cardiovascular disease in the emergency room setting. This provides coverage when decisions must be made quickly and delaying by even a few minutes could cost lives. This coverage should also prove cost-effective right away and provide strong evidence for expanding coverage to other services in the future. DHMH was still leery of providing the coverage, but we had lobbied the Senate Finance and House Health and Government Operations Committees and they eventually imposed this reasoned compromise on the Department. Client – American Heart Association.

Limiting the ACA’s Smoking Surcharge in the Maryland Health Benefit Exchange — Right before the 2013 General Assembly Session started, the federal government issued regulations regarding the Affordable Care Act that allowed states to impose a surcharge on smokers of up to 50 percent of the normal premium. This directive caught state officials in Maryland and around the country by surprise, as they all expected federal guidelines would not allow a surcharge. The American Cancer Society and American Heart Association opposed the surcharge because it could discourage smokers from admitting their habit and seeking treatment for their deadly addiction. With little time to crunch numbers and assess potential impacts, the Administration and legislative leaders worried about imposing state authority forbidding the surcharge in the first premium year.

The American Cancer Society and American Heart Association were sympathetic to the state’s plight considering the lateness of the federal dictate. But they were determined to ensure that smokers would be eligible for affordable coverage that would help them quit when they are ready. We crafted an amendment that requires the Maryland Health Benefit Exchange and the Maryland Insurance Administration to track how many smokers are forced to pay a premium in the first year and to determine if there are any impacts on smokers’ ability to purchase coverage on the Exchange. Requiring the Exchange to track surcharge data prospectively was critical since it most likely would not have been available otherwise. ACS and AHA (and many others) believe that the active tracking of such information will prevent insurers from imposing the smokers’ surcharge because they know doing so will spur legislation forbidding the practice.  Clients – American Cancer Society and American Heart Association.

Implementing Comprehensive Palliative Care in Maryland Hospitals – For years, health care advocates have been working patiently to integrate palliative care into our health care system. The path hasn’t been easy because Western medicine has always been geared toward curing disease and fixing ailments, not in treating the human being as a whole. And insurers have often balked at providing coverage for services they don’t view as medically necessary. In the summer of 2012 a workgroup focused on legislation that would require comprehensive palliative care in all Maryland hospitals within a couple of years. The American Cancer Society was eager to expand palliative care in Maryland but worried that the original legislation was moving too far too soon, and would create a mandate that couldn’t be implemented by the current workforce under current training levels. Many hospitals around the state concurred. On the other side some institutions continued to oppose any implementation, arguing they just couldn’t handle the expansion of services.

We helped the American Cancer Society assemble a coalition of hospitals and providers and crafted a compromise that will accelerate the implementation of palliative care programs at a workable pace. We worked with members of the Senate Finance Committee and House Health and Government Operations Committee to convince the original workgroup that going slower and getting it right was more important than plowing full speed ahead. With that group on board we were able to defeat the opposition and enact what is believed to be the first comprehensive palliative care legislation in the United States.

The Maryland Health Care Commission will select at least five hospitals around the state to implement pilot palliative care programs. Under the current terms many hospitals have volunteered for the pilot and are eager to get started. The Commission will work with selected hospitals to identify needs, help them acquire additional services and assess what additional training and resources are necessary to implement the program in all hospitals statewide. Client – American Cancer Society.

2012 Highlights
Clean Water, Healthy Families Campaign – Conventional wisdom in Annapolis is that you can’t raise two fees in the same year on the same issue, but we proved that axiom wrong when we helped create, frame and enact this comprehensive clean water program. The three-bill package included an increase in the Bay Restoration Fund fee (“Flush Fee”), creation of local stormwater management fees and a landmark growth management law called the Sustainable Growth and Agricultural Preservation Act. All three faced substantial opposition from a host of well-financed special interests. But extensive polling and focus groups helped us craft and deliver strong messages to the public and elected officials. The votes were close, but in the end we pushed all three across the finish line. Client – Chesapeake Bay Foundation.

Oral Chemotherapy Parity – This legislation prohibits Maryland-regulated insurance plans from charging patients higher co-pays for oral chemotherapy than traditional intravenous chemotherapy. Some insurers were charging huge co-pays for newer pill-based chemotherapy and forcing patients to endure office or hospital based treatment that is not only more debilitating and invasive, but in some cases does not give the patient the best chance of recovery. The Kathleen A. Mathias Cancer Chemotherapy Parity Act was enacted despite huge resistance from powerful insurance companies after months of hard work and difficult negotiations with committee members. The end result is preventing suffering and perhaps even saving lives. Client – American Cancer Society.

Securing Consumer Protection in Maryland Health Benefit Exchange – Maryland moved forward with implementing the Affordable Care Act during session but there were serious challenges regarding the protection of existing mandated coverage in state law and consumer interests in general. Representing the American Cancer Society and American Heart Association, we lobbied hard to secure that the existing mandates were covered in the Exchange’s essential benefits package and that consumers had significant official representation on the Exchange’s advisory board that will make recommendations on a host of matters. Additionally we helped secure a strong navigator program that will help consumers sift through the reams of information about each plan and make smarter choices that meet their specific needs. Clients – American Cancer Society and American Heart Association.