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MD Senate Finance Committee Approves Mandated Reimbursement Increases for Mental Health

Several hundred rallied in Annapolis Thursday in support of the Keep The Door Open Act, a bill that would increase funding for mental health and addiction treatment and tie the reimbursement rate for service providers to the Consumer Price Index.

A few hours later, the Senate Finance Committee voted to send the bill, SB 476, to the full Senate after 16 groups representing hospitals, service providers and nonprofits spoke in support of the bill.

Opposition from two cabinet officials at the hearing won a small concession from Finance Chair Thomas “Mac” Middleton, D-Charles, who added an amendment that would sunset the act in five years.

“Some of the testimony against the bill is very notable,” Middleton said.

Gov. Larry Hogan proposed a 2% increase in his fiscal 2018 budget. But supporters of the bill say a mandatory formula increasing payments based on the price index was needed to maintain a stable workforce and increase access to patients in their communities.

“This is really about keeping the door open for our constituents so they have access to mental health and substance abuse services in their community,” said the bill’s lead sponsor, Sen. Guy Guzzone, D-Howard County, at Thursday’s hearing. The bill currently has 33 co-sponsors in the Senate out of 47 members, including three Republicans. A similar bill passed the Senate and House last year but got hung up on differing amendments and was never enacted.

Guzzone said treatment should be available long before a patient ends up in the emergency room and easily accessible after release from the hospital. He said over a million Marylanders are in need of mental health and addiction treatment.

People in crisis

“We’ve been dealing with people in crisis, and having people end up in crisis in a hospital room is not the solution,” Guzzone said. “We need to [provide services] before they end up in the hospital.”

Under the bill, service providers would be reimbursed based on the Consumer Price Index averaged over the prior three years. Currently that average is 3.24% for the Baltimore-Washington region, according to the fiscal analysis.

General fund expenditures increase by nearly $179 million through fiscal 2022 and are matched by $170 million in federal Medicaid dollars over the same period.

Lori Doyle, public policy director for the Community Behavioral Health Association of Maryland, said inadequate funding would increase costs to the state in other areas and make it difficult to maintain a workforce.

Keeping people whole

“We’re going to continue to spend money on this population, It’s just a matter of where you want to spend it,” Doyle told the committee. “You can spend it in emergency departments, inpatient care and in our jails and prisons, or do you want to keep people whole and with their families?”

She said the federal reimbursement rate was paying just $10 to $12 an hour. “We used to hire college graduates but we can’t get them anymore,” she said.

She said 13 of Maryland’s 24 counties have a federally recognized shortfall in the mental health workforce and that “financial neglect” of service providers is evident in the rise of drug overdoses and suicides.

Brian Frazee of the Maryland Hospital Association said emergency room visits related to behavioral health have increased by 18% while all other visits have declined by 5%. He said Medicaid covered ER visits since 2013 have increased by nearly 30% at a cost of $47 million.

Administration says mandate inflexible

Marc Nicole, deputy secretary of Budget and Management, defended Hogan’s commitment to increase funding for service providers. He said the 2% increase when confronting a $544 million deficit demonstrated a clear commitment without the need for a mandate.

“These rate increases are mandated and quite costly,” Nicole said. He said the mandate would climb from $17 million in 2018 to $76 million by 2022. He said during that same period the fiscal deficit could reach $1.2 billion.

“We have shown our commitment on this,” Nicole said.

The administration should be allowed to make the funding decisions for service providers on an annual basis, he said.

Barbara Bazron, deputy director of behavioral health, echoed Nicole and said the compulsory rate increases in the bill create an “unsustainable fiscal impact” on the general fund that discriminates against other types of providers.

“The administration believes it is not fiscally prudent or socially responsible to mandate an expenditure that will likely balloon to $76 million,” she said. “By mandating that the administration dedicate Maryland’s scarce resources to only one type of provider [the bill] removes the flexibility for us to focus on all treatment providers.”

By Dan Menefee

80,000 Maryland Salaried Workers could get Overtime Pay under Proposed Bill

A bill that would make 80,000 more salaried employees in Maryland eligible for overtime pay is not sitting well with business and nonprofit groups, whose salaried employees often work more than 40 hours a week.

Del. Jimmy Tarlau

But the bill’s sponsor says companies have avoided paying overtime for decades by unfairly classifying hourly workers as salaried employees.

The bill, HB665, would increase the salary cap for white-collar and service workers currently exempt from overtime pay to $47,476 up from the current $23,660. That would be $913 per week, up from $455 weekly.

“This salary level has not been changed since 2004 and is now less than the poverty level for a family of four,” said Del. Jimmy Tarlau, D-Prince George’s, in testimony before the House Economic Matters Committee on Tuesday.

The bill mirrors a rule change to the Fair Labor Standards Act attempted by President Obama but now tied up in court. The rule change was to go into effect on Dec. 1, but U.S. District Court Judge Amos Mazzant III in Texas, granted a nationwide injunction against the rule change a week before it was to take effect.

Tarlau wants to advance the rule change at the state level because of low expectations that President Trump’s new pick to head the U.S. Department of Labor, R. Alexander Acosta, will defend the ruling in court. Maryland’s Wage and Hour Law has traditionally been tied to the federal standards, according to the legislative staff analysis.

By classifying ordinary workers as “supervisors,” companies have exempted many of their workers from receiving overtime pay, Tarlau told the committee on Tuesday.

“This means that a supervisor at a McDonald’s who makes $455 a week might be working 76 hours a week without extra compensation and might actually only be making $7/hour or less than the minimum wage,” Tarlau said. “We ought to close this loophole and restore this law’s coverage and the right to overtime pay to what they were back when America was a great place for working Americans.”

Fewer workers qualify for overtime

Ross Eisenbrey, vice president of the Economic Policy Institute, told the committee that 60% of the population was covered under federal law up until 1975 and received overtime after 40 hours of work. He said currently less than 8% of working adults receive overtime pay because of the low salary threshold.

If passed, the income levels would have to be recalibrated every three years, following a formula based on the wages of the poorest area of the U.S. It would be the 40th percentile of full-time wages “in the lowest-wage Census Region,” which is currently the Southeastern United States and calculates to $913 per week, or $47,476 annually.

But nonprofit and business groups say raising the income threshold for the exemption is unaffordable.

“Our workforce is the backbone of the community services,” said Lauren Kallins, director of government relations for the Maryland Association of Community Services, which represents over 100 service providers for people with intellectual and developmental disabilities. “We are Medicaid providers. Unlike other businesses we are also prohibited from passing on costs or fees to the people we support.”

Kallins said most of the providers are nonprofits operating on thin margins due to the Medicaid reimbursement rate that is only a smidgen above the minimum wage.  She said 67% of the workforce she represents, roughly 13,000 salaried employees, would be eligible for overtime pay under the bill.

Cailey Locklair Tolle, president of the Maryland Retailers Association, said the bill would reduce wages and benefits, discourage bonuses and advancement opportunities and reduce hours and income stability to workers. She also said a small business owner would be unable to allow exempt workers with children to work from home if they were reclassified as hourly employees.

Restaurants impacted

“In our industry we have a very narrow profit margin and very high labor costs,” said Melvin Thompson of the Restaurant Association of Maryland. He said if the bill passes the industry would likely move to reclassify chefs and managers to hourly status, which would affect morale and reduce the fringe benefits they receive as exempt employees.

“Many of those employees have worked hard to reach a management level and they would view the reclassification as a demotion,” Thompson said.

Tarlau said companies could either pay the overtime or hire more workers. He said the time off to spend with family was sacrosanct and and the intent of the Fair Labor Standards Act.

“Overtime regulations serve a double purpose,” Tarlau said. “By requiring time-and-a-half pay after 40 hours in a week, they discourage excessive work hours but they also more fairly compensate employees who do work long hours. If an employer needs to keep an employee at work beyond the 40 hours of a normal work week, making it harder for the employee to care for her family, engage in civic life, or even work a second job, [the employer] should pay for that time.”

The Fair Labor Standards Act was a Roosevelt-era law that established the 40-hour work-week and provided for overtime pay at 1.5 times the hourly rate for workers. Since it was enacted in 1938 it has been adjusted for inflation eight times, most significantly in 1975 during the Ford administration and then not until 2004 when the Bush administration set the exemption floor at $23,660.

White- and blue-collar workers have been made exempt from overtime by merely giving them a title.

Texas ruling

The Texas court agreed that “any employee employed in a bona fide executive, administrative, or professional capacity” was exempt from overtime but also found that Congress made no salary test for the exemption. But the U.S. Department of Labor appealed, insisting the 1938 law gave them the power to set new salary thresholds for white-collar workers through regulation as had happened under the Ford and Bush administrations.

by Dan Menefee 

Attorney General Frosh asks for $1 million to Exercise New Powers to Sue Federal Government

Hours after the House of Delegates gave final approval to broad new powers for Attorney General Brian Frosh to sue the federal government, he was in front of a House committee asking for $1 million a year to hire five lawyers for his new mission.

The delegates approved the new powers for the Democratic AG to go after the Trump administration without the permission of Republican Gov. Larry Hogan in a straight party line vote 89-50, with all Republicans opposed.

Republicans on the House Health and Government Operations Committee wondered why the fiscal analysis of the just passed Maryland Defense Act, SJ5, and its House companion, HJ3, stated that “The Office of the Attorney General can use existing resources to handle any litigation initiated as a result of the resolution,” yet here he was asking for a million dollars in mandated spending in HB913.

The mandated spending would not kick in until the fiscal 2019 budget begins July 1, 2018. For the next 16 months, Frosh would be using existing attorneys in his main office, but they would be pulled from other duties, he said.

The new spending mandate was sponsored by Del. Sandy Rosenberg, D-Baltimore, who also was the lead sponsor of the House joint resolution. The bill contains the same language as the resolutions authorizing the attorney general to pursue lawsuits.

The bill and the resolution explicitly mention “ensuring the availability of affordable health care; safeguarding public safety and security; protecting civil liberties; and preserving and enhancing the economic security of workers and retirees” along with protection of consumer rights, pensions, the environment and “the general health and well-being of [state] residents.”

A key difference between what the House passed Wednesday morning and the bill in committee is the joint resolutions go into effect immediately without the signature of the governor and HB913 is regular legislation that needs the governor’s OK.

“We’re opposed to mandated spending,” said Hogan communication director Doug Mayer, who refused to speculate about whether the governor would veto the bill. Hogan has consistently pushed legislation to reduce spending mandates, not increase them, since they control over 80% of the discretionary general fund budget.

Asked how they arrived at a figure of $1 million for five new assistant attorneys general and support staff, Rosenberg and Frosh said the model was a federalism division in the office of the Oklahoma Attorney General Scott Pruitt, a Republican.

Pruitt has been nominated as head of the Environmental Protection Agency, an agency he has sued 14 times.

Frosh said he might wind up suing Pruitt if he tries to dismantle the Chesapeake Bay clean-up, an EPA program that was the subject of a Pruitt lawsuit.

By Len Lazarick

Op-Ed: Legislating Death with Dignity needs Debate with Dignity by Michael Collins

The introduction again of legislation that would allow people with terminal illnesses to obtain lethal doses of drugs with which to kill themselves has reignited the debate about assisted suicide in Maryland.

The attraction of the “Richard E. Israel and Roger “Pip” Moyer Death End-of-Life Option Act,” HB370 and SB354, is understandable. Who has seen people in the last stages of a terminal illness and not thought, “What can we do to ease their suffering?” Whose heart has not gone out to families whose loved ones endure often intense pain as they die?

I’m sure many people have thought, “If I am ever in that condition, I don’t know how long I’d want to hang on.”

These laws’ advocates often use intensely personal tales, such as that of former Annapolis Alderman Dick Israel, who succumbed to Parkinson’s disease, and, Brittany Maynard, a 29-year-old California woman with terminal brain cancer, who moved to Oregon to take advantage of that state’s assisted-suicide law.

Yet, that the passage of these laws relies so heavily on their raw emotional appeal should make us pause. We need to ask some hard questions about these issues and think just as hard about their potentially ugly answers.

Have we exhausted all options related to palliative care? If there are laws and regulations that onerously restrict physicians from prescribing the painkillers that can alleviate a terminal patient’s suffering, shouldn’t we change them first?

If enacted, this law will establish the principle that people in Maryland have a right to “death with dignity,” as the legislation was called when first introduced two years ago. With that accomplished, what is there to prevent the law from expanding to allow physician-administered suicide?

Slippery slope

In the Netherlands, where euthanasia has been legal since 2002, physicians are helping people with treatable mental illnesses—like depression—commit suicide. And, numerous doctors have become “angels of death,” euthanizing terminally ill patients without their consent.

A 2012 paper by J. Pereira in Current Oncology, found that despite safeguards built into so-called “death with dignity” laws, most safeguards are ignored.

For example, in 2005, more than 540 people in Holland were euthanized without providing explicit consent. In the Flemish part of Belgium, 208 people were euthanized without consent because they were in a coma.

Pereira’s study concluded that in 30 years, the Netherlands has slowly moved from euthanasia for terminal illnesses to euthanasia for psychological distress. That point was driven home last year in a widely reported case where a woman in her 20s—who did not have a terminal illness—was euthanized in Holland. She had been a victim of sexual trauma and her psychiatrist determined that she had untreatable Posttraumatic Stress Disorder.

Lawsuits

Proponents of so-called “death with dignity” argue a patient should have the right to self-administer a lethal dose of prescription drugs. But what about people with disabilities? Such a law is one lawsuit from being an Americans With Disabilities Act (ADA) violation for those who cannot self-administer.

Opponents of capital punishment point to the Hippocratic Oath to keep doctors from assisting in legal executions. They have also attacked drug companies for providing the lethal cocktails for executions. And they have pointed to botched executions as reason to end all executions.

Would doctors who prescribe lethal doses of drugs be violating their Hippocratic Oath? Could they be subject to professional sanctions?
Will drug companies have an incentive to create more powerful poisons so a patient does not have to swallow 100 capsules?
If even medically supervised executions can be botched, what can we assume about patient suicide? If not supervised, what happens? Could a patient be in a permanent vegetative state requiring life support? If supervised, would more active measures be required?
Proponents of such abortion-inducing drugs as Plan-B have sued pharmacists who refuse to dispense abortificients because it violates their conscience. Will pharmacists be liable to lawsuits if they refuse to prescribe life-ending drugs?

Conscience

The introduction of euthanasia will place Maryland’s health-care professionals on a collision course with numerous ethical and moral dilemmas. Anti-capital punishment activists argue that the Hippocratic Oath prohibits doctors from assisting with legal executions. Can it be made to square with euthanasia?

What about those with religious objections? Will a Muslim doctor be able to refuse to write a prescription for lethal drugs based on his religious beliefs? Will a pharmacist who is an evangelical Protestant be able to refuse to fill such a prescription on the same grounds?

Grim efficiency?

In 2008, Barbara Wagner and Randy Stroop were denied further cancer treatments by Oregon’s state-run Medicaid program because their cancers were in advanced stages. They were informed, however, that it would pay for their assisted suicide drugs.

Opponents of Oregon’s assisted suicide have noted potential conflicts of interest between doctors who approve assisted suicide and their employment with health maintenance organizations (HMOs).

Will Maryland’s Medicaid provide suicide drugs? What about insurance policies purchased through Maryland’s health exchange? Will we create a two-tier system where the wealthy with private insurance get their expensive cancer treatment while the poor on Medicaid get offered suicide drugs?

I fear that many of the people now holding out the promise of “death with dignity” are exploiting our compassion, anxieties, and fears in order to move us—incrementally, at first—toward a truly nightmarish future in which human life will be easily and callously disposed of in service to some amorphous “greater good.” Will we soon have ambulatory “dignity” clinics, like the dystopian future presented in the 1970s film “Soylent Green?” Recall how the Edward G. Robinson character “went home,” a euphemism for assisted suicide.

Before we pass the “End-of-Life Option Act” law, we need a debate with dignity, that strips away the euphemisms, asks the hard questions and gets the unvarnished answers.

Michael Collins can be reached at michael.collins.capital@gmail.com.

E-ZPass System Under Attack in Annapolis

Excessive penalties and poor customer service at the E-ZPass electronic toll collection system have put some Marylanders on the path to “toll bankruptcy,” Sen. Roger Manno told the Senate Finance Committee last week.

“Folks [are] exasperated because they’ve been caught in a system that is not working,” Manno said.

Broad enforcement powers enacted in 2013 to address toll violations have led to wage attachments, financial hardship and non-renewal of vehicle registrations at MVA, witnesses testified.

Sen. Roger Manno

Sen. Roger Manno

“The penalty structure that we set several years ago in the General Assembly was not intended to be punitive,” Manno said. “It was not intended to strip people of their rights and their assets.”

But the head of the Maryland Transportation Authority, which runs the toll facilities, told the senators that only a tiny percentage of drivers have been affected.

“I don’t want to minimize the pain that certain customers have gone through, but running the numbers only .001% wound up in a circumstance” like this, said Kevin Reigrut, MDTA’s new executive director. He said 99.3% of Maryland toll customers are paying their tolls without incident.

“MDTA has no intention of wanting to be in the bill collection business,” Reigrut said. He said the 2013 law gave MDTA the power to address extraordinary circumstances — but the agency has to hear about them.

In the past two years, the state collected $223 million in toll fines.

 

Biggest problems at ICC

Almost all the citizens who testified for the bill had problems with the InterCounty Connector, Route 200, the state’s all-electronic video toll road connecting Gaithersburg and Laurel. The ICC uses video snapshots of license plates to bill commuters who don’t subscribe to E-ZPass or when subscribers’ transponders fail to register at any of eight tolling gantries along the route.

Manno’s office has been inundated with pleas to help settle minor toll violations that snowballed into “tens of thousands of dollars” in penalties – after citizens failed get a resolution from E-Z Pass or MDTA. Manno’s District 19 in Montgomery County includes part of the ICC.

“The myriad of problems that they encountered with MDTA steered them toward a path of accruing civil penalties and exorbitant debt: late bill notices in the mail, lost checks, and inconsistent and confusing customer service,” said Manno in written testimony.

The 2013 law gave MDTA the power to block registrations renewals and refer past due accounts to the state’s Central Collection Unit.

A $50 fine kicks in for each violation not paid after 45 days. After an additional 45 days the debt is transferred to CCU where a 17% fee is tacked on.

Manno is sponsoring a bill, SB139, co-sponsored by most of the Montgomery County’s Democratic senators and two Republicans, to reduce the $50 fine per violation to 25% of the original toll — and prohibit MDTA from referring delinquent accounts to CCU.

“If it’s a two-dollar toll the penalty would be 50 cents,” Manno said.

Of the 5.1 million violations in 2016, 4.7 million occurred on the ICC, according to a legislative analysis.

Motorists testify on ‘toll hell’

Manno told committee members that technical problems with transponders and credit card processing mistakes started motorists on a path to “toll hell.” Often motorists were unaware of any problems while they continued to accrue additional tolls and penalties.

After an expired credit card prevented replenishment of her E-ZPass account, Deborah Liverpool of Silver Spring said 17 tolls of less than $3 each swelled to almost $1,000 in fines in one month.

She said penalties had already accrued before she was able to provide new credit card information.

Stephanie Grogoza of Rockville said her elderly parents received a collection notice of $300 for less than $9 in tolls incurred on the ICC. Grogoza said her parents, one retired Navy and the other a bank auditor, never received the initial bill.

“If they got a bill they would have paid it,” she said. “They play by the rules.”

John McNamara, a retired Foreign Service officer from Derwood, said he was billed twice for the same trip on the ICC, once on his E-ZPass account and later with a video toll he received by mail. He said E-ZPass refused to accept proof of the mistake by email. He was told he had to send a fax or visit a service center.

In written testimony, the Maryland Motor Truck Association said a member’s registration renewal was blocked due to $23,000 in tolls and fines that had accumulated since 2008.

Notices were sent to the wrong mailing address even though MVA records were correct.

“MDTA mailed these notices of tolls due to an address this company has not occupied for many years,” said Louis Campion of the truck association. “He is not a toll avoider.  His E-ZPass account has never been negative and last year [he] paid $50,000 in tolls.”

Jen Diamond, of the Maryland Consumer Rights Coalition, a group that advocates for low income Marylanders said the 2013 law was a “classic case of unintended consequences” and a “draconian approach to funding Maryland’s infrastructure.”

“We’ve heard horror stories of clients forced to file for bankruptcy in order to address a few unpaid E-ZPass tolls,” Diamond said.

Four notices sent

MDTA chief Reigrut said that no fewer than four notifications are sent to the vehicle owner before the violations are sent to CCU

“For the 99.3% of our customers who are paying as expected, we have an obligation to ensure that we are able to collect the tolls that are due,” Reigrut said.

He said his agency has the power to recall accounts from CCU only if a mistake was made by MDTA or E-ZPass

“This is a punitive, if not predatory, collections process by a government against its people,” Manno said in an interview Monday. “Tell me where else in commerce in the real world where a penalty scheme like this exists.”

“There are 340,000 Marylanders whose accounts have been forwarded to CCU,” Manno said. “That’s one in every 18 Marylanders in collection at CCU for toll violations.”

Toll bonds could see downgrade

All MDTA toll-backed revenue bonds are subject to trust agreements that require revenues be maintained at certain levels. Historically, Maryland has enjoyed stellar bond ratings because MDTA’s board has the authority to set toll rates without  legislative interference.

“The bill necessitates a change to the trust agreement with MDTA’s bondholders and/or prompts a reduction in MDTA’s bond ratings,” according to the fiscal note.

“Bills like SB139 could be problematic for our Trust Agreement,” said Cheryl Sparks, communications director for MDTA. “It could compromise our statutory independence and have a negative effect on the MDTA credit worthiness and lead to higher bond/loan rates.”

In 2015 and 2016 the state collected $91 million and $132 million respectively in toll fines.

Collections unit wants to place liens

While Manno wants to take accounts away from CCU, the state government collection agency now wants the power to file property liens as proposed in HB104, a Department of Budget and Management bill aimed at quicker collections.

CCU Director Anthony Fuegett said the agency’s primary tool of wage garnishments was time consuming, taking up to three years.

“We don’t garnish enough people,” Fuegett told the House Appropriations Committee Jan. 31, referring to findings in two years of legislative audits.

Jesse Lawyer, deputy director of CCU told the committee that E-ZPass account “are a large part of our portfolio.To date we’ve brought on 1.9 million accounts.”  Each represents a single violation.

by Dan Menefee

Annapolis: Third Effort for the Right to Die Legislation

After two years of dead ends, Maryland lawmakers have again introduced measures to give terminally ill Marylanders the right to die using doctor prescribed medications.

The nation’s oldest end-of-life advocacy group, Compassion & Choices, brought nearly 200 supporters to Annapolis on Wednesday to urge lawmakers to pass the “Richard E. Israel and Roger ‘Pip’ Moyer End of Life Options Act.”

“As a physician I’ve always seen my vocation as an obligation to work with my patients as honestly and professionally as I can, respecting their sense of autonomy, their values and their priorities in order to use my skills to support them throughout their life,” Del. Terri Hill, M.D., a Columbia Democrat and physician, told the crowd of supporters and fellow lawmakers. “When that support is to cure or mediate, that’s terrific, but my obligation to support them and respect them doesn’t end when I run out of options.”

“Support for this legislation is about completing that contract,” said Hill.

The legislation would allow a terminally ill adult patient, who is not mentally ill, to end his or her life using doctor prescribed medications.

Sponsors mostly Democrats

Del. Terri Hill at the podium explains why she supports end-of-life options, as co-sponsors Del. Shane Pendergrass, right, and Sen. Guy Guzzone look on. MarylandReporter.com photo.

Del. Terri Hill at the podium explains why she supports end-of-life options, as co-sponsors Del. Shane Pendergrass, right, and Sen. Guy Guzzone look on. MarylandReporter.com photo.

The Senate Bill, SB354, sponsored by Sen. Guy Guzzone, D-Howard, has 14 co-sponsors, all Democrats. The House version, HB370, sponsored again by Del. Shane Pendergrass, has 44 co-sponsors, only one a Republican, Delegate Chris West, R-Baltimore County.

This is the third year in a row Pendergrass has sponsored the legislation, and she now chairs the House Health and Government Operations Committee that will hear it again.

A Senate version last year received an unfavorable report from the Judicial Proceedings Committee and was withdrawn by the sponsor, Sen. Ron Young, D-Frederick.

The House committee never took a vote on the measure after the Senate panel killed the bill.

In 2015 House and Senate versions also failed to clear their committees.

Tough issue to talk about

“It’s a tough issue,” Guzzone said. “We have a hard time in this country talking about death and dying and we have to have that conversation, it’s critically important.”

As the rally wound down a Rockville resident spoke passionately in support of the legislation as it will ultimately affect her and her son — and could have made her father’s death more dignified.

“I love life. I love being a parent to my 17-year-old son and working toward becoming a minister, a journey I started several years ago,” said Rockville resident Alexa Fraser, who was diagnosed in December with a rare and aggressive form of cancer.

“I just want the ability to choose a peaceful death with my family around me rather than one filled with pain, or drowning in my bodily fluids, or with my abdomen bursting as happened to a good friend who…died of abdominal cancer,” said Fraser.

She said her father killed himself as a result of dealing with Parkinson’s, but it took three attempts before he succeeded.

“It didn’t go well,” she said. “First he tried pills, then cutting his wrists, neither worked, and finally he used a gun.”

In a “deep twist of fate” Fraser said her son was recently diagnosed with MS.

“If, when he is old and sick…and concludes that using the death with dignity provision is his choice, I would support that for him,” she said.

There is greater optimism this year for passage said Sean Crowley, director of media relations for Compassion & Choices.

“Naturally when you have a new issue legislators are unfamiliar with it and it takes time,” he said. He said recent polling data in Maryland and the nation show significant support for end-of-life choice.

“Sixty-five percent of Maryland voters support medical aid in dying and 60% of physicians either support it or are neutral on the issue,” Crowley said. “It’s a strong majority in both cases.”

Crowley said Gov. Larry Hogan was initially opposed to it but has signaled he is now more open to it.

Opposition gearing up

The Maryland Catholic Conference, the lobbying arm of the Catholic bishops, is gearing up to oppose the legislation, as are groups representing people with disabilities, part of a coalition called Maryland Against Physician Assisted Suicide.

“It’s critical that we protect people with intellectual and developmental disabilities from this dangerous legislation,” said Lori Scott, board member of The Arc Maryland. “One of the top reasons people want to end their lives is to avoid being a burden to loved ones. Sadly, people with disabilities often feel they are a burden throughout their entire life.”

“People with intellectual and developmental disabilities are frequently coerced into making decisions that are not in their best interest because they are led to believe it will please a health care provider or family member,” Scott said. “It is impossible to legislate the safeguards needed to protect these individuals from the dangers of physician-assisted suicide.”

by Dan Menefee

Maryland Legislature’s Fiscal Chief Presses for Spending Reform

Maryland’s legislative leaders are getting pressure to fix their approach to spending not just from Republican Gov. Larry Hogan but from their own top budget expert, Warren Deschenaux.

In his analysis of the $43.5 billion state budget Hogan sent to the legislature last week, Deschenaux told legislators Monday, “This is another kick-the-can-down-the-road budget,” putting off hard choices about future spending.

Deschenaux, who’s been analyzing state spending for 18 years, said, “we’ve settled into a pattern that the world of 2008 is going to reappear,” and revenues are going to grow by 5% a year to match projected spending driven by formulas and mandates.

As he has done for years, Deschenaux pointed to a chart that shows a balanced budget for fiscal 2018, but then a widening gap between spending and revenue in future years.

spending-chart-1-23-2017

Need to fix out-year spending

“I think we need to fix the out-years spending pressure,” Deschenaux said in response to a question from Sen. Andrew Serafini, a Republican budget hawk, who suggested reducing spending growth to 2% or 3%.

“That would go a long way” to change the spending curve, said Deschenaux, who now heads the nonpartisan Department of Legislative Services in addition to his longtime role as head of policy analysis.

Deschenaux again highlighted the problem with Maryland’s continuing structural deficits. He did the same thing in November when he told the Spending Affordability Committee that they needed to “get real” about matching spending to revenue growth.

Nerds can’t do it

“It’s not up to the nerds to do this,” he said. “It’s up to the political leadership.”

Gov. Hogan has proposed changing the spending mandates that control what he can do with 83% of the general funds raised from Maryland taxpayers.

“The measure [Hogan] proposed is fundamentally weak,” only dealing with 4% of the budget, Deschenaux said. “A more vigorous and comprehensive approach is called for.”

In rolling out his spending plan last week, Hogan emphasized that he was actually spending less of the general fund budget — about $17 billion — while curing a deficit, funding all the mandates, and cutting few programs.

“The governor didn’t do bad,” Deschenaux said. “But he did not alter the fundamental structural relationships.”

Hogan balanced the budget by taking $170 million of the rainy day fund, which he had built up in this year’s budget in case revenue dipped, which eventually did occur.

Potential problems

In the fiscal briefing report prepared by a dozen DLS staff members, they identified 11 “potential legislative issues” that needed to be resolved.

They are especially concerned with actions that the new Trump administration may take. The Hogan budget “leaves the state vulnerable to expected federal cost containment actions, including hiring freezes, spending reductions and the repeal of the Affordable Care Act.”

Changes in the ACA could deeply affect the Medicaid health insurance program, which currently covers 1.4 million Marylanders.

“We think it’s underfunded,” Deschenaux said of Medicaid. The expansion of coverage to 312,000 people under Obamacare (the ACA) is 90% subsidized by the federal government — and much of that might disappear — costing an additional $1.2 billion.

“The state is going to face some pretty hard choices,” said Medicaid analyst Simon Powell.

Analysts also believe that there is not enough money in the Transportation Trust Fund to fund operating costs, local road aid and all the road projects Hogan has promised.

Cut in payment for PG hospital

House Speaker Michael Busch was particularly upset that a $56 million payment for building a new Prince George’s County medical center was cut from the capital budget. The Hogan administration believes that the payment can be put off because of delays in construction of the new regional hospital.

“That’s an awful big can to kick down the road,” Busch said.

By Len Lazarick

Annapolis Bills would Boost Public Financing of Campaigns for Governor, Legislature

Public financing of Maryland gubernatorial elections could get help from the general fund in years the Fair Campaign Financing Fund falls short, said Del. Eric Luedtke, D-Montgomery.

Prince George’s Del. Jimmy Tarlau plans to introduce legislation creating public financing for legislative races.

Eric Luedtke, D Montgomery

Eric Luedtke, D Montgomery

Luedtke is sponsoring a bill, HB72, that would require the State Board of Elections to assess the sufficiency of the fund the year before an election — to make sure it can fully finance bids for two candidates in the primaries and one in the general election.

If passed the law would allow the campaign fund to borrow from the general fund in the event of a shortfall and pay it back through the normal revenue stream of fines, tax form check offs, penalties and online contributions — revenue streams that were restored in a bill Luedtke sponsored in 2015 with strong bipartisan support.

Hogan, Mizeur used fund in 2014

The fund paid out $3.6 million in public funds for the gubernatorial bids of Heather Mizeur and Larry Hogan in 2014, said Jared DeMarinis, director of candidacy and campaign finance with Maryland State Board of Elections.

Republican Larry Hogan was the first to successfully run for governor using public financing. In last year’s budget, Hogan proposed replenishing the campaign finance fund with taxpayer dollars.

According to a legislative budget analysis (page 13), Hogan wanted to put $1.8 million from the general fund into the campaign finance fund that had previously been filled only with voluntary contributions from an income tax check-off. That check-off was repealed in 2010, and $1 million was taken out of the campaign fund for other uses. The voluntary check-off was restored two years ago.

The legislature cut $790,000 from Hogan’s proposed funding, and replenished the campaign fund with $1 million to replace the money from the fund that had been taken for other purposes.

Luedtke said there should be a mechanism to ensure public financing is available in 2018.

Mandated appropriation

Luedtke’s bill would require the governor to provide an appropriation in the year before an election in the event of a shortfall.

The fund was established in 1974 and was only used once before Hogan and Mizeur tapped the fund — by Republican Del. Ellen Sauerbrey in 1994, when she lost the race for governor to Prince George’s County Executive Parris Glendening by only 6,000 votes, a result the GOP contested in the courts.

Public funding of legislative races

Del. Jimmy Tarlau, D-Prince George, said he also plans to introduce a bill to establish public financing for legislative races because “We have to do something about the role of big money in elections.”

In a newsletter Sunday, Tarlau told constituents: “The bill would give candidates incentives to stay away from big contributors. Under this bill, if a candidate agrees not to take contributions above $250 and has raised money from more than 300 different contributors, the state will match 70% of the contributions up to $50,000.”

Howard County voters approved public financing for local races in November, but the County Council must pass legislation to implement the program. Montgomery County already has a public financing for local races which will be used for the first time in the 2018 election.

By Dan Menefee

Op-Ed: Maryland’s Demeaning ‘Begathon’ Continues by Barry Rascovar

Here we go again. In a few weeks, school superintendents will trek, en masse, to the second floor of the Maryland State House to grovel before the Board of Public Works for additional school construction funds.

It is a demeaning “begathon” that long ago outlived its usefulness and turned into a political circus allowing the governor and comptroller to praise and reward their friends in the counties and humiliate their enemies.

This time, the target for Gov. Larry Hogan, Jr. and Comptroller Peter Franchot is Baltimore County Executive Kevin Kamenetz – a man who has signaled a desire to run for statewide office next year.

Anything Hogan and Franchot can do to undercut Kamenetz’ credibility helps their reelection chances.

That explains the consistent animosity by this tag-team tandem toward Kamenetz’ requests.

Comptroller’s crusade

Franchot has conducted a consistent crusade to force the county to install portable, temporary air-conditioners in all schools lacking central cooling units.

Former Baltimore County executives bear the brunt of the blame for leaving too many school kids in overheated classrooms during the early fall and early summer.

Kamenetz, on the other hand, has been making up for lost time with a $1.3 billion program to get students into air-conditioned schools. But his expensive plan is phased in due to fiscal constraints.

Franchot has persisted in pummeling Baltimore County’s leader for not following his insistence that Kamenetz buy window A/C units.

Each has a point: Kids should not swelter on extremely hot days, yet it makes little sense to spend millions for a short-term fix when a long-term fix is in the works.

The ideal solution is for the state to forward-fund the money Baltimore County needs to finish the job ASAP through a combination of costly upgrades and replacement buildings.

Embarrass Kamenetz

However, neither Franchot nor Hogan has lifted a finger to support the county’s efforts. They could have designated a pot of school construction money for jurisdictions needing window-unit air-conditioners. Instead, they remained silent.

Their goal is to publicly embarrass Kamenetz. Thus, the dynamic duo voted last May to punish Baltimore County (and its school kids) by withholding $10 million in state funds for county school construction – thus delaying portions of the work on air-conditioning classrooms.

The two also withheld $5 million in badly needed construction dollars from Baltimore City, which also is in the process of getting all schools air-conditioned.

They demanded that the two jurisdictions air-condition all classrooms in a matter of months – an impossibility for any number of legal and practical reasons.

The two Annapolis politicos apparently think the city and county can simply wave a wand and, voila! they’ll reverse a situation that’s been festering for two decades.

The reality is that it will take a number of years – and billions – to correct this situation.

Political favoritism

When the “begathon” parade shamelessly takes place on Jan. 25, it is likely Hogan in particular will look kindly upon Baltimore City’s requests, including the withheld $5 million, as a goodwill gesture toward the city’s new mayor, Catherine Pugh.

He and Franchot will save their contempt for Baltimore County School Superintendent Dallas Dance and, indirectly, Kamenetz. There could well be “plants” in the room to demonstrate Hogan and Franchot are supported by county residents in their harsh criticisms.

It’s all part of the set-piece melodrama the “begathon” has become.

In most cases, conservative, Republican-leaning counties will be treated with kid-gloves by the Republican governor while Democratic strongholds get a cold reception.

It’s quite a distasteful scene, one that is as unbecoming for the governor and comptroller as it is for the school chiefs forced to grovel before them.

Barry Rascovar’s blog is www.politicalmaryland.com. He can be reached at brascovar@hotmail.com.

Republican Maryland Losses did not Dampen Celebration of Trump’s Win

Maryland Republicans were losing the U.S. Senate race by a wide margin, losing hard fought races for Congress, and yet Tuesday night in a ballroom at the BWI Marriott, they were celebrating and looking ahead to the 2018 election with glee.

And it was only 10:30 p.m., over four hours away from Donald Trump’s victory speech in New York, yet they were cheering every return.Rep. Andy Harris, who will remain the only Republican in Maryland’s 10-man congressional delegation, was the last candidate to take the stage, but he was pumped about Trump trends and the prospects for Maryland Republicans in coming years.

“What a night! They just called Ohio for Donald Trump,” Harris shouted. “He’s going to be the next president of the United States.”

Del. Kathy Szeliga thanks supporters of her Senate race.

Del. Kathy Szeliga thanks supporters of her Senate race

He praised the achievement of Del. Kathy Szeliga, his former aide and campaign manager, losing to Democrat Chris Van Hollen 60% to 36% in the race to replace Barbara Mikulski in the U.S. Senate.

“Can you imagine getting outspent 10 to 1 to running against the special interests … carrying on the Larry Hogan tradition of running against the special interests,” Harris said.

He said Van Hollen “better treasure every one of those six years he has down there because he’s not going back after that because he’s exactly what’s wrong with Washington.”

“We know there’s going to be lawsuit after lawsuit when Donald Trump looks like he’s the winner tonight,” Harris said.

“We know we’ve had the best candidates across the state,” the congressman went on.

Starting the 2018 campaign

“Tomorrow morning, with Donald Trump as president, we start the 2018 campaign election where we elect Larry Hogan as the next governor of the state of Maryland, where we elect enough delegates and senators” that they can sustain Hogan’s veto of a Democratic redistricting map, “where we elect Mark Plaster to the 3rd congressional district, where we retire Dutch Ruppersberger, where we retire John Delaney, and we bring Maryland back into the red column.” Democrats Ruppersberger and Delaney represent the 3rd and 6th congressional districts, beating challenges from Del. Pat McDonough and Amie Hoeber.

Harris recalled the 1980 presidential race where Ronald Reagan was considered dangerous, like Donald Trump, but went on to become “one of the best presidents of the modern era.” He said voters were choosing Trump “over business as usual.”

“When we wake up tomorrow morning, [it will be] 730 days till the next election, when we take back Maryland for the Republicans.”

Plaster, a doctor who ran against Rep. John Sarbanes, D-3rd, for more than a year but only got 34% of the vote, promised the Republican crowd. “I’m coming back.”

“Next time, the most popular governor in the United States is going to be at the top of the ticket,” Plaster said. “We’re going to win the 3rd District. You can take it to the bank.”

Szeliga did not mention her plans, saying only, “We came up a little short this time.”

Maryland Democratic Party Chair Bruce Poole dismissed the GOP rhetoric. “It will be a sign if they win by a large margin, it shows the idea that Maryland is not trending to a purple state,” Poole said in a phone interview with MarylandReporter.com. “It means the tea leaves after 2014 are not true.”

Harris made no mention of Democratic U.S. Sen. Ben Cardin, whose second term is up in 2018. In a brief interview earlier on Tuesday as he toured polling places around the state with Van Hollen, Cardin deflected rumors that he might resign or retire.Cardin said voters deserved at least a brief rest before the next campaign begins. But he suggested that anyone interested in his future plans should take a look at his schedule of appearances and examine his campaign fundraising reports.

Cardin typically has lots of events on his calendar, and he has raised $477,000 since the beginning of 2015, with $725,000 cash on hand.

By Len Lazarick