Opioid and Heroin Overdoses Have Reached ‘Crisis Level’ In Maryland

When Carin Miller’s son was about 19 years old, he began to abuse heroin by snorting pills, eventually moving on to shooting up. This went on for six years before he got help.

Lucas Miller’s history of drug use started in high school with smoking marijuana. When he moved out of his parents’ house, one of his housemates had access to between 750 to 1,500 pills at any given time between five houses located in Frederick, Maryland.

“My son was addicted to heroin, he’s in recovery by the grace of God since Thanksgiving 2014, I think that’s where we are at,” Miller said.

Opioid overdoses now rank with cancer, strokes and heart attacks among the top killers in Maryland.

State and federal lawmakers have passed legislation aimed at addressing the crisis, although they and public health experts agree the battle will be long.

On April 10, the Maryland General Assembly passed several bills to address this ongoing statewide crisis. The Start Talking Maryland Act, HB1082, and the HOPE Act, HB1329, were both passed.

The HOPE Act would increase access to naloxone, an overdose-reversal drug and would require hospitals to establish a new protocol when discharging patients treated for substance abuse disorders. It also introduced Keep the Door Open, a provision that provides three years of funding to reimburse community health providers. The act also requires the Behavioral Health Administration to establish a crisis treatment center before June 2018.

The Start Talking Maryland Act would require schools to have defined education programs on opioid addiction.

Other opioid related bills passed by the General Assembly were HB1432, which places a restriction on the number of opioid painkillers a doctor can prescribe to a patient per visit, and SB539, a bill that sets new penalties for distributing fentanyl.

The opioid-related legislation have been sent to Maryland Gov. Larry Hogan’s desk for his signature. The governor has until May 30 to either sign or veto the 900 bills passed by the General Assembly; otherwise they automatically become law.

On March 1, Hogan signed an executive order, declaring a state of emergency in response to the heroin, opioids and fentanyl crisis “ravaging communities in Maryland and across the country.”

“We need to treat this crisis the exact same way we would treat any other state emergency,” Hogan said in a statement. “This is about taking an all-hands-on-deck approach so that together we can save the lives of thousands of Marylanders.”

The final numbers for 2016 are expected to show that approximately 2,000 people died from heroin and other opioid overdoses in the state over the last year, about double the number of deaths in 2015.

Additionally, drug overdose deaths rose by 19.2 percent from 2013 to 2014 in Maryland, according to a press release from Sen. Ben Cardin, D-Md.

“There’s no question, no question there has been a spike in opioid overdoses,” Cardin said in an interview with Capital News Service. “Let me indicate the numbers in Maryland are shocking as we are seeing the doubling and tripling over the last couple of years, but the Maryland numbers are typical to what we see all over the country.”

Both Cardin and Sen. Chris Van Hollen backed passage of the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act of 2015 (CARA). Van Hollen was a cosponsor for the 21st Century Cures Act.

“The opioid addiction epidemic is having a devastating impact on communities in Maryland and across the country,” Van Hollen said in a statement for Capital News Service. “I fought to pass the 21st Century Cures Act, which helps states expand programs to treat those suffering from addiction, but we must do much more to prevent substance abuse and to get help to those who need it.”

The 21st Century Cures Act was signed by President Barack Obama in December. It will provide $1 billion over two years for state grants to support opioid abuse prevention and treatment activities. CARA, a bipartisan bill, was signed into law by Obama last July. CARA assists drug-dependent newborns and their parents.

The federal Department of Health and Human Services has just awarded Maryland a $10 million grant under the 21st Century Cures Act.

“These grants are a small but encouraging step toward addressing the opioid crisis,” Rep. John Sarbanes, D-Towson, said in a statement. He was among those who pressed for the funds in the law. “But to make real progress in our effort to combat the epidemic, it’s the responsibility of Congress to provide additional resources to programs, families and communities in Maryland and across America that are working day in and day out to end the crisis.”

Van Hollen said there is more to be done with the crisis, including “protecting the significant investments made by the Affordable Care Act, and ensuring institutions like the National Institute for Drug Abuse at NIH in Maryland and others across the country have the resources necessary to carry out their critical missions.”

On March 29, President Donald Trump signed an executive order creating a presidential commission designed to combat opioid addiction and the opioid crisis nationwide. New Jersey Gov. Chris Christie is leading the commission.

A main reason for the doubling of overdoses for Maryland has been a new street drug, fentanyl, a powerful synthetic opioid that dealers are increasingly blending into regular heroin and selling cheaply.

Fentanyl is coming to the United States from China, and that needs to be stopped, Cardin said. The senator added that there also is work to be done with Mexico to stop heroin from flowing from that country.

“We’ve seen an abuse of using these drugs for pain and an abuse of people selling these drugs on the street and getting people addicted,” Cardin said. “There are things we can do to dry up the supply and help people who have addiction and health issues.”

In response to the rise in drug-related deaths, Hogan announced on March 1 that he has budgeted an additional $10 million per year to combat overdoses over the next five years.

Miller said Hogan’s action would help, but more money is needed from the federal government.

Miller is no stranger to opioid abuse as well. She said her husband, Greg Miller, had been abusing opioids since the late 1990s after he was hit by a drunk driver and had an additional, separate accident at work.

It reached a point where her husband’s withdrawals were so terrible that he almost died after being denied narcotics prescriptions at Frederick Memorial Hospital six years ago, Miller said.

“I was trying to get my husband off the pills, never thinking that my own kids would go on them after they saw the hell that I was put through,” Miller said.

Three years ago, Miller co-founded Maryland Heroin Awareness Advocates (MHAA), a grassroots organization in Frederick. It was founded “out of necessity,” by a group of women from Frederick in order to save their children from the opioid and heroin epidemic, Miller said.

“We have all been affected in some way, a lot of my colleagues have lost their children to overdoses,” said Miller, who is the president of MHAA.

Miller noted that there is not enough education about these drugs in schools. While one of her colleagues is invited into middle and high schools in Carroll County to give presentations, MHAA is “just nipping the bud” at giving presentations in Frederick County, Miller said.

Frederick County is a 40,000-student district with 10 high schools.

“We really give the principals the autonomy to address any issue in their community,” said Mike Maroke, Frederick County Public Schools deputy superintendent. “They determine if this is something be address or not.”

If the Start Talking Maryland Act is signed by Hogan, it would require schools to have opioid education programs, possibly through presentations such as MHAA’s.

After one presentation at a school, Miller handed out index cards to the students, ranging from seventh to twelfth grades, and asked for their feedback. She recalled what happened next: “One little girl came up to me and handed me her card and it said ‘Thank you for coming out and telling us about drugs because I wouldn’t want to lose any friends because my dad died a couple of months ago from a heroin overdose.’”

 

by Jess Nocera

 

Spy Profile: United Needs & Abilities and the Shore’s Developmentally Challenged Residents

For an organization that serves over 400 of the most developmentally challenged residents on the Eastern Shore, including Kent and Talbot County, United Needs & Abilities continues to struggle with name recognition. That might be partly due to UNA’s name change in three years ago when it decided that the Epilepsy Association of the Eastern Shore was far to limited in defining their work, but it also may be the result of the stigma that comes when serving those with cerebral palsy, traumatic brain injury, autism, intellectual disabilities, epilepsy and other mental and physical impairments.

Board President Debbie Horner Palmer and Executive Director Michael Dyer want to start changing that mindset. Debbie, who suffers from Epilepsy herself, and who has played a number of leadership roles in the organization over the years, is determined to end this historical blind spot on the Shore by using her own story as a way to focus attention on the needs and aspirations of those with developmental disabilities. Michael, who has worked in management positions at Perdue Farms before taking on the day-to-day management of UNA, is also driven by the same goals as the organization sees new challenges in funding and outreach during a time of governmental austerity.

The Spy sat down with Debbie and Michael to talk about the mission of United Needs & Abilities and its unique role on the Shore at Bullitt House last week.

This video is approximately four minutes in length For more information please go here

The Faces of Mental Illness: The Photography of Michael Nye at Chesapeake College

While it may be true that most people on the Mid-Shore have a very real and distinct impression of the toll of mental illness in our society, it still is hard for many of use to truly understand the profound impact that these conditions has on victims and their families.

A new art exhibition, sponsored by the Mental Health Association of the Eastern Shore in partnership with Chesapeake College in May, might very well help change some of those perceptions using the stunning images and oral narratives of those victims by award winning  photographer Michael Nye.

Some fifty photographs and recorded messages of people who suffer from various forms of mental illness will be on display as part of a major educational effort to remove the stigma and misunderstanding of a growing problem in our communities.

The Spy spoke the Association’s director, Jackie Davis, last week at Bullitt House to talk about the show and the important work of the organization in serving families impacted by mental illness throughout the Shore.

This video is approximately three minutes in length. For more information about  Mental Health Association of the Eastern Shore and their opening reception, please go here 

Welcome to the 21st Century Mid-Shore ​Health Care with Dr. Marc Zubrow

Approximately a year ago or so, there was a good bit of anxiety on the Mid-Shore about the plans of the region’s two major hospitals in Chestertown and Easton. In Chestertown, there was a growing fear that UM Regional Shore Health would eventually eliminate the existing hospital and replace it with an urgent/emergency care center. While in Easton there were increased concerns that Shore Health would abandon its plans for a new hospital.

Those community apprehensions turned out to be fortunately unfounded thanks to a combination of the politicians interceding to create a state study group on rural hospitals and a more stable economic climate which allowed for the advancement of a new hospital near the Easton Airport.

But one of the major takeaways of these two episodes was how profoundly attached communities are with their local hospitals. For a variety of reasons, including interest in patient comfort, proximity, and in some cases, mere nostalgia, residents were determined to fight to keep their local facilities alive and functioning.

The other takeaway, perhaps not as well noticed by many, was the increasing awareness that through advanced technology and efficiency, there is an emerging radically new way to provide health care in the 21st-century and is the growth of telemedicine.

The Spy, which has had an ongoing curiosity about the use of technology and how it may impact rural health delivery, was lucky enough to secure an interview with Marc Zubrow, Vice President, Telemedicine and Medical Director, eCare in charge of telemedicine for the entire University of Maryland Medical System. And in our interview, Dr. Zubrow makes a compelling case why this use of remote medical consultation will be dramatically improving patient care and outcomes regardless of location.

This video is approximately six minutes in length. For more information about UMMS and telemedicine please go here

Mid-Shore Health Future: The Risks of Repealing the ACA on the Shore with Jeananne Sciabarra

On Thursday, Jeananne Sciabarra, Executive Director of Consumer Health First spoke in Kent County about the implications of repealing the Patient Protection and Affordable Act (ACA), also known as “Obamacare.”

Founded in 2006 as the Maryland Women’s Coalition for Health Care Reform, the organization transitioned into CHF in 2016 with the same mission: to work collaboratively to promote health equity through access to comprehensive, high-quality and affordable health care for all Marylanders.

While the impact of repealing and replacing ACA with the currently proposed American Health Care Act (ACHA) would cause profound changes to healthcare nationwide, Sciabarra focused on what Marylanders, and specifically Congressional District, 1 would lose.

Talking about the rollback of Medicaid expansion, Sciabarra said that “the bottom line is that will push back the matching (between state and federal) to 50-50 which is going to make it extremely expensive for Maryland to continue that provision.” She added that on top of that, a block grant per capita system for each person enrolled in Medicaid would force the state to decide who doesn’t get services.

Also, in regard to hospitals, Sciabarra noted that Maryland has a unique rate-setting system that provides services at the same rate anywhere in the state and that during the expansion of Medicaid, uninsured costs went down $311 million between 2013-2015, and that with set amounts or “global budgets” hospitals were incentivized to participate in wellness programs to help people stay healthy and out of the hospital. A rollback of those kinds of programs would have a “catastrophic” effect on people not covered in the health exchange, especially older people.

The district’s uninsured rate has gone from 8.3% to 4.1% since the ACA was implemented. This 4.2 percentage point drop in the uninsured rate could be reversed if the ACA is entirely or partially repealed.

401,400 individuals in the district who now have health insurance that covers preventative services like cancer screenings and flu shots without any co-pays, coinsurance, or deductibles stand to lose this access if the Republican Congress eliminates ACA provisions requiring health insurers to cover essential preventative services without cost-sharing.

445,400 individuals in the district with employer-sponsored health insurance are at risk of losing important consumer protections like the prohibition on annual and lifetime limits, protection against unfair policy recession, and coverage of pre-existing health conditions if the ACA is entirely or partially repealed.

15,800 individuals in the district who have purchased high-quality marketplace coverage now stand to lose their coverage if the Republican Congress dismantles the Marketplaces.

11,800 individuals in the district who received financial assistance to purchase Marketplace coverage in 2016 are now at risk of coverage becoming unaffordable if the Republican Congress eliminates the premium tax credits.

8400 individuals in the district who are receiving cost-sharing reductions to lower out-of-pocket costs such as deductibles, co-pays, and coinsurance, are now at risk of healthcare becoming unaffordable is the Republican Congress eliminates cost-sharing reductions.

32,900 individuals in the district who are covered by the ACA’s Medicaid expansion now stand to lose coverage if the Republican Congress eliminates the Medicaid expansion.

This video is approximately nine minutes in length. For more information about Consumer Health First please go here. Sources: US Department of Health and Human Services, Urban Institute, Families USA, The Commonwealth Fund, National Women’s Law Center.

UM Shore Regional Health Publishes Community Benefits Report Online

The 2016 Community Health Improvement Report is now published and available for viewing on the UM Shore Regional Health website at http://umshoreregional.org/news-and-events/news/2017/um-shore-regional-2016-community-health-improvement-report.

The report, which describes highlights of the community health improvement programs and conducted by UM SRH, includes articles on four initiatives: the Ask the Expert series; the inauguration of Shore Behavioral Health’s Bridge Clinic; the Stepping On program offered by the Balance Center in partnership with Maintaining Active Citizens (MAC); and guided support programs (classes, screenings, support groups, etc.) that support better health management.

According to Ken Kozel, UM SRH president and CEO, “The value of our community benefits programs and services, including charity care, exceeds $32 million, but the value is stronger than money. It is building healthier communities and our steadfast commitment to helping our patients and their families enjoy their best health and quality of life.”

Senior Nation: The Science of Forgetfulness with Dr. Constantine Lyketsos

The celebrated poet Billy Collins wrote in one of his poems that his memory had retired “to the southern hemisphere of the brain, to a little fishing village where there are no phones.”  It is perhaps one of the most accurate descriptions of memory loss and the disorientation it causes in almost every human being of a certain age from time to time.

But what if the feeling of “no phones” was a more permanent condition?  That beyond the simple and temporary experience of forgetting where one left the car keys, one also could not remember what those car keys do. In that case, the condition is called dementia. And what has intrigued Johns Hopkins doctor Constantine Lyketsos is why those “phones,” the neurochemistry of the brain, are not working.

On March 8, the Talbot Hospice will be sponsoring a lecture by one of the leading experts in dementia and Alzheimer’s disease at Easton High School. Dr. Lyketsos, from the Hopkins department of psychiatry and behavioral sciences, will address these issues and the devastating effects of the illness, but also promising new treatments that give hope to patients and their families.

The Spy traveled to Baltimore to sit down with Lyketsos before the event for a primer on dementia and memory loss.

This video is approximately six minutes in length. For more information about the event please go here

 

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

1st District Health Care Town Hall Meetings to be Held Without Rep. Andy Harris

Constituents in Maryland’s 1st Congressional District are growing increasingly concerned about the potential repeal of the Affordable Care Act, and are looking to their elected officials to help address those concerns. Many calls, letters, and emails to Representative Andy Harris’s office have gone unanswered, or answered without addressing specific concerns. Constituent requests for Representative Harris to hold an in-person town hall meeting have not been successful.

Citizens for Health Care, a local grassroots organization, has heard these concerns and will host a series of citizens town hall meetings entitled “Patient Protection and the Affordable Care Act (ACA) Town Hall Meetings” intended to inform and educate constituents about the ACA and what it’s repeal could mean to them and their families and to consider methods to improve the ACA.

These town hall meetings will feature speakers from the professional healthcare community for an information session, as well as an open-panel question and answer session for public attendees. Representative Harris and other local elected officials have been invited to attend, in hopes of opening the lines of communication with their constituents and allowing for a discussion of what might come next. Hundreds of constituents have indicated they are interested in attending.

“At Citizens for Health Care, we understand that the subjects of health care and the ACA are not partisan issues: they are human issues,” said DeLane Lewis, one of the founders of Citizens for Health Care. “Congress is facing a dilemma at this moment, arguing whether to repeal or repair parts of the ACA. However, any decision they make will have a real, lasting impact on all U.S. citizens. It is our mission to keep the public informed and aware as to how these proposed changes could affect them.”

One of the major aims of the town hall meetings will be to answer the many questions that citizens currently have, including: What will be the impact on employer based plans? While all current and proposed plans, would continue to offer insurance for pre-existing conditions, under the ACA insurance companies are not allowed to charge higher premiums for pre-existing conditions. Will that be true under any new plan? In Maryland alone, almost 500,000 people are enrolled in health care coverage through the ACA. What will be the impact on the State of Maryland financially? On jobs?

Proposed plans that would eliminate current provisions of the ACA for federal financial assistance and Medicaid expansion are also of significant concern. According to research by the Urban Institute, eliminating individual and employer mandated, federal financial assistance and Medicaid expansion would increase the number of uninsured Americans by 22.5 million. The group estimates that an additional 7.3 million Americans would lose their insurance due to anear collapse of the non group insurance market.

Speakers at the citizens town hall plan to review and compare coverage options and statistics from pre-ACA, versus current options, as well as the various policy aspects of proposed changes or replacements. Health care professionals will also be available to discuss the implications for addiction treatment and mental health care in the community, as the ACA has greatly expanded coverage in both of these areas. Additionally, the financial costs of premiums and out-of-pocket expenses will be discussed to get a clear picture of the impact on the average healthcare consumer’s wallet.

The town hall meetings will be held as follows:

Tuesday, February 21, 6:30 pm, Harford Community College, Darlington Hall, Room 202, Bel Air
Thursday, February 23, 6 pm, Queen Anne’s County Library, 200 Library Circle, Stevensville
Friday, February 24, 6 pm, Salvation Army, 429 N Lake Drive, Salisbury
Thursday, March 2, 6 pm, St Paul’s UCC, 17 Bond Street, Westminster

Current guest speakers scheduled to appear include:

– Sue Ehlenberger, Maryland Health Connection-Seedco
– Mark Romaninsky, Maryland Health Connection-Seedco
– Jeananne Sciabarra, Consumer Health First
– Scot Hurley, Ashley Addiction Treatment
– Katia Callan, MSW, LCSW-C, Insight Wellness of Maryland
– Dr. James Burdick, author of Talking About Single Payer: Health Care Equality for America
– Dr. Margaret Flowers, Healthcare is a Human Right
– Kaylie Potter, Door to Healthcare

About Citizens for Health Care: Citizens for Health Care, located in Bel Air, Md., is a grassroots organization dedicated to providing education and information regarding the Affordable Care Act and proposed changes to the bill. For more information, please visithttps://www.facebook.com/CitizensforHealthCare/

 

More Marylanders Enroll in Health Exchange as Repeal Looms

Enrollment in the Maryland Health Exchange thus far has been climbing at faster rates than in previous years, while President Donald Trump and the Republican-led Congress have taken their first steps to repeal the Affordable Care Act. 
 
As of Monday, more than 465,500 Marylanders had enrolled in the Maryland Health Connection since it opened on Nov. 1, surpassing the 457,862 who had enrolled by the same date last year. The enrollment period ends on Jan. 31
 
Delegate Clarence Lam, a Democrat representing Baltimore and Howard counties, and a physician, discusses the upcoming state budget and the impact a repeal of the Affordable Care Act

Delegate Clarence Lam, a Democrat representing Baltimore and Howard counties, and a physician, discusses the upcoming state budget and the impact a repeal of the Affordable Care Act

Of those 465,500, about 150,000 have enrolled in private health insurance and about 315,500 have enrolled in Medicaid. About 73,500 additional Marylanders have passively re-enrolled, meaning they will retain their same coverage if they do nothing to change their plans, according to data provided by Andrew Ratner, director of marketing and strategic initiatives at the Maryland Health Benefit Exchange. 

 
However, an executive order Trump signed on his first day in office could pave the way to gut the Affordable Care Act, signaling its repeal as one of his top priorities. The order gives federal agencies the power to eliminate or loosen some regulations created by the health care law.  
 
This followed a Jan. 12 measure by the U.S. Senate to begin dismantling the Affordable Care Act by passing a budget resolution that would make it easier to begin rolling back portions of the law. 
 
Health care advocates and state officials have been continuing to urge Marylanders to enroll in the exchange, touting the Affordable Care Act’s role in reducing the number of uninsured state residents by about 50 percent. Since the rollout of the health care law, the percentage of uninsured Marylanders has shrunk from 10.2 percent in 2013 to 6.6 percent in 2015, according to the U.S. Census. 
 
If the Affordable Care Act is repealed, the state could stand to lose up to $1.2 billion of federal funding for Medicaid and up to $200 million for other related services, according to David Romans, fiscal and policy analysis deputy director for the Maryland Department of Legislative Services.
 
The proposed 2018 state budget includes funding for 312,000 Marylanders who are enrolled under the Affordable Care Act Medicaid expansion, Romans said. Ninety-five percent of funding for Medicaid is provided by the federal government, but this number could be slashed in half if the health care law is repealed. 
 
To continue insuring the thousands of Marylanders who benefit from the Medicaid expansion, the state, which is already operating on a “lean budget,” would likely have to cut from other programs and services, Delegate Clarence Lam, D-Howard and Baltimore counties, told the University of Maryland’s Capital News Service. 
 
If the Affordable Care Act is repealed soon, the Maryland General Assembly may need to call a special session later in the year to address the budgetary concerns, Lam added. 
 
“There’s no place to get billions of dollars within the state of Maryland,” said Vincent DeMarco, president of Maryland Citizen’s Health Initiative. “We need to prevent the Affordable Care Act from being repealed and we’re going to work very hard to do that.” 
 
DeMarco has helped lead a recent health coverage enrollment initiative at a dozen faith organizations in Maryland over the inauguration weekend. He said he’s seen firsthand how the Affordable Care Act has saved the lives of the previously uninsured. 
 
“Any program that expands healthcare to 20 million plus Americans … is a huge success,” DeMarco said. “We’re going to protect it (and) we’re going to keep it there and build on it.”
 
About 18 million Americans would lose health insurance the first year after repealing the Affordable Care Act, according to a non-partisan report from the Congressional Budget Office. This number could double to 32 million by 2026, the office reported.
 
Moreover, premiums would increase by 20 percent to 25 percent in the first year, according to the same report. 
 
“It would be a significant step backwards to throw these people out of insurance and be concerned about how they pay their medical bills again,” Lam said. “That there are things that are afoot in Washington–maybe abstract or maybe things that we hear in the news–but at the end of the day there are real people being affected in our communities that will go without health insurance. We all pay for that.”
 
(Capital News Service correspondent Cara Newcomer contributed to this report.)