After years of work, ground was broken this summer on a long-awaited replacement for the Shore Regional Medical Center in Easton. Photo by Danielle J. Brown
After years of delays and debate, 2024 was the year when several health initiatives started to move forward. And advocates now worry that 2025 could be the year when those gains move in the other direction.
Voters enshrined abortion rights in the state constitution, lawmakers expanded health care access to undocumented immigrants and a long-stalled effort to rein in prescription drug costs for state employees finally got off the ground, among other changes.
But with a projected $2.7 billion state budget deficit, and the uncertainty of a second Trump administration, advocates concede they are “unsure what the future holds.”
The year began with legislative passage of the Access to Care Act, a bill that will let undocumented immigrants buy private health care policies on the state’s insurance marketplace, starting in 2026. It was a major win for health car and immigrant advocates, who saw the measure pass the House but stall in the Senate the year before.
Another repeat bill was not so lucky. Supporters had hoped that after years of trying, 2024 would be the year lawmakers legalized so-called medical aid-in-dying procedures, which let people with less than six months to live due to a terminal illness select when they die with the help of a physician.
Medical aid-in-dying legislation teetering as undecided senators deliberate how they’ll vote
Supporters say such a law would give a measure of dignity and control to those facing the end of their lives, instead of a potentially slow and painful death. But opponents say medical aid-in-dying is a problematic concept, with disastrous repercussions if misused.
But the bill stalled in the Senate Judicial Proceedings Committee, where some members were unsure where they stood on the issue. With no committee vote, the bill died in committee.
Medicaid unwind ends
April marked the end of the “Medicaid unwinding” for Maryland, closing the chapter on a pandemic-era policy that prohibited states from kicking people off Medicaid while the COVID-19 public health emergency was in effect. Medicaid is a federal-state health care plan for low-income households, with eligibility determined by income.
But when the public health emergency ended in May 2023, the state began the “unwinding” process, redetermining Medicaid eligibility for almost 1.8 million enrollees at a pace of 100,000 to 160,000 a month. It took a year to complete, during which time the state launched a campaign to remind Medicaid recipients that they had to reapply for coverage for the first time since COVID-19 hit.
When the review finished in April, about 1.69 million residents were still enrolled in Medicaid — well over the 1.4 million Marylanders who were enrolled at the outset of COVID-19.
Those still on Medicaid now need to reapply annually, as they did before. Those who lost coverage did so because of age or income, because they found insurance elsewhere, or they simply failed to reapply for coverage, but many of them are likely finding health care elsewhere, said Michele Eberle, executive director for the Maryland Health Benefit Exchange.
“Several things are going on. We know that folks did get coverage in the health exchange,” Eberle said, referring to the state’s insurance marketplace. “We know that some people went on to their spouse’s coverage … We also know some were truly no longer eligible or they moved out of state. So there’s been a lot of changes.”
Eberle said that the Maryland Health Benefit Exchange is going over a reconciliation process to ensure that all those who no longer qualify for Medicaid have been disenrolled. The end of that reconciliation marks the official end of a holdover policy from the pandemic, she said.
“This is just our final clean up after a year of unwind,” Eberle said.
PDAB selects drugs for cost review
2024 also saw movement by the Prescription Drug Affordability Board, charged with lowering prescription drug costs for employees on state health insurance plans, after years of administrative challenges and opposition delayed its ability get started.
The board this year finally selected the first six drugs for cost review: Dupixent, Farxiga, Jardiance, Ozempic, Skyrizi and Trulicity, prescription medications used to treat conditions including Type 2 diabetes, heart disease, kidney disease, eczema, Crohn’s disease and more.
The cost review is still underway. If it ends up determining that any of those drugs are “unaffordable” for Marylanders, the board will look to various methods to reduce prices. That could include setting an upper payment limit on those medications so state and local governments have a price ceiling that the state is willing to pay drug manufacturers for those drugs.
Vinny DeMarco, president of Maryland Health Care for All and staunch supporter of the board, wishes that the board’s work began earlier.
“We fully expected the state and local government upper payment limit to be in place by 2023. That was undermined for former Gov. Larry Hogan’s veto of the funding bill and he slow-walked appointments and other measures that really delayed it a couple years,” DeMarco said.
The board took a year to set-up regulatory frameworks to conduct business and was only able to select the six drugs for a cost-review study in May.
“We wish it had happened years ago,” said DeMarco, of the board that was authorized in a 2019 law.
Other stalled programs that got underway this year included the creation of long-awaited heat-illness regulations to protect workers from illness and death due to extreme temperatures. The rules went into effect after Maryland faced its most deadly heat-season since 2018, with 25 fatalities caused by heat-related illnesses in 2024.
And in October, officials broke ground on a new regional hospital for the Middle Shore, after nearly a decade of trying to get enough funding and support to replace the aging Shore Medical Center operated by the University of Maryland Medical System.
Voters overwhelmingly support abortion rights
In November, Marylanders voted overwhelmingly to enshrine reproductive rights in the Maryland Constitution, with 76% supporting an amendment protecting access to abortion and other reproductive freedoms.
Abortion-rights advocates celebrate Question 1 win, now worry about a federal abortion ban
The Maryland State Board of Elections reports that nearly 2.2 million Marylanders voted for the amendment, the only statewide ballot question this year, compared to 692,000 who opposed. Erin Bradley, vice president of public affairs for Planned Parenthood of Maryland, said that the support “almost rises to the level of a mandate” to protect abortion access and reproductive health care.
But while they were encouraged by the success of the ballot question, abortion rights activists worry that federal officials will try to chip away at those protections, with the White House and both chambers of Congress in Republican control beginning next month.
“We’re unsure what the future holds, but what we know is that Marylanders have made it really clear: it is imperative that reproductive rights be in the state of Maryland, and access to those rights be upheld in the state of Maryland,” Bradley said.
“With every new threat, we have to assess it and be responsive to that threat,” she said. “But a constitutional amendment was the best and highest level of protection that Maryland could give to Marylanders.”