The Meyer Plan: Expanded coverage, hiring initiatives to improve health

Why Should Delaware Care?
Since the COVID pandemic, Delaware’s health care system has faced an increase in rising costs, workforce shortages and disparities. Governor-elect Matt Meyer’s plan addresses these issues, which advocates feel will provide much needed relief, but they stress the need for immediate action to ensure a truly equitable and effective system.  

Governor-elect Matt Meyer is stepping into office with an ambitious four-year health care agenda that plans to tackle Delaware’s growing health challenges, sparking both optimism and caution among advocates and stakeholders. 

Since the COVID-19 pandemic, Delaware has seen worsening health care access and affordability, stemming from rising care costs, a shortage of providers, an increase in chronic illness and health inequities among different demographics.   

The issues have affected the state’s most vulnerable populations hardest while straining the workforce’s ability to meet growing demands. 

And while advocates are excited about Meyer’s focus on these challenges, they stress the need for immediate relief for both patients and providers. 

Decreasing the cost of care

A major focus of Meyer’s plan is to make health care more affordable, with initiatives like eliminating medical debt. 

He proposes purchasing the current $400 million valued debt that residents have from creditors, following successful models in other states. 

Meyer also aims to expand Medicaid and the Children’s Health Insurance Program (CHIP), ensuring everyone who is eligible is enrolled.

During the pandemic, relaxed Medicaid and Medicare requirements helped residents stay covered, but when eligibility reviews resumed in 2023, an estimated 60,000 Delawareans lost coverage, according to the Kaiser Family Foundation.

Meyer plans to address these gaps while also lowering costs for health care providers by allowing businesses and individuals to join the state employee health care program, a move that could benefit small nonprofits and organizations.

“As an organization, that would drive our rates down significantly, make insurance more affordable, which would also bring us money that we would have in our budget to do more work directly with the community,” said Marie Wenzel, CEO of the National Alliance on Mental Illness of Delaware.

Competition is another key aspect of Meyer’s agenda. He seeks to reduce the state’s dependence on single hospital systems in each county and on Highmark Blue Cross Blue Shield for a majority of coverage. 

While Meyer sees competition as a way to lower costs and improve quality, some, like Westside Family Health CEO Chris Fraser, say creating more competition could be an expensive venture and suggest focusing instead on strengthening existing partnerships among health care systems.

Westside is a nonprofit community health center and one of three federally qualified health care centers in the state that provides health care to underserved communities. 

Westside sees over 24,000 patients, more than 80% of whom are either uninsured or on Medicaid and CHIP. It partners with ChristianaCare and Beebe Healthcare to provide care to pregnant women, offer residency training programs and ensure continuous care for patients. 

“If the governor could really highlight the work that federally qualified health centers are doing and the investment that we need right now from the state to continue to do that, that would be really meaningful,” Fraser said. 

Meyer’s plan also proposes tackling high drug costs through a Prescription Drug Affordability Board to cap prices on expensive medications and introducing a transparency law requiring drug companies to explain price increases. 

Delaware households currently face an average prescription cost of over $6,500 annually.

Advocates, like Maggie Norris Bent, chief strategy officer of Westside, point out the strain these prices also put on providers.  

“Some of our nurses are spending three or four hours of their time trying to find a medication that the patient can afford,” she said. 

Norris Bent said finding affordable replacement drugs forces providers to take time away from caring for patients and using cheaper options can result in side effects and dosage changes that could negatively impact patients. 

Westside urges Meyer to look into the 340B Drug Pricing Program, a federal initiative that has allowed eligible health care facilities like Westside to receive prescription medication from manufacturers at a discounted price for decades. 

In the past four years, over 35 pharmaceutical manufacturers have “eroded” the program by challenging it and imposing different limitations on how providers can distribute 340B drugs, claiming that they don’t want providers misusing the program. 

Norris Bent argued these restrictions undermine the program’s purpose and called for legislative action to restore it by preventing drug companies from imposing such limitations.

Advocates also emphasize the importance of preventative care, an aspect Meyer wants to encourage through incentives and reimbursements for providers that have education on diet, smoking and other risk factors. 

This area will require a more holistic approach that should prompt initiatives that look at adequate housing and encourage insurance plans to include benefits like access to healthy foods, as all of these aspects are connected to bettering the health of residents, according to advocates. 

Mental health disparities 

Delaware is in the midst of a mental health crisis, with nearly one in five adults experiencing mental illness each year and over 28% unable to access needed care, according to Meyer’s plan. He is focused on improving oversight of mental health insurance, requiring insurers to report compliance with parity laws and conducting regular market reviews to ensure fairness.

He also wants to expand protections under the Federal No Surprise Act, which improved cost transparency by preventing surprise billing hikes, to include behavioral health crisis centers and other specialties. 

To address workforce shortages, he will work to recruit and retain more mental health professionals. 

Wenzel, of NAMI, emphasized the importance of incentivizing minority groups to pursue careers as mental health clinicians, noting that loan forgiveness programs could be a powerful tool to build a workforce reflective of the communities most affected by mental illness.

“People already struggle with the stigma of getting help for their mental health challenges. It’s even harder when you can’t find a clinician who looks like you, who can relate to you, and has some sort of similar understanding of whatever the challenges are that you’re facing,” she said. 

Wenzel also highlighted the strides Delaware has made in funding substance use programs, noting that similar investments are lacking in the behavioral health system, which she believes could go hand in hand. 

Advancing maternal health, protecting reproductive rights

Delaware has made progress in reducing its infant mortality rate, with deaths per 1,000 live births dropping from 9 to 5.4 between 2015 and 2020 — a 40% decrease, according to the Delaware Healthy Mother & Infant Consortium. 

However, racial disparities remain an issue. Black women account for 28% of live births in the state but represent 78% of pregnancy-related deaths, reflecting systemic issues like chronic conditions, structural racism and implicit bias, as reported by WHYY. 

Meyer’s plan aims to tackle these disparities by funding the state’s Perinatal Quality Collaborative to focus on Black maternal health, improving access to preconception care and promoting safe sleep practices to reduce Sudden Infant Death Syndrome, or SIDS.

He will also extend continuous health care coverage for children until age 3, ensuring uninterrupted access regardless of changes in family income.

The governor-elect also pledged to protect reproductive rights by pursuing a constitutional amendment to secure women’s right to choose.

While recent legislation has mandated abortion coverage through Medicaid, private insurance and state employee plans, advocates like Melissa Froemming, founding president of Delaware NOW, say the focus must now shift to improving access, particularly in underserved areas like Sussex County.

Froemming, a key advocate for reproductive rights in Delaware, especially after the overturning of Roe v. Wade, played a key role in advocating for HB 320, which permitted physician assistants and advanced practice registered nurses to prescribe medication for terminating pregnancies.

She expressed excitement about Meyer’s plan but highlighted the need for more providers and clinics to ensure women receive timely care, noting that some women have to make long trips or cross state lines for services.

“We can give women rights. We can create programs for Black mothers. We can do these great things, but if we don’t have doctors and other providers to care for these patients, it doesn’t matter if they have access,” she said. 

Froemming also encouraged Meyer to look into repealing the state’s parental notification law, which requires those under 16 to get permission from their parents to obtain an abortion. 

She said this law limits young people’s reproductive freedom and adds unnecessary barriers to care.

Strengthening the workforce for accessibility

Meyer wants to work on accessibility in the state by expanding the health care workforce and implementing initiatives to improve retention rates, as the pandemic worsened workforce challenges resulting in shortages, burnout and stress among providers. 

To tackle these issues, Meyer proposes launching Delaware’s first medical school to increase the number of physicians and specialists. However, some advocates argue this long-term solution must be paired with immediate action.

“A medical school is great and will help in the long run, but that needs to happen in conjunction, parallel to investments in the overall health care workforce,” said Christopher Otto, the executive director of the Delaware Nurses Association..

Advocates like Westside and DNA would like Meyer to spend more time on his plan to foster supportive work environments with initiatives like competitive wages, flexible scheduling, child care support and wellness programs.

His current agenda proposes financial incentives for professionals in underserved areas, streamlining licensing processes and expanding telehealth services to improve access in remote regions.

Otto said that while loan repayment programs help, they’re not enough, as many nurses leave the state due to overwhelming work demands, limited resources and rising workplace violence. 

“The problem that’s going to be encountered there is these are private employers,”  Otto said. “And so if they don’t have the resources or structure to put programs like this into place, then it’s not going to necessarily be a priority.”

Meyer also plans to collaborate with educational institutions to expand training opportunities for health care professionals, ensuring workforce development complements the eventual launch of a medical school.

What is missing from Meyer’s plan

Although Meyer’s health care plans are promising, advocates highlight gaps that need addressing. 

Representatives from Westside point to a decline in routine cancer screenings prompted by the pandemic and the urgent need to refocus on early detection. 

Health literacy is another concern for them, as patients often misunderstand clinical instructions, leading to poor adherence and unnecessary ER visits. 

Creating initiatives to simplify materials and tailoring them to suitable reading levels and languages can help.

Wenzel raised concerns about gaps in how benefits are handled for individuals with mental health issues in pretrial detention. 

She said federal benefits like Medicaid and Social Security Disability Insurance are often cut off for those awaiting trial, even though they haven’t been convicted of a crime. 

This can disproportionately affect people unable to afford bail and leaves individuals without access to crucial medications, worsening mental health symptoms during an already traumatic experience.

Advocates agree that addressing these issues would strengthen Meyer’s agenda and create a more equitable health care system for all Delawareans.

“The underlying theme right now, particularly in health care, is the Meyer administration is going to have to continue to build trust with the community and with the public,” Otto said. 

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