Conduit Street Podcast: County Collaboration on Tax Reform, Lockbox Redux, Employer Mandates, and Bad Docs

The MACo Legislative Committee formally adopted a statement this week to express its views on broad-based tax reform proposals pending before the General Assembly, designed to react (in various ways) to the recently enacted federal tax reforms. Absent state action, some Maryland taxpayers would see an increase in their state and county tax liability — the potential means to offset these changes sit before the legislature in multiple variations of changes to deductions, exemptions, rates, and brackets — each with distinct distributional effects.

Governor Larry Hogan this week announced a “lockbox” proposal to ensure that taxes on casino revenues set aside for education are used to supplement, not supplant state funding for public schools. Last month, legislature leadership announced a plan to place a constitutional amendment on the November ballot. The ballot question would ask voters to approve of putting a “lockbox” on casino money (around $500M per year), requiring it to be used for education above the amount set by state formulas. The Governor’s proposal would not require a referendum, it would be done through statute.

The House Economic Matters Committee voted down SB 304, Maryland Healthy Working Families Act – Enforcement – Delayed Implementation, which would have delayed implementation of the Maryland Healthy Working Families Act until July 1. The vote was 12-11. The focus now turns to a new wave of employer mandate proposals.

A proposal to strengthen Maryland’s Prescription Drug Monitoring Program is likely to spur a debate over who should have access to the database and under what circumstances. As heroin and opioid deaths continue to skyrocket in Maryland, County Health Officers could play a vital role in sharing vital information and best practices with identified prescribers, and increase awareness and improve intervention efforts in cases of patients who may be doctor shopping.

On the latest episode of the Conduit Street Podcast, Kevin Kinnally and Michael Sanderson break down MACo’s position on broad-based tax reform proposals, discuss the competing education “lockbox” initiatives, examine employer mandate proposals, preview the looming debate on Maryland’s PDMP, and more!

MACo has made the podcast available through both iTunes and Google Play Music by searching Conduit Street Podcast. You can also listen on our Conduit Street blog with a recap and link to the podcast.

Listen here:

If you are having trouble using this media player, listen on our website.

Carroll Launches Innovative Visitation Program for Jailed Parents

The Carroll County Detention Center in collaboration with the the Family Law Administration, the Carroll County Local Management Board have started a program to reduce generational incarceration.

The Family Ties program is the first in the state to allow incarcerated parents and children to meet weekly and have contact visitation — outside of the detention center. The visits occur at the county Visitation Center which is operated by the Family Law Administration.

The Carroll County Times reports:

For an hour at a time, incarcerated individuals in the program can meet with their minor children in person. They are able to hold them and interact with them — no glass, no phones.

Along with the visitation comes mandatory participation in the 14-session Strengthening Families program, which has been around since the 1990s and is tailored to improving parenting skills and family relationships. The curriculum used by Family Ties is adapted to be more useful for incarcerated individuals.

For more information read The Carroll County Times.

More Data Gives Counties a Clearer Picture of the Opioid Crisis

A bill authorizing law enforcement officers to report information related to an overdose within 24 hours of responding to the incident is a potential aid to county efforts to obtain reliable data concerning opioid overdoses in each jurisdiction. MACo Legislative Director Natasha Mehu appeared before the House Health and Government Operations Committee on February 13, 2018 to testify in support of House Bill 359, “Health – Reporting of Overdose Information”, with amendments.

Counties encourage law enforcement officers and other health providers to promptly submit data related to overdoses that they have responded to. This would provide local jurisdictions with added flexibility and accurate data that will help them in developing effective ways to tackle the opioid crisis.

From MACo Testimony:

As Maryland continues to grapple with the opioid crisis, it is vital that local governments and first responders have timely and accurate information regarding overdoses. Secure online platforms that provide the ability to track overdoses across jurisdictional lines are valuable tools for pinpointing spikes in overdoses and observing patterns of use and distribution. This information would help governments efficiently manage the use of their resources to address the threats to public health and public safety.”

Follow MACo’s advocacy efforts during the 2018 legislative session here.



The Good News: Maryland Spared Massive Federal Shutdown

While you were presumably sleeping, the federal government partially shut down. Then, just before dawn, the House voted through a two-year spending plan – preventing a more extended shutdown. But, the deal leaves Dreamers in the dark and infrastructure and the opioid crisis with drops in their proverbial buckets. Governing reports on what this means for states and counties.

The agreement only includes $20 billion for infrastructure – and that mostly funds existing programs. Water, energy, broadband expansion and improved surface transportation will all share these funds. In addition, it only includes $6 billion  to address the opioid crisis.

The agreement increases federal spending by $300 billion over two years. Congress has six weeks now to incorporate the additional funds into a spending plan. This could be good or bad for Maryland:

This all means that some states could benefit or take a massive hit financially, depending on how closely appropriators align themselves with the administration. For example, in Maryland, Trump has called for Congress to eliminate money for the Chesapeake Bay, a pair of high-tech biodefense laboratories in the state and several programs at NASA Goddard Space Flight Center.

Despite House Democrat Nancy Pelosi’s best efforts otherwise, the agreement does not address how to handle the Dreamers.

It does provide:

  • nearly $90 billion in disaster relief, with about ten percent of that going to Puerto Rico and the U.S. Virgin Islands;
  • long-term funding for health care programs including the Community Health Center Fund and the Children’s Health Insurance Program (CHIP);
  • $6 billion for mental health and programs addressing the opioid crisis
  • $20 billion for infrastructure

Read more here.

Costs of Opioid Epidemic High but Hard to Quantify

Maryland residents among those most impacted by the costs of the crisis.

When it comes to the opioid epidemic, some costs are easier to quantify than others leaving the full scope of impact open to estimation.

Governing reports on the national and local efforts to tie a full dollar figure to the impacts of the epidemic:

In November, S&P Global Ratings looked at Medicaid spending, which the authors reasoned was one of the few available state-by-state comparison measurements on the opioid crisis. The report noted that 3 in 10 non-elderly adults on Medicaid struggled with opioid addiction in 2015 — double the rate of 2010.

The S&P report found that the states with the biggest impact on their finances included Kentucky, New Hampshire, Ohio, Rhode Island and West Virginia.

Data that has been collected by AEI shows that Maryland is among the states where residents are carrying a large burden of the costs.

Meanwhile, the American Enterprise Institute (AEI) estimates that the top five places residents shouldering the biggest burden are, in order, West Virginia, the District of Columbia, Maryland, Ohio and Connecticut.

The institute, which will release the full results of its study later this month, incorporated data on the societal cost of opioids from a 2016 Centers for Disease Control and Prevention report and a more recent report from the White House Council of Economic Advisers. Together, those reports concluded the epidemic cost the country a half-trillion dollars in 2015 alone.

The AEI report found that the per resident cost ranged from $465 in Nebraska to $4,793 in West Virginia. Their report took into consideration overdose deaths, abuse disorders, health-care and criminal justice costs, and worker productivity.

The article notes that full picture of financial impacts on the local level have been hard to gather as local governments tend to not calculate opioid-related costs until they become a significant part of their budget. Additionally indirect costs, such as loss of economic productivity and children entering state care due to loss of their parents, remain most difficult quantify.

For more information:

How Much Is the Opioid Crisis Costing Governments? (Governing)

New state-level estimates of the economic burden of the opioid epidemic (AEI)

Conduit Street Podcast: #FixtheFund, Opioid Litigation, Wave of HUR Bills, Local Aid Intrigue, and more!

Maryland lawmakers on Tuesday unveiled a plan to amend the state constitution to ensure that taxes on casino revenues set aside for education are used to supplement, not supplant state funding for public schools.

Also this week, Baltimore City became the latest jurisdiction to announce plans to file lawsuits against opioid manufacturers, doctors, and so-called “pill mills,” in an effort to stem the drug abuse epidemic that is killing tens of thousands of Americans each year.

Could a compromise be in the works for the restoration of local highway user revenues? A new wave of bills may be pointing in that direction.

Finally, the Department of Legislative Services (DLS) has released their annual report detailing state aid to local governments and local effects of the state budget. The report includes details on virtually every component of state aid to local governments in the proposed FY 19 budget.

On the latest episode of the Conduit Street Podcast, Kevin Kinnally and Michael Sanderson break down the plan to place casino revenues in an education “lockbox,” analyze the possible outcomes of opioid litigation, discuss the new wave of highway user revenue bills, highlight some interesting tidbits from the DLS report, and more!

MACo has made the podcast available through both iTunes and Google Play Music by searching Conduit Street Podcast. You can also listen on our Conduit Street blog with a recap and link to the podcast.

Listen Here:

If you are having trouble using this media player, listen on our website.

City Files Suit Against Opioid Manufacturers, Distributors and Local Doctors

Baltimore City has become the latest Maryland jurisdiction to sue opioid manufacturers and distributors for their role in creating the opioid crisis.

The Baltimore Sun reports:

In announcing the lawsuit, filed in Baltimore Circuit Court, City Solicitor Andre Davis said he would personally be part of the team handling the case. Davis, a former federal judge, said the companies marketed the pills knowing they would be “destructive of lives.”

“They were reckless, they were intentional, it was marketing, it was greed,” Davis said.

The City’s lawsuit alleges the defendants funded unethical research, the spread biased and false information, and the failed to report suspicious pill orders. It names Purdue, Cephalon, Janssen, Actavis,  Endo Health Solutions, McKesson, Cardinal Health and AmerisourceBergen, as well as two local doctors that operate pain clinics as defendants.

For more information read The Baltimore Sun

Calvert to Hire Paid EMS — A First for the County

Calvert County will go from a 100% volunteer EMS and first responder corp to phasing in some paid personnel. 

The Calvert County Board of Commissioners has unanimously voted to phase in paid EMS personnel.

The decision was made in order to help address the challenges of a growing number of emergency calls, timely response to all parts of the county, and difficulties recruiting and retaining volunteer fire, rescue and emergency medical services teams. The county has historically relied on a 100% volunteer corp.

The Calvert Recorder reports:

To supplement existing volunteer ALS staff, the committee recommended the future placement of a paramedic ambulance staffed with a paramedic and emergency medical technician at fire departments in Solomons, Prince Frederick and North Beach, 24 hours a day, seven days a week.

In addition, the committee recommended the placement of one ALS chase car, staffed with an EMS supervisor lieutenant and EMT, running at large around the clock daily.

The future supplemental staffing is estimated at $3.3 million annually. The cost for the fiscal 2019 hiring of a career EMS supervisor is anticipated somewhere between $100,000 and $150,000.

The move to phase in paid personnel does not come at the expense of the long-standing volunteer corp that county has historically relied on. To help recruit and retain volunteers the committee recommended offering targeted property tax, homebuying assistance, and day care incentives, changing eligibility requirements for tuition assistance programs, and implementing a billing program that would help capture insurance revenue.

For more information read the full article in The Calvert Recorder


Hogan Proposes Suit Against Drug Manufacturers, Jail into Treatment Center

As part of the continued effort to tackle the opioid crisis the Hogan Administration has announced a new package of initiatives.

As reported by The Baltimore Sun the package included possibly turning the former Baltimore City jail into a treatment center:

The administration said it would order a feasibility study on repurposing the Civil War-era jail, which Hogan closed in 2015 because of its decrepit condition. The study would be conducted by a consultant chosen by three state agencies.

The feasibility study will help determine, among other things, the level of security needed for this type of therapeutic facility and recommended programming for mental health, substance abuse and medical treatment, Chasse said.

Additionally, The Washington Post reports the governor would also like for the Attorney General to pursue litigation against drug manufacturers. However the characterization and funding for that directive was challenged by the AG:

The governor’s announcement directed Attorney General Brian E. Frosh (D) to consider lawsuits against opioid companies, without naming any, and to direct any settlement proceeds generated by those suits to addiction prevention and treatment programs.

But Frosh said his office is already involved in a 41-state investigation into opioid companies and doesn’t need the governor’s permission to sue them.

To learn more:

Hogan opioid plan would possibly turn closed Baltimore jail into a treatment center (The Baltimore Sun)

Hogan wants Md. to sue opioid manufacturers, turn jail into treatment center (The Washington Post)

Commissioner Pens Op-Ed, Pledges to Hold Drug Companies Accountable

Queens Anne’s County Commissioner James Moran penned an op-ed on the impacts the opioid crisis has inflicted on the county, the role drug companies played contributing to the crisis, and the steps he will take along with his fellow commissioners to ensure the drug companies are held accountable in court.

I doubt that there are many of us that have not been affected by this epidemic or know someone close to us that has. As you will see from the signs that I have helped the Drug Free Coalition and the Queen Anne’s County Sheriff Department erect, we had over 50 overdoses resulting in five (5) fatalities from opioids in Queen Anne’s County in 2017 alone. And this doesn’t include our residents that have OD’d in other counties so our numbers could be much higher.

The drug companies and the drug distributors recognized this potential and flooded physicians with opioid marketing ploys that falsely promised the following:

  1. Millions suffer from chronic pain, and it’s undertreated;
  2. Opioids are convenient and effective;
  3. Addiction to opioids is very rare;
  4. Don’t give into “opiophobia”;
  5. Tapering is easy;
  6. Effective for chronic pain.

Their marketing was tragically successful. In 1996 when Purdue Pharma introduced OxyContin until 2016, accidental overdoses from opioids increased from 300,000 per year to over 1.7 million resulting in 64,000 deaths in 2016 alone. Additionally, since 2000 over half a million Americans have died from opioid overdoses.

Commissioner Moran ended his post by committing to take the fight against the drug manufacturers to court and working with his fellow commissioners to find the right legal team to handle the suit on a contingency basis.

For more information read the full piece written by Commissioner James Moran.