EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0610*
HOUSE BILL 610
J1 2lr1620
HB 470/21 – HGO CF SB 493
By: Delegates Ruth, Bagnall, Bartlett, Belcastro, C. Branch, Bridges,
Charkoudian, Ebersole, W. Fisher, Foley, Forbes, Fraser–Hidalgo, Guyton,
Henson, Howell, R. Jones, Lehman, Moon, Palakovich Carr, Solomon,
Stewart, Terrasa, Toles, Wilkins, and Williams
Introduced and read first time: January 31, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Public Health – Commission on Universal Health Care 2
FOR the purpose of establishing the Commission on Universal Health Care to develop a 3
plan for the State to establish a universal health care program to provide health 4
benefits to all residents of the State through a single–payer system; requiring a 5
member of the Commission to be subject to ethics laws and disclose certain other 6
information related to ethics; prohibiting a member of the Commission from being 7
held personally liable for actions taken as a member under certain circumstances; 8
and generally relating to the Commission on Universal Health Care. 9
BY adding to 10
Article – Health – General 11
Section 13–4401 through 13–4403 to be under the new subtitle “Subtitle 44. 12
Commission on Universal Health Care” 13
Annotated Code of Maryland 14
(2019 Replacement Volume and 2021 Supplement) 15
Preamble 16
WHEREAS, § 1332 of the federal Patient Protection and Affordable Care Act (ACA) 17
allows states to request waivers of key provisions of health care reform, including the 18
requirement to set up a health benefit exchange and provisions relating to premium credits 19
and reduced cost sharing; and 20
WHEREAS, Under § 1332 of the ACA, a waiver for state innovation may be granted 21
if it covers at least as many people as would be covered under the ACA and provides 22
coverage that is at least as comprehensive and affordable, at no greater cost to the federal 23
government; and 24 2 HOUSE BILL 610
WHEREAS, If an approved waiver does not provide individuals or small businesses 1
with premium tax credits or cost–sharing reductions, a state may receive the federal 2
funding it would have received for these purposes to help implement its approved plan; and 3
WHEREAS, Extensive work has been done in other states, including New York, 4
Washington, and Maine, developing plans and legislation for state–based universal health 5
care, including funding mechanisms and financial analyses; and 6
WHEREAS, Multiple jurisdictions in Maryland, including Prince George’s County, 7
Montgomery County, and An napolis, have passed resolutions supporting universal 8
healthcare, some of which specifically mention the creation of a Maryland Commission on 9
Universal Health Care; and 10
WHEREAS, Maryland should seek to establish a health care program to contain 11
costs and to provide comprehensive, affordable, and high–quality publicly financed health 12
care coverage for all Maryland residents in a seamless manner regardless of income, assets, 13
health status, or availability of other health care coverage; now, therefore, 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Health – General 17
SUBTITLE 44. COMMISSION ON UNIVERSAL HEALTH CARE. 18
13–4401. 19
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 20
INDICATED. 21
(B) “AFFILIATION” MEANS: 22
(1) A FINANCIAL INTEREST ; 23
(2) A POSITION OF GOVERNAN CE, INCLUDING MEMBERSHIP ON A 24
BOARD OF DIRECTORS , REGARDLESS OF COMPEN SATION; 25
(3) A RELATIONSHIP THROUGH WHICH COMPENSATION I S RECEIVED; 26
OR 27
(4) A RELATIONSHIP FOR THE PROVISI ON OF SERVICES AS A 28
REGULATED LOBBYIST . 29
(C) “COMMISSION” MEANS THE COMMISSION ON UNIVERSAL HEALTH 30 HOUSE BILL 610 3
CARE ESTABLISHED UNDE R § 13–4402 OF THIS SUBTITLE. 1
(D) “COMPENSATION ” HAS THE MEANING STAT ED IN § 5–101 OF THE 2
GENERAL PROVISIONS ARTICLE. 3
(E) (1) “EXCHANGE” MEANS THE MARYLAND HEALTH BENEFIT 4
EXCHANGE, ESTABLISHED AS A PUB LIC CORPORATION UNDE R § 31–102 OF THE 5
INSURANCE ARTICLE. 6
(2) “EXCHANGE” INCLUDES: 7
(I) THE INDIVIDUAL EXCHANGE; AND 8
(II) THE SMALL BUSINESS HEALTH OPTIONS PROGRAM 9
(SHOP EXCHANGE). 10
(F) “FINANCIAL INTEREST ” HAS THE MEANING STAT ED IN § 11
5–101 OF THE GENERAL PROVISIONS ARTICLE. 12
(G) “REGULATED LOBBYIST ” HAS THE MEANING STAT ED IN § 13
5–101 OF THE GENERAL PROVISIONS ARTICLE. 14
13–4402. 15
(A) THERE IS A COMMISSION ON UNIVERSAL HEALTH CARE. 16
(B) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 17
(1) THE SECRETARY, OR THE SECRETARY’S DESIGNEE, AS AN EX 18
OFFICIO MEMBER OF TH E COMMISSION; 19
(2) FOUR MEMBERS APPOINTE D BY THE GOVERNOR, WITH THE 20
ADVICE AND CO NSENT OF THE SENATE; 21
(3) THREE MEMBERS APPOINT ED BY THE PRESIDENT OF THE 22
SENATE; AND 23
(4) THREE MEMBERS APPOINT ED BY THE SPEAKER OF THE HOUSE. 24
(C) FROM AMONG ITS MEMBER S, THE COMMISSION SHALL ELEC T A CHAIR 25
AND VICE CHAIR. 26
(D) THE DEPARTMENT SHALL PROVIDE STAFF FOR TH E COMMISSION. 27 4 HOUSE BILL 610
(E) IN APPOINTING MEMBERS UNDER SUBSECTION (B) OF THIS SECTION , 1
THE APPOINTING AUTHO RITY SHALL: 2
(1) ENSURE THAT THE APPOI NTEE HAS DEMONSTRATE D AND 3
ACKNOWLEDGED EXPERTI SE IN HEALTH CARE ; 4
(2) CONSIDER THE EXPERTIS E OF THE OTHER MEMBERS OF THE 5
COMMISSION AND ATTEMP T TO MAKE APPOINTMEN TS SO THAT THE COMMISSION’S 6
COMPOSITION REFLECTS A DIVERSITY OF EXPER TISE IN VARIOUS ASPE CTS OF 7
HEALTH CARE ; AND 8
(3) CONSIDER THE CULTURAL , ETHNIC, AND GEOGRAPHICAL 9
DIVERSITY OF THE STATE SO THAT THE COMMISSION’S COMPOSITION REFLEC TS 10
THE COMMUNITIES OF T HE STATE. 11
(F) (1) A MEMBER OF THE COMMISSION, WITHIN THE 2–YEAR PERIOD 12
IMMEDIATELY PRECEDIN G THE MEMBER ’S APPOINTMENT AND WH ILE SERVING ON 13
THE COMMISSION, MAY NOT BE EMPLOYED , OR HAVE BEEN EMPLOYED , IN ANY 14
CAPACITY BY A CONSUL TANT TO A MEMBER OF THE BOARD OF DIRECTO RS OF OR 15
OTHERWISE BE A REPRE SENTATIVE OF: 16
(I) A HEALTH CARE PROVIDER ; 17
(II) A HEALTH CARE FACILITY ; 18
(III) A HEALTH CLINIC ; 19
(IV) A PHARMACEUTICAL COMPA NY; 20
(V) A MEDICAL EQUIPMENT CO MPANY; OR 21
(VI) A CARRIER, AN INSURANCE PRODUCE R, A THIRD–PARTY 22
ADMINISTRATOR , A MANAGED CARE ORGAN IZATION, OR ANY OTHER PERSON 23
CONTRACTING DIRECTLY WITH THOSE PERSONS . 24
(2) A MEMBER OF THE COMMISSION MAY NOT BE A MEMBER, A BOARD 25
MEMBER, OR AN EMPLOYEE OF A TRADE ASSOCIATION OF HEALTH CARE FACILITI ES, 26
HEALTH CLINICS , HEALTH CARE PROVIDER S, CARRIERS, INSURANCE PRODUCERS , 27
THIRD–PARTY ADMINISTRATORS , MANAGED CARE ORGANIZ ATIONS, OR ANY OTHER 28
ASSOCIATION OF ENTIT IES IN A POSITION TO CONTRACT DIRECTLY WITH THE 29
COMMISSION UNLESS THE MEMBER OF THE COMMISSION: 30
HOUSE BILL 610 5
(I) RECEIVES NO COMPENSAT ION FOR RENDERING SE RVICES 1
AS A HEALTH CARE PRO VIDER; AND 2
(II) DOES NOT HAVE AN OWNE RSHIP INTEREST IN A HEALTH 3
CARE PRACTICE . 4
(3) THE PROVISIONS IN THIS SUBSECT ION MAY NOT BE CONST RUED 5
TO PROHIBIT A PHYSIC IAN OR NURSE WHO DOE S NOT SERVE AS A MEM BER OF A 6
BOARD OF DIRECTORS F OR AN ENTITY LISTED IN PARAGRAPH (1) OF THIS 7
SUBSECTION FROM SERV ING AS A MEMBER OF T HE COMMISSION. 8
(G) (1) THE COMMISSION SHALL DETERMINE THE TIMES, PLACES, AND 9
FREQUENCY OF ITS MEE TINGS. 10
(2) FIVE MEMBERS OF THE COMMISSION CONSTITUTE A QUORUM. 11
(3) ACTION BY THE COMMISSION REQUIRES T HE AFFIRMATIVE VOTE 12
OF AT LEAST FIVE MEM BERS. 13
(H) A MEMBER OF THE COMMISSION: 14
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 15
COMMISSION; BUT 16
(2) IS ENTITLED TO: 17
(I) A PER DIEM RATE AS PRO VIDED IN THE STATE BUDGET FOR 18
ATTENDING SCHEDULED MEETINGS OF THE COMMISSION; AND 19
(II) REIMBURSEMENT FOR EXP ENSES UNDER THE STANDARD 20
STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 21
(I) A MEMBER OF THE COMMISSION SHALL PERF ORM THE MEMBER ’S 22
DUTIES: 23
(1) IN GOOD FAITH; 24
(2) IN THE MANNER THE MEM BER REASONABLY BELIE VES TO BE IN 25
THE BEST INTEREST OF THE STATE; AND 26
(3) WITHOUT INTENTIONAL O R RECKLESS DISREGARD OF THE CARE 27
AN ORDINARILY PRUDEN T PERSON IN A LIKE P OSITION WOULD EXERCI SE UNDER 28
SIMILAR CIRCUMSTANCE S. 29 6 HOUSE BILL 610
(J) (1) (I) A MEMBER OF THE COMMISSION SHALL BE S UBJECT TO 1
TITLE 5, SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE. 2
(II) IN ADDITION TO THE DI SCLOSURE REQUIRED UN DER TITLE 3
5, SUBTITLE 6 OF THE GENERAL PROVISIONS ARTICLE, A MEMBER OF THE 4
COMMISSION SHALL DISC LOSE TO THE COMMISSION AND TO THE PUBLIC ANY 5
RELATIONSHIP NOT ADD RESSED IN THE REQUIR ED FINANCIAL DISCLOSURE THAT 6
THE MEMBER HAS WITH A HEALTH CARE PROVID ER, A HEALTH CLINIC , A 7
PHARMACEUTICAL COMPA NY, A MEDICAL EQUIPMENT COMPANY, A CARRIER, AN 8
INSURANCE PRODUCER , A THIRD–PARTY ADMINISTRATOR , A MANAGED CARE 9
ORGANIZATION , OR ANY OTHER ENTITY IN AN INDUSTRY INVOLVED IN MATTERS 10
LIKELY TO COME BEFOR E THE COMMISSION. 11
(2) ON ALL MATTERS THAT C OME BEFORE THE COMMISSION, THE 12
MEMBER SHALL : 13
(I) ADHERE STRICTLY TO TH E CONFLICT OF INTERE ST 14
PROVISIONS UNDER TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS ARTICLE 15
RELATING TO RESTRICT IONS ON PARTICIPATIO N, EMPLOYMENT , AND FINANCIAL 16
INTERESTS; AND 17
(II) PROVIDE FULL DISCLOSU RE TO THE COMMISSION AND THE 18
PUBLIC ON: 19
1. ANY MATTER THAT GIVES RISE TO A POTENTIAL 20
CONFLICT OF INTEREST ; AND 21
2. THE MANNER IN WHICH THE MEMBER WILL COMPLY 22
WITH THE PROVISIONS OF TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS 23
ARTICLE TO AVOID ANY CONFLICT OF INTEREST OR APPEARANCE OF A C ONFLICT 24
OF INTEREST. 25
(K) A MEMBER OF THE COMMISSION WHO PERFOR MS THE MEMBER ’S 26
DUTIES IN ACCORDANCE WITH T HE STANDARD ESTABLIS HED UNDER SUBSECTION 27
(I) OF THIS SECTION MAY NOT BE PERSONALLY LI ABLE FOR ACTIONS TAK EN AS A 28
MEMBER IF DONE IN GO OD FAITH, WITHOUT INTENT TO DE FRAUD, AND IN 29
CONNECTION WITH THE ADMINISTRATION , MANAGEMENT , OR CONDUCT RELATED 30
TO THIS SUBTITLE. 31
(L) A MEMBER OF THE COMMISSION MAY BE REM OVED FOR 32
INCOMPETENCE , MISCONDUCT , OR FAILURE TO PERFOR M THE DUTIES OF THE 33
POSITION. 34 HOUSE BILL 610 7
13–4403. 1
(A) THE COMMISSION SHALL DEVE LOP A PLAN FOR THE STATE TO 2
ESTABLISH, ON OR BEFORE JULY 1, 2025, A UNIVERSAL HEALTH C ARE PROGRAM TO 3
PROVIDE HEALTH BENEF ITS TO ALL RESIDENTS OF THE STATE THROUGH A 4
SINGLE–PAYER SYSTEM . 5
(B) THE COMMISSION SHALL CONS IDER HOW TO: 6
(1) INCORPORATE HEALTH CA RE EQUITY AS A GOAL OF THE PLAN; 7
(2) REDUCE HEALTH C ARE DISPARITIES; AND 8
(3) INCREASE HEALTH CARE ACCESS, PARTICULARLY IN URBA N AND 9
RURAL SETTINGS WITH LIMITED ACCESS . 10
(C) IN DEVELOPING THE PLA N, THE COMMISSION SHALL CONS IDER PLANS 11
AND ANALYSES DONE IN OTHER STATES . 12
(D) THE HEALTH CARE PROGR AM SHALL BE DESIGNED TO : 13
(1) PROVIDE COMPREHENSIVE , AFFORDABLE , AND HIGH–QUALITY 14
PUBLICLY FINANCED HE ALTH CARE COVERAGE F OR ALL RESIDENTS OF THE STATE 15
IN A SEAMLESS AND EQ UITABLE MANNER , REGARDLESS OF INCOME , ASSETS, 16
HEALTH STATUS , CITIZENSHIP OR IMMIG RATION STATUS, OR AVAILABILITY OF 17
OTHER HEALTH CARE CO VERAGE; 18
(2) INCLUDE A BENEFIT PAC KAGE COVERING PRIMAR Y CARE, 19
PREVENTIVE CARE , CHRONIC CARE , ACUTE EPISODIC CARE , REPRODUCTIVE CARE , 20
INCLUDING PREGNANCY , BIRTH CONTROL , AND ABORTION SERVICE S, AND 21
HOSPITAL SER VICES; 22
(3) RECOMMEND HOW , TO THE MAXIMUM EXTEN T ALLOWABLE 23
UNDER FEDERAL LAW AN D WAIVERS FROM FEDER AL LAW, TO: 24
(I) ENSURE THAT ALL FEDER AL PAYMENTS PROVIDED IN THE 25
STATE FOR HEALTH CARE SERVICES ARE PAID DI RECTLY TO THE HEALTH CARE 26
PROGRAM; AND 27
(II) ASSUME RESPONSIBILITY FOR THE BENEFITS AND 28
SERVICES CURRENTLY P AID FOR AND PROVIDED UNDER STATE AND FEDERAL 29
PROGRAMS, INCLUDING THE EXCHANGE, MEDICAID, AND MEDICARE; 30 8 HOUSE BILL 610
(4) INCLUDE HEALTH CARE C OVERAGE PROVIDED : 1
(I) BY EMPLOYERS THAT CHO OSE TO PARTICIPATE; AND 2
(II) TO STATE, COUNTY, AND MUNICIPAL EMPLOY EES; AND 3
(5) CONTAIN COSTS BY : 4
(I) PROVIDING INCENTIVES TO RESIDENTS TO AVOI D 5
PREVENTABLE HEALTH C ONDITIONS, PROMOTE HEALTH , AND AVOID UNNECESSAR Y 6
EMERGENCY ROOM VISIT S; 7
(II) ESTABLISHING INNOVATIVE PAYMEN T MECHANISMS TO 8
HEALTH CARE PROFESSI ONALS, SUCH AS GLOBAL PAYME NTS; AND 9
(III) REDUCING UNNECESSARY ADMINISTRATIVE 10
EXPENDITURES . 11
(E) THE PLAN SHALL INCLUD E: 12
(1) A TIMELINE FOR THE EST ABLISHMENT OF THE HE ALTH CARE 13
PROGRAM; 14
(2) PLANS FOR TRANSITION TO THE HEALTH CARE P ROGRAM, 15
INCLUDING: 16
(I) SUSPENDING OPERATIONS OF THE EXCHANGE TO ENABLE 17
THE STATE TO RECEIVE THE APPROPRIATE FEDERAL FUND CONTRIBUTION IN LIEU 18
OF THE FEDERAL PREMI UM TAX CREDITS , COST–SHARING SUBSIDIES , AND SMALL 19
BUSINESS TAX CREDITS PROVIDED IN THE AFFORDABLE CARE ACT; 20
(II) HOW TO FULLY INTEGRAT E OR ALIGN MEDICAID, 21
MEDICARE, PRIVATE INSURANCE , AND STATE, COUNTY, AND MUNICIPAL 22
EMPLOYEES INTO OR WI TH THE HEALTH CARE P ROGRAM; AND 23
(III) A PLAN FOR TRANSITI ONING WORKERS DISPLA CED BY 24
CHANGES TO THE HEALT H CARE SYSTEM ; 25
(3) A PROPOSED OPERATING S TRUCTURE FOR THE HEA LTH CARE 26
PROGRAM; 27
(4) COST PROJECTIONS FOR THE HEALTH CARE PROG RAM AND 28 HOUSE BILL 610 9
RECOMMENDATIONS FOR THE AMOUNTS AND MECH ANISMS NECESSARY TO FINANCE 1
THE HEALTH CARE PROGRA M; 2
(5) (I) A PROPOSED HEALTH BENE FIT PACKAGE TO BE OF FERED IN 3
THE HEALTH CARE PROG RAM; AND 4
(II) AN ANALYSIS OF WHETHE R THE HEALTH CARE PR OGRAM 5
SHOULD INCLUDE DENTA L, VISION, HEARING, AND LONG–TERM CARE BENEFITS ; 6
AND 7
(6) RECOMMENDATIONS FOR LEGIS LATION REQUIRED TO E STABLISH 8
THE HEALTH CARE PROG RAM. 9
(F) THE COMMISSION SHALL SUBM IT TO THE GOVERNOR AND , IN 10
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, THE SENATE 11
FINANCE COMMITTEE AND THE HOUSE HEALTH AND GOVERNMENT OPERATIONS 12
COMMITTEE: 13
(1) ON OR BEFORE JUNE 1, 2023, AN INTERIM PROGRESS REPORT ON 14
THE DEVELOPMENT OF A PLAN TO ESTABLISH TH E HEALTH CARE PROGRA M; AND 15
(2) ON OR BEFORE OCTOBER 1, 2024, THE PLAN TO ESTABLIS H THE 16
HEALTH CARE PROGRAM . 17
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 18
1, 2022. It shall remain effective for a period of 4 years and 1 month and, at the end of June 19
30, 2026, this Act, with no further action required by the General Assembly, shall be 20
abrogated and of no further force and effect. 21