EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0493*
SENATE BILL 493
J1 2lr1619
SB 522/21 – FIN CF 2lr1620
By: Senators Pinsky, Lam, and Guzzone
Introduced and read first time: January 27, 2022
Assigned to: Finance
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
WHEREAS, If an approved waiver does not provide individuals or small businesses 25
with premium tax credits or cost–sharing reductions, a state may receive the federal 26 2 SENATE BILL 493
funding it would have received for these purposes to help implement its approved plan; and 1
WHEREAS, Extensive work has been done in other states, including New York, 2
Washington, and Maine, developing plans and legislation for state–based universal health 3
care, including funding mechanisms and financial analyses; and 4
WHEREAS, Multiple jurisdictions in Maryland, including Prince George’s County, 5
Montgomery County, and Annapolis, have passed resolutions supporting universal health 6
care, some of which specifically mention the creation of a Maryland Commission on 7
Universal Health Care; and 8
WHEREAS, Maryland should seek to establish a health care program to contain 9
costs and to provide comprehensive, affordable, and high–quality publicly financed health 10
care coverage for all Maryland residents in a seamless manner regardless of income, assets, 11
health status, or availability of other health care coverage; now, therefore, 12
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 13
That the Laws of Maryland read as follows: 14
Article – Health – General 15
SUBTITLE 44. COMMISSION ON UNIVERSAL HEALTH CARE. 16
13–4401. 17
(A) IN THIS SUBTITLE THE FO LLOWING WORDS HAVE T HE MEANINGS 18
INDICATED. 19
(B) “AFFILIATION” MEANS: 20
(1) A FINANCIAL INTEREST ; 21
(2) A POSITION OF GOVERNAN CE, INCLUDING MEMBERSHIP ON A 22
BOARD OF DIRECTORS , REGARDLESS OF COMPEN SATION; 23
(3) A RELATIONSHIP THROUGH WHICH COMPENSATION I S RECEIVED; 24
OR 25
(4) A RELATIONSHIP FOR THE PROVISION OF SERVICE S AS A 26
REGULATED LOBBYIST . 27
(C) “COMMISSION” MEANS THE COMMISSION ON UNIVERSAL HEALTH 28
CARE ESTABLISHED UNDE R § 13–4402 OF THIS SUBTITLE. 29
(D) “COMPENSATION ” HAS THE MEA NING STATED IN § 5–101 OF THE 30 SENATE BILL 493 3
GENERAL PROVISIONS ARTICLE. 1
(E) (1) “EXCHANGE” MEANS THE MARYLAND HEALTH BENEFIT 2
EXCHANGE, ESTABLISHED AS A PUB LIC CORPORATION UNDE R § 31–102 OF THE 3
INSURANCE ARTICLE. 4
(2) “EXCHANGE” INCLUDES: 5
(I) THE INDIVIDUAL EXCHANGE; AND 6
(II) THE SMALL BUSINESS HEALTH OPTIONS PROGRAM 7
(SHOP EXCHANGE). 8
(F) “FINANCIAL INTEREST ” HAS THE MEANING STAT ED IN § 9
5–101 OF THE GENERAL PROVISIONS ARTICLE. 10
(G) “REGULATED LOBBYIST ” HAS THE MEANING STAT ED IN § 11
5–101 OF THE GENERAL PROVISIONS ARTICLE. 12
13–4402. 13
(A) THERE IS A COMMISSION ON UNIVERSAL HEALTH CARE. 14
(B) THE COMMISSION CONSISTS O F THE FOLLOWING MEMB ERS: 15
(1) THE SECRETARY, OR THE SECRETARY’S DESIGNEE, AS AN EX 16
OFFICIO MEMBER OF TH E COMMISSION; 17
(2) FOUR MEMBERS A PPOINTED BY THE GOVERNOR, WITH THE 18
ADVICE AND CONSENT O F THE SENATE; 19
(3) THREE MEMBERS APPOINT ED BY THE PRESIDENT OF THE 20
SENATE; AND 21
(4) THREE MEMBERS APPOINT ED BY THE SPEAKER OF THE HOUSE. 22
(C) FROM AMONG ITS MEMBER S, THE COMMISSION SHALL ELEC T A CHAIR 23
AND VICE CHAIR. 24
(D) THE DEPARTMENT SHALL PROV IDE STAFF FOR THE COMMISSION. 25
(E) IN APPOINTING MEMBERS UNDER SUBSECTION (B) OF THIS SECTION , 26
THE APPOINTING AUTHO RITY SHALL: 27 4 SENATE BILL 493
(1) ENSURE THAT THE APPOI NTEE HAS DEMONSTRATE D AND 1
ACKNOWLEDGED EXPERTI SE IN HEALTH CARE ; 2
(2) CONSIDER THE EXPERTIS E OF THE OTHER MEMBE RS OF THE 3
COMMISSION AND ATTEMP T TO MAKE APPOINTMEN TS SO THAT THE COMMISSION’S 4
COMPOSITION REFLECTS A DIVERSITY OF EXPER TISE IN VARIOUS ASPE CTS OF 5
HEALTH CARE ; AND 6
(3) CONSIDER THE CULTURAL, ETHNIC, AND GEOGRAPHICAL 7
DIVERSITY OF THE STATE SO THAT THE COMMISSION’S COMPOSITION REFLEC TS 8
THE COMMUNITIES OF T HE STATE. 9
(F) (1) A MEMBER OF THE COMMISSION, WITHIN THE 2–YEAR PERIOD 10
IMMEDIATELY PRECEDIN G THE MEMBER ’S APPOINTMENT AND WH ILE SERVING ON 11
THE COMMISSION, MAY NOT BE EMPLOYED , OR HAVE BEEN EMPLOYE D, IN ANY 12
CAPACITY BY A CONSUL TANT TO A MEMBER OF THE BOARD OF DIRECTO RS OF OR 13
OTHERWISE BE A REPRE SENTATIVE OF: 14
(I) A HEALTH CARE PROVIDER ; 15
(II) A HEALTH CARE FACILITY ; 16
(III) A HEALTH CLINIC ; 17
(IV) A PHARMACEUTICAL COMPA NY; 18
(V) A MEDICAL EQUIPMENT CO MPANY; OR 19
(VI) A CARRIER, AN INSURANCE PRODUCE R, A THIRD–PARTY 20
ADMINISTRATOR , A MANAGED CARE ORGAN IZATION, OR ANY OTHER PERSON 21
CONTRACTING DIRECTLY WITH THOSE PERSONS . 22
(2) A MEMBER OF THE COMMISSION MAY NOT BE A MEMBER, A BOARD 23
MEMBER, OR AN EMPLOYEE OF A TRADE ASSOCIATION OF HEALTH CARE FACILITI ES, 24
HEALTH CLINICS , HEALTH CARE PROVIDER S, CARRIERS, INSURANCE PRODUCERS , 25
THIRD–PARTY ADMINISTRATORS , MANAGED CARE ORGANIZ ATIONS, OR ANY OTHER 26
ASSOCIATION OF ENTIT IES IN A POSITION TO CONTRACT DIRECTLY WI TH THE 27
COMMISSION UNLESS THE MEMBER OF THE COMMISSION: 28
(I) RECEIVES NO COMPENSAT ION FOR RENDERING SE RVICES 29
AS A HEALTH CARE PRO VIDER; AND 30
SENATE BILL 493 5
(II) DOES NOT HAVE AN OWNE RSHIP INTEREST IN A HEALTH 1
CARE PRACTICE . 2
(3) THE PROVISIONS IN THI S SUBSECTION MAY NOT BE CONSTRUED 3
TO PROHIBIT A PHYSICIAN OR NURSE W HO DOES NOT SERVE AS A MEMBER OF A 4
BOARD OF DIRECTORS F OR AN ENTITY LISTED IN PARAGRAPH (1) OF THIS 5
SUBSECTION FROM SERV ING AS A MEMBER OF T HE COMMISSION. 6
(G) (1) THE COMMISSION SHALL DETE RMINE THE TIMES , PLACES, AND 7
FREQUENCY OF ITS MEE TINGS. 8
(2) FIVE MEMBERS OF THE COMMISSION CONSTITUTE A QUORUM . 9
(3) ACTION BY THE COMMISSION REQUIRES T HE AFFIRMATIVE VOTE 10
OF AT LEAST FIVE MEM BERS. 11
(H) A MEMBER OF THE COMMISSION: 12
(1) MAY NOT RECEIVE COMPE NSATION AS A MEMBER OF THE 13
COMMISSION; BUT 14
(2) IS ENTITLED TO: 15
(I) A PER DIEM RATE AS PROVIDED IN THE STATE BUDGET FOR 16
ATTENDING SCHEDULED MEETINGS OF THE COMMISSION; AND 17
(II) REIMBURSEMENT FOR EXP ENSES UNDER THE STANDARD 18
STATE TRAVEL REGULATIONS, AS PROVIDED IN THE STATE BUDGET . 19
(I) A MEMBER OF THE COMMISSION SHALL PERF ORM THE MEMBER ’S 20
DUTIES: 21
(1) IN GOOD FAITH; 22
(2) IN THE MANNER THE MEM BER REASONABLY BELIE VES TO BE IN 23
THE BEST INTEREST OF THE STATE; AND 24
(3) WITHOUT INTENTIONAL O R RECKLESS DISREGARD OF THE CARE 25
AN ORDINARILY PRUDEN T PERSON IN A LIKE P OSITION WOULD EX ERCISE UNDER 26
SIMILAR CIRCUMSTANCE S. 27
(J) (1) (I) A MEMBER OF THE COMMISSION SHALL BE S UBJECT TO 28
TITLE 5, SUBTITLES 1 THROUGH 7 OF THE GENERAL PROVISIONS ARTICLE. 29 6 SENATE BILL 493
(II) IN ADDITION TO THE DI SCLOSURE REQUIRED UN DER TITLE 1
5, SUBTITLE 6 OF THE GENERAL PROVISIONS ARTICLE, A MEMBER OF THE 2
COMMISSION SHALL DISC LOSE TO THE COMMISSION AND TO THE PUBLIC ANY 3
RELATIONSHIP NOT ADD RESSED IN THE REQUIR ED FINANCIAL DISCLOS URE THAT 4
THE MEMBER HAS WITH A HEALTH CARE PROVID ER, A HEALTH CLINIC , A 5
PHARMACEUTICAL COMPA NY, A MEDICAL EQUIPMENT CO MPANY, A CARRIER, AN 6
INSURANCE PRODUCER , A THIRD–PARTY ADMINISTRATOR , A MANAGED CARE 7
ORGANIZATION , OR ANY OTHER ENTITY IN AN INDUSTRY INVOL VED IN MATTERS 8
LIKELY TO COME BEFOR E THE COMMISSION. 9
(2) ON ALL MATTERS THAT C OME BEFORE THE COMMISSION, THE 10
MEMBER SHALL : 11
(I) ADHERE STRICTLY TO TH E CONFLICT OF INTERE ST 12
PROVISIONS UNDER TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS ARTICLE 13
RELATING TO RESTRICT IONS ON PARTICIPATIO N, EMPLOYMENT , AND FINANCIAL 14
INTERESTS; AND 15
(II) PROVIDE FULL DISCLOSU RE TO THE COMMISSION AND THE 16
PUBLIC ON: 17
1. ANY MATTER THAT GIVES RISE TO A POTENTIAL 18
CONFLICT OF INTEREST ; AND 19
2. THE MANNER IN WHICH T HE MEMBER WILL COMPL Y 20
WITH THE PROVISIONS OF TITLE 5, SUBTITLE 5 OF THE GENERAL PROVISIONS 21
ARTICLE TO AVOID ANY CONFLICT OF INTEREST OR APPEARANCE OF A C ONFLICT 22
OF INTEREST. 23
(K) A MEMBER OF THE COMMISSION WHO PERFOR MS THE MEMBER ’S 24
DUTIES IN ACCORDANCE WITH THE STANDARD ES TABLISHED UNDER SUBS ECTION 25
(I) OF THIS SECTION MAY NOT BE PERSONALLY LI ABLE FOR ACTIONS TAK EN AS A 26
MEMBER IF DONE IN GO OD FAITH, WITHOUT INTENT TO DE FRAUD, AND IN 27
CONNECTION WITH THE ADMINISTRATION , MANAGEMENT , OR CONDUCT RELATED 28
TO THIS SUBTITLE. 29
(L) A MEMBER OF THE COMMISSION MAY BE REM OVED FOR 30
INCOMPETENCE , MISCONDUCT , OR FAILURE TO PERFORM THE DUTIES OF THE 31
POSITION. 32
13–4403. 33
SENATE BILL 493 7
(A) THE COMMISSION SHALL DEVE LOP A PLAN FOR THE STATE TO 1
ESTABLISH, ON OR BEFORE JULY 1, 2025, A UNIVERSAL HEALTH C ARE PROGRAM TO 2
PROVIDE HEALTH BENEF ITS TO ALL RESIDENTS OF THE STATE THROUGH A 3
SINGLE–PAYER SYSTEM . 4
(B) THE COMMISSION SHALL CONS IDER HOW TO: 5
(1) INCORPORATE HEALTH CA RE EQUITY AS A GOAL OF THE PLA N; 6
(2) REDUCE HEALTH CARE DI SPARITIES; AND 7
(3) INCREASE HEALTH CARE ACCESS , PARTICULARLY IN URBA N AND 8
RURAL SETTINGS WITH LIMITED ACCESS. 9
(C) IN DEVELOPING THE PLA N, THE COMMISSION SHALL CONS IDER PLANS 10
AND ANALYSES DONE IN OTHER STATES . 11
(D) THE HEALTH CARE PROGR AM SHALL BE DESIGNED TO: 12
(1) PROVIDE COMPREHENSIVE , AFFORDABLE , AND HIGH–QUALITY 13
PUBLICLY FINANCED HE ALTH CARE COVERAGE F OR ALL RESIDENTS OF THE STATE 14
IN A SEAMLESS AND EQ UITABLE MANNER , REGARDLESS OF INCOME , ASSETS, 15
HEALTH STATUS , CITIZENSHIP OR IMMIG RATION STATUS , OR AVAILABILITY OF 16
OTHER HEALTH CARE CO VERAGE; 17
(2) INCLUDE A BENEFIT PAC KAGE COVERING PRIMAR Y CARE, 18
PREVENTIVE CARE , CHRONIC CARE , ACUTE EPISODIC CARE , REPRODUCTIVE CARE , 19
INCLUDING PREGNANCY , BIRTH CONTROL , AND ABORTION SERVICE S, AND 20
HOSPITAL SERVICES ; 21
(3) RECOMMEND HOW, TO THE MAXIMUM EXTENT A LLOWABLE 22
UNDER FEDERAL LAW AN D WAIVERS FROM FEDER AL LAW, TO: 23
(I) ENSURE THAT ALL FEDER AL PAYMENTS PROVIDED IN THE 24
STATE FOR HEALTH CARE SERVICES ARE PAID DI RECTLY TO THE HEALTH CARE 25
PROGRAM; AND 26
(II) ASSUME RESPONSIBILIT Y FOR THE BENEFITS A ND 27
SERVICES CURRENTLY P AID FOR AND PROVIDED UNDER STATE AND FEDERAL 28
PROGRAMS, INCLUDING THE EXCHANGE, MEDICAID, AND MEDICARE; 29
(4) INCLUDE HEALTH CARE C OVERAGE PROVIDED : 30
8 SENATE BILL 493
(I) BY EMPLOYERS THAT CHO OSE TO PARTICIPATE ; AND 1
(II) TO STATE, COUNTY, AND MUNICIPAL EMPLOY EES; AND 2
(5) CONTAIN COSTS BY : 3
(I) PROVIDING INCENTIVES TO RESIDENTS TO AVOI D 4
PREVENTABLE HEALTH C ONDITIONS, PROMOTE HEALTH , AND AVOID UNNECESSAR Y 5
EMERGENCY ROOM VISIT S; 6
(II) ESTABLISHING INNOVATI VE PAYMENT ME CHANISMS TO 7
HEALTH CARE PROFESSI ONALS, SUCH AS GLOBAL PAYME NTS; AND 8
(III) REDUCING UNNECESSARY ADMINISTRATIVE 9
EXPENDITURES . 10
(E) THE PLAN SHALL INCLUD E: 11
(1) A TIMELINE FOR THE EST ABLISHMENT OF THE HE ALTH CARE 12
PROGRAM; 13
(2) PLANS FOR TRANSITION TO THE HEALTH CARE P ROGRAM, 14
INCLUDING: 15
(I) SUSPENDING OPERATIONS OF THE EXCHANGE TO ENABLE 16
THE STATE TO RECEIVE THE APPROPRIATE FEDERAL FUND CONTRIBUTION IN LIEU 17
OF THE FEDERAL PREMI UM TAX CREDITS , COST–SHARING SUBSIDIES , AND SMALL 18
BUSINESS TAX CREDITS PROVIDED IN THE AFFORDABLE CARE ACT; 19
(II) HOW TO FULLY INTEGRAT E OR ALIGN MEDICAID, 20
MEDICARE, PRIVATE INSURANCE , AND STATE, COUNTY, AND MUNICIPAL 21
EMPLOYEES INTO OR WI TH THE HEALTH CARE P ROGRAM; AND 22
(III) A PLAN FOR TRANSITIO NING WORKERS DISPLAC ED BY 23
CHANGES TO THE HEALT H CARE SYSTEM ; 24
(3) A PROPOSED OPERATING S TRUCTURE FOR THE HEA LTH CARE 25
PROGRAM; 26
(4) COST PROJECTIONS FOR THE HEALTH CARE PROG RAM AND 27
RECOMMENDATIONS FOR THE AMOUNTS AND MECH ANISMS NECESSARY TO FINANCE 28
THE HEALTH CARE PROGRAM ; 29
SENATE BILL 493 9
(5) (I) A PROPOSED HEALTH BENE FIT PACKAGE TO BE OF FERED IN 1
THE HEALTH CARE PROG RAM; AND 2
(II) AN ANALYSIS OF WHETHE R THE HEALTH CARE PR OGRAM 3
SHOULD INCLUDE DENTA L, VISION, HEARING, AND LONG–TERM CARE BENEFITS ; 4
AND 5
(6) RECOMMENDATIONS FOR LEGISL ATION REQUIRED TO ES TABLISH 6
THE HEALTH CARE PROG RAM. 7
(F) THE COMMISSION SHALL SUBM IT TO THE GOVERNOR AND , IN 8
ACCORDANCE WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, THE SENATE 9
FINANCE COMMITTEE AND THE HOUSE HEALTH AND GOVERNMENT OPERATIONS 10
COMMITTEE: 11
(1) ON OR BEFORE JUNE 1, 2023, AN INTERIM PROGRESS REPORT ON 12
THE DEVELOPMENT OF A PLAN TO ESTABLISH TH E HEALTH CARE PROGRA M; AND 13
(2) ON OR BEFORE OCTOBER 1, 2024, THE PLAN TO ESTABLIS H THE 14
HEALTH CARE PROGRAM . 15
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 16
1, 2022. It shall remain effective for a period of 4 years and 1 month and, at the end of June 17
30, 2026, this Act, with no further action required by the General Assembly, shall be 18
abrogated and of no further force and effect. 19