Category Archives: Medicine/Health Care

Hogan’s Worst Nightmare: Trumpcare

By Barry Rascovar

May 8, 2017 – Maryland Gov. Larry Hogan’s worst nightmare is starting to come true. Trumpcare has passed the U.S. House of Representatives. If the Senate finds a way to give President Trump what he wants, it could spell a heap of trouble for Hogan in 2018’s general election.

The Republican Party’s mania with obliterating Barack Obama’s massive health insurance law has led the majority party in Washington to ignore common sense.

“Repeal and replace” is a GOP obsession – though an estimated 24 million people could lose their insurance, tens of millions more could be out of luck due to pre-existing conditions and medical programs for the poor could be cut 25%.

It also would damage the nation’s economy. That’s especially true in Maryland, where healthcare is one of the state’s biggest employers.Hogan's Worst NightmareIt is almost certain to be the No. 1 issue in the 2018 mid-term elections, even if the Senate approves a diluted Trumpcare bill.

What a devastating state of affairs for Republican Hogan. Until the House vote last week, he appeared in excellent shape to win a second term.

Now he has to figure out how to tiptoe around this explosive issue that already is proving highly unpopular.

Unfavorable Poll Numbers

A Washington Post-ABC poll last month found 61% of Americans opposed Trumpcare. A Quinnipiac poll the month before found Trumpcare support stood at just 17%.

Most Americans, it appears, would rather stick with the existing – though seriously flawed – Obamacare medical insurance program and fix parts that aren’t working well (“keep and improve” as opposed to the GOP’s “repeal and replace”).

Wait until the Congressional Budget Office issues its cost and impact analysis of the House-passed version of Trumpcare. It could expose the bill’s soft underbelly. Public resistance could grow louder.

For Hogan, House passage of Trumpcare might be the beginning of bad news.

He could be trapped in a nearly untenable position: A Republican who might have to disavow his own party leaders in Washington to survive.

Hogan won election in 2014 by promising “no new taxes.” Does that mean he will let Trumpcare’s 25% cut in federal Medicaid funds lay waste to Maryland’s health programs for the poor and near-poor? Where would he find hundreds of millions in state dollars to cover those unfunded programs?

How does he run for reelection with Trumpcare hanging over his head?

Justifying Republican Plan

How does Hogan justify to voters his party’s plan to let insurance companies charge outrageously high premiums – or deny coverage entirely – for people with “pre-existing conditions”? This could be anyone with acne, anxiety, depression, diabetes, obesity, cancer, pulmonary problems, asthma or even allergies.

How does he tell older working Marylanders that under his party’s plan their insurance premiums could jump an unaffordable 500%?

How does he explain a cut of $600 billion in taxes that supported Obamacare – a massive windfall for wealthy Americans, insurance companies and medical device companies?

How does he justify $880 billion in healthcare cuts to Medical Assistance for the poor?

Hogan & Company should be praying that the Senate junks the House bill and takes a few years to figure out what to do next.

Otherwise, the GOP across the country – including here in Maryland – could take a shellacking for its all-out effort to appease its conservative base.

Gift to Democrats

There’s no doubt Democratic candidates for Maryland governor will tie Hogan to Trumpcare.

Every candidate will be running ads with tales of how middle-class and working-class Marylanders would be hurt, how lives hang in the balance.

It is a gift from heaven for Democrats.

One Republican pollster called the GOP’s insistent quest to wipe out Obamacare “political malpractice.”

Until recently the notion of Democrats regaining control of the House by picking up 24-plus seats next year appeared wishful thinking. Thanks to House Speaker Paul Ryan’s determination to pass a draconian Trumpcare bill, that’s no longer the case.

Little wonder Democratic House leader Nancy Pelosi – the former Nancy D’Alesandro from Baltimore’s Little Italy – was practically giddy.

Every Republican will be vulnerable, unless he or she disowns the GOP’s No. 1 issue and risks losing support from Trump’s supporters. “This vote will be tattooed to them,” Pelosi vowed.

That includes Republican Hogan, who has made an extensive effort to distance himself from Donald Trump and his controversial comments and proposals.

That may not be enough to give him immunity from this highly contagious political disease.

When virtually every healthcare group – from the American Medical Association to the American Hospital Association to AARP – as well as virtually every insurance group vehemently opposes the Republicans’ “repeal and replace” crusade, smart politicians should pay attention.

Failure by the GOP to “listen and learn” could prove fatal come November 2018 – both in Maryland and nationwide.

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Hogan, Trump & Trouble?

By Barry Rascovar

March 13, 2017–Maryland’s Republican governor, Larry Hogan, Jr., has done all in his power to separate himself from the new, controversial Republican president, Donald Trump.

Given Trump’s unpopularity in Maryland – he lost by a whopping 25% in November – that wall of separation keeps Hogan in good stead with most voters in this top-heavy Democratic state.

His popularity remains sky-high and Hogan continues to skirt controversial social issues that could bring him trouble with liberal voters while losing the backing of GOP conservatives.

Hogan, Trump & Trouble?

MD Gov. Larry Hogan, Jr.

His prime objective is getting reelected in 2018 while dragging in with him enough Republican legislators to ensure a veto-proof state Senate.

Then Hogan would have more leverage and ability to help the state GOP turn the corner in Maryland and become a truly viable statewide alternative to Democrat hegemony.

But that scenario could blow up in Hogan’s face through no fault of his own.

Trump Referendum?

The 2018 election is looking more and more like a national referendum on Donald Trump’s manic, unpredictable presidency. If that become the case, Hogan’s continuation in office could hang by a thread.

The beginning of the end for Hogan may have commenced last week with House Speaker Paul Ryan’s rush to eliminate Obamacare and replace it with a haphazard health-care insurance program that punishes the lower-middle class, the poor and citizens nearing retirement age.

It also is sending the nation’s health-insurance industry into a prolonged period of chaotic uncertainty. The result could be a rapid pullout next year by insurers from what’s left of Obamacare to avoid gigantic losses caused by the program’s slow, agonizing demise mandated by Ryan’s legislation.

The Congressional Budget Office on Monday estimated a whopping 14 million Americans would lose their health insurance coverage next year under the Republican plan being rammed through the House of Representatives. That’s terrible for Republicans who have to run for reelection in the fall of 2018.

Cutting subsidies out from under Obamacare also would devastate state health budgets. Hundreds of thousands of Marylanders now receiving health insurance support or care through Medicaid could be cut off without the resources to afford health-care protection (CBO says premiums could rise 20 percent next year alone).

Ryan’s plan calls for Maryland and other states to receive far less to undergird their health insurance programs. Hospitals could be flooded by non-paying patients with nowhere else to go. Preventive health care, a key component of Obamacare, would disappear; people would show up at emergency rooms needing far more costly medical treatment.

Bad timing

For Hogan, the timing couldn’t be worse. By next year, Maryland’s entire health care network could face an unprecedented financial and medical crisis. Maryland’s health expenditures could balloon, and many of the state’s citizens could be panicking over the loss of their medical safety net.

That’s a recipe for problems at the polls.

Unfortunately for Hogan, this could be just the initial blow coming from Trump’s Washington.

Sweeping federal layoffs this year and next seem in the cards — the largest cutbacks since the end of World War II by one account.

Last week, Comptroller Peter Franchot wrote down state revenue estimates for the next 18 months by $33 million and warned of the likelihood of major job losses in federal agencies employing hundreds of thousands of Free State citizens.

The budgets for programs affecting all aspect of the Maryland economy are at risk, from housing assistance critical in poor communities like Baltimore and rural Maryland to severe reductions in funding for the Coast Guard that could hurt the state’s important maritime economy and policing of the Chesapeake Bay.

Maryland impact

Massive budget cuts in the space program, food and drug enforcement, agriculture, the Census Bureau, the Medicaid agency, education aid, medical research and environmental protection would reverberate ithrough Maryland, home to many of these agencies.

All of this is dreadful news for Hogan.

He’s got nothing to do with what Trump and his Republican allies are foisting on the American public. Yet he may end up paying the ultimate political price.

Let’s face it. Hogan’s 2014 election victory was a fluke, the result of a well-run campaign and exceedingly good luck: Democrats nominated a historically bad candidate (Lt. Gov. Anthony Brown, now a member of Congress) who ran one of the worst-ever gubernatorial campaigns.

Given Maryland’s 2-1 Democratic voter registration edge, Hogan’s re-election was always less than certain, even with his high poll numbers. Inflame the state’s Democratic voters and any Republican, even a popular incumbent, could have big problems.

So if Marylanders are infuriated with Trump & Friends; if hundreds of thousands are scared, angry and afraid of having little or no health coverage; if the state’s large federal workforce endures unprecedented layoffs and spending cuts, and if Democrats are so enraged they take out their fury on Election Day, Hogan had better prepare for the worst.

Déjà vu?

It’s happened before.

In 2006, Republican Gov. Bob Ehrlich enjoyed exceptionally high polling numbers right up till the general election. Most people said Ehrlich had done a pretty good job. Yet he lost by 6% – nearly 120,000 votes.

How could that happen?

Ehrlich’s loss was linked to the unpopularity of a Republican president, George W. Bush, saddled with a wobbly economy, a flagging war on terrorism, an unnecessary, trumped-up war against Saddam Hussein in Iraq and ineptness in the White House.

By the November 2006 election, Bush’s poll rating – which hit 90% after the 2001 terrorist bombings, had plunged to 38%. (It would continue to sink to a low of 25%).

Voters wanted to send Bush a message – and in Maryland the only way to do that was by voicing disapproval of the top Republican candidate on the ballot that year – Bob Ehrlich.

Hogan should be alarmed that Donald Trump’s approval rating as of two weeks ago was just 38% – identical to Bush’s low appeal in 2006. The Obamacare controversy and the new president’s angry Twitter insults, unsubstantiated allegations and inflammatory rhetoric could shrink Trump’s approval numbers to record lows for an American president.

Should 2018 turn into a “message” election, Larry Hogan’s “good guy” image and Marylanders’ lack of animus toward him may prove all but worthless.

He could well become, for state voters, Donald Trump’s surrogate on the ballot.

It could be 2006 all over again in Maryland.  ##  

Medical Miracle in Largo?

By Barry Rascovar

Oct. 24, 2016—It took over three years to surmount the bureaucratic, regulatory and political hurdles but it finally looks like a half-billion-dollar, state-of-the-art regional medical center will rise slowly in populous Prince George’s County.

It’s way overdue. For a county of 900,000 people, Prince George’s lacks a premier hospital. No wonder so many local residents go outside the county for their medical care.

The organization that runs aging

Medical Miralce in Largo?

Aging Prince George’s Hospital Center in Cheverly

medical facilities in Cheverly, Bowie and Laurel, Dimensions Health Corp., has been a disaster for the county over the past quarter-century. Political hacks and cronies filled management posts. The quality of health care suffered.

For a jurisdiction with a high rate of chronic diseases and the second-largest pool of indigent patients in Maryland (after Baltimore City), there’s long been a crying need for dramatic change.

Now it finally may be coming.

Last week, the Maryland Health Care Commission gave unanimous approval to the 205-bed University of Maryland Prince George’s Regional Medical Center in Largo Town Center. The 11-0 vote masked the enormous, complicated struggle that preceded it.

Plenty of Political Resistance

For years, county politicians with vested interest in maintaining the status quo fought furiously to block efforts to overhaul the Dimensions system. The group’s tentacles extended into the county executive’s office and the county council.

Compounding the situation was the war cry of these officials that white outsiders were trying to oust black Dimensions leaders. In a county with a large African American majority, this vocal objection proved loud enough to ward off reforms.

Finally, the current county executive, Rushern Baker, pressed hard for a Dimensions housecleaning. He brokered a deal with the University of Maryland Medical System to assume control – of both the medical and management staffs. It wasn’t easy getting the Dimensions higher-ups to agree.

Capital contributions from Annapolis proved daunting as well. Lawmakers and governors have been reluctant to pour big bucks into the Prince George’s medical system as long as Dimensions remained in control.

Then Gov. Larry Hogan, Jr. objected to paying $20 million a year to Dimensions to keep the existing medical centers afloat until a regional medical facility can be built.

The legislature eventually had to mandate an annual state contribution to keep the current medical facilities in operation until the opening of the new center in 2020.

Total cost: $543 million, with $208 million coming from the state, $208 million from the county and $127 million in bonds issued by the new hospital entity.

Downsized Project

The total would have been higher but for the fact Robert Moffit of the health care commission, who carefully reviewed and analyzed the project, insisted that the new facility be financially viable. The size of the high-rise was reduced and so was the price – by $100 million.

What sealed the deal, though, was the fact UMMS now will be the owner-operator of the regional medical center. With its close ties to the state’s largest medical school, UMMS dominates Maryland’s hospital landscape.

It has a proven track record of turning around deep-in-debt medical centers and bringing superb talent and health care to under-utilized facilities it manages.

Such a reversal still is some years away but already UMMS’ presence at Dimensions hospitals has improved the quality of care and brought down operating expenses.

Medical Miracle in Largo?

Proposed University of Maryland Prince George’s Regional Medical Center in Largo

But UMMS faces another challenge: attracting enough physicians and physician groups to the county to minister to this underserved population. That’s a slow process but the work has begun.

Once the new regional medical center is fully staffed by UMMS personnel and filled with the latest in medical technology, physicians and patients are likely to develop a magnetic attraction to the Largo facility – which Moffit of the health care commission termed an “excellent” location in the heart of the county’s population.

Now that the worst of the regulatory and political barriers seem to have been surmounted, there is light at the end of this long tunnel – and the prospect of greatly enhanced health care for people living in the state’s second-largest jurisdiction.

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Crunch Time for P.G. Hospital

By Barry Rascovar

June 13, 2016 – Here we go again: Another liberal-conservative showdown over a new hospital for Prince George’s County. Only this time, the confrontation isn’t between Republican Gov. Larry Hogan, Jr. and the Democratic legislature.

Instead, the tug-of-war is between a conservative political scientist from a Republican think-tank and Democrats in the county who control its hospital system.

Crunch Time P.G. Hospital

Proposed Prince George’s Regional Medical Center

The think-tank guru, Robert Moffit, was placed on the Maryland Health Care Commission by Hogan. It’s his second time around, having been on the panel before under Republican Gov. Bob Ehrlich.

Due to a quirk in the way the commission conducts its business, Moffit has life-or-death powers over the proposed $655 million Prince George’s Regional Medical Center. He’s been assigned to evaluate this project and if he’s unwilling to sign off, the panel won’t issue the essential certificate of need (CON) for construction.

Wring Price Concessions

At the moment, Moffit is playing hardball.

He wants to wring $112 million from the project’s cost by cutting the number of acute care beds and dramatically shrinking room size. Moffit’s modifications call for fewer inpatient beds, fewer operating rooms, fewer emergency room bays and no specialty wing run by the Mt. Washington Pediatric Center.

It would be a stripped-down model designed to break even with far fewer customers coming through the doors.

That’s in keeping with both conservative Republican manta (do more with less) and a trend in health care that stresses outpatient treatment over hospital admissions.

Moffit, who works at the Heritage Foundation, doesn’t want a white elephant – a hospital that is half-empty and unable to pay its bills or avoid red ink.

That’s been the sorry state of county hospitals for decades under Dimensions Healthcare System, which has shortchanged county residents through long-standing management incompetence, political cronyism and an inability to offer quality medical care.

Deal in Annapolis

A running battle in Annapolis finally led to an agreement in which the state and county governments would chip in for a brand-new regional medical center in Largo, replacing the run-down, 75-year-old hospital at Cheverly and consolidating county in-patient beds at one site.

What sealed the deal was agreement by county politicians to relinquish control to the University of Maryland Medical System (UMMS), which has a record of turning woebegone hospitals into winners for patients and the bottom line.

But Moffit doesn’t seem impressed with what UMMS brings to the table. He’s so focused on the financials that he may be missing key, unspoken elements.

First, Prince George’s County is a health care desert. It is bereft of a comprehensive medical center. No wonder sick residents go elsewhere for in-patient hospital care – to Southern Maryland, to Anne Arundel County, to Montgomery County and to the District of Columbia.

A gleaming, ultra-modern regional medical mecca at Largo, with all the bells and whistles patients and doctors demand, could reverse the out-migration of patients in a hurry.

Indeed, the combination of a cutting-edge, high-tech hospital run by a nationally ranked teaching hospital could result in a stampede of primary care physicians seeking office space nearby. The dearth of primary care docs has been a major shortcoming in the county – a situation UMMS already is working hard to fix.

Different Fruits

Moffit also wrongly compares costs for the P.G. regional medical center to the new community hospital Washington Adventist Hospital is building in Montgomery County. The two have as much in common as apples and oranges.

The Largo project will be far more expensive because the demands for services are far greater in Prince George’s – and infinitely more complex.

The current Dimensions hospital in Cheverly is the second busiest trauma center in Maryland. With violent crime rising in the populous county, you can expect an even greater need for more emergency room bays and high-cost trauma medical care. That’s not factored into Moffit’s equation.

Nor does the commissioner take into account the enormous size of the county with a population that will hit 1 million in the not too distant future. Yet there’s a lack of even one high-caliber hospital.

That’s unacceptable.

Centerpiece of Change

Moffit concedes “a new general hospital campus in Prince George’s County is needed.”

What he doesn’t acknowledge is that this large, fast-growing subdivision with a huge minority population has always been short-changed. For too long, this populous region of Maryland has been denied a first-class regional medical center that can handle diverse and complex cases.

The last thing Prince George’s needs is a shrunken, run-of-the-mill general hospital.

Additionally, Moffit fails to take into consideration that a highly competent and experienced operating team from a premier teaching hospital will be running things.

Moreover, the mission isn’t just cost-efficient management of the new Prince George’s hospital. There’s a larger goal: to transform the county’s entire health care delivery system.

The centerpiece of that transformation is the new regional medical center.

Dumbing down the medical centerpiece denies county residents the kind of top-flight regional inpatient facility they deserve. It sets the stage for a penny wise/pound foolish decision from the Health Care Commission.

It also could lead to an angry response in Annapolis from dismayed Democratic legislators who are unwilling to accept a second-rate compromise.

They could demand sweeping changes in laws governing the Health Care Commission, reconstituting the panel and ensuring that one commissioner no longer gets to rule with near-dictatorial authority on hospital-construction projects.

There’s still time for a sensible resolution. Dimensions and UMMS have until Aug. 31 to respond to Moffit’s unreasonably stiff demands. It would be just as unrealistic to under-build as to over-build at Largo.

This is one decision the Health Care Commission had better get right.

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Hogan’s Cancer Awareness

By Barry Rascovar

Sept. 28, 2015 – We’re coming to the end of Childhood Cancer Awareness Month and Leukemia and Lymphoma Awareness Month and Maryland Gov. Larry Hogan, Jr., has played a big role in both campaigns.

Hogan's Cancer Awareness

MD Gov. Larry Hogan, Jr.

As most Marylanders are aware, Hogan was diagnosed with late stage 3 non-Hodgkins lymphoma in June. That’s an extremely serious but treatable disease in most cases.

Since then, he has undergone a series of exhaustive hospital stays that included three small surgeries, three spinal taps and 25 chemotherapy sessions. He’s got one more round of these arduous chemo treatments next month.

The good news is that 95 percent of his cancer has disappeared. The treatments – painful, uncomfortable and in every way disagreeable – so far seem to be working.

Throughout this ordeal Hogan has been an exemplary advocate for bringing awareness to cancer treatments and keeping spirits high among adults and children with cancer. The more people know about cancers, the more likely they will be to keep themselves healthy and react promptly when they suspect health problems.

They won’t look upon it as a certain death sentence, either.

No Secrets

Hogan, as a public official, recognized early on that he has a special responsibility to be forthright with Marylanders about his situation.

Unlike public officials of the past, he never tried to keep his illness a secret.

Indeed, he has gone out of his way to let people know about his lymphoma and his hospitalizations at University of Maryland Medical Center.

During those five-day stays, Hogan has taken upon himself the role of cheerleader, especially for cancer patients in the pediatric ward at UMMC. Brightening the day of these kids and letting the public know the governor of Maryland is on their side helps the kids and their parents immensely.

They no longer feel alone or that important government official don’t care.

Hogan also has scheduled plenty of cancer awareness appearances since June, including one at Oriole Park with baseball stars Rick Dempsey and Jim Palmer and others with pediatric cancer patients at Redskins and Ravens football games. He not only shows up but broadcasts these promotional visits on his Facebook page to spread the word.

Papal Encounters

Hogan took his cancer advocacy to a totally different level last week in making a big deal about his encounters with Pope Francis, first at an event at Catholic Charities in Washington and then at Joint Base Andrews in Prince George’s County.

He called his brief conversations with the pope “the experience of a lifetime.”

When Hogan, a Catholic, greeted the pontiff, he said, “Holy Father, may I ask that you please give a blessing to all those suffering from cancer around the world?”

What followed was dramatic to say the least. The pope placed his hands on Hogan’s head – bald from the chemo treatments – then traced the sign of the cross on his forehead and said, “God bless you.”

Hogan's Cancer Awareness

Pope Francis blesses Governor Hogan

At Andrews, Hogan and his wife, Yumi, stood in the receiving line as the pope boarded his customized jet, Shepherd One.

This time, according to the governor, Francis placed Hogan’s hands in his own and said, “I pray for you.”

This powerful episode will long be etched in Hogan’s memory. He took on the mission of representing all cancer victims before the pope rather than his own predicament.

Making Political Hay

There is clearly a political dimension to Hogan’s activities. That is unavoidable.

Hogan’s cancer diagnosis and treatment make him a sympathetic person even among Marylanders who strongly disagree with his actions as a conservative Republican governor.

Partisanship disappears, though, when people fall ill or experience personal misfortune.

There’s no doubt Hogan is benefiting from his Facebook page emphasis on cancer awareness and his own chemo treatments. His political aides have capitalized on this situation.

Yet other public officials might want to keep serious health conditions under wraps, to handle the chemo treatments, the unwelcome side effects and the personal problems that result as a private family matter.

Hogan isn’t giving the public a blow-by-blow account of this difficult journey he’s embarked upon. That’s only natural.

Still, he is being open, inclusive and transparent with Marylanders about his cancer. He is a role model for us in this regard.

It’s what true leadership is all about.

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Hogan’s Holt Problem

By Barry Rascovar

Aug. 24, 2015–Maryland Housing Secretary Ken Holt may be a nice guy, a financial expert, a former member of the House of Delegates from Baltimore County, a cattle rancher and a breeder of thoroughbred race horses, but he has turned himself into a giant liability for Maryland Gov. Larry Hogan, Jr.

Holt’s stunningly ignorant claim made at the Maryland Association of Counties gathering in Ocean City — that some low-income mothers poison their children with lead weights to get free housing — was so far afield from reality that both Hogan and Lt. Gov. Boyd Rutherford disassociated themselves from his assertions.

Hogan's Holt Problem

MD Housing Secretary Ken Holt

The governor then had choice words for Holt in private about his “unfortunate and inappropriate statement” — but is keeping him on as housing secretary.

Holt’s comments were far more than “unfortunate and inappropriate.”

They had no basis in fact and showed an abysmal understanding of Maryland’s lead paint law — an area that Holt’s department deals with.

Lacking Evidence

Even worse, it turns out Holt has no evidence to back up his claim that low-income moms intentionally poison their kids to receive free, long-term government housing. It was an anecdotal story, he said, that came from a housing developer.

Holt told the MACO attendees that he wanted to submit legislation to ease the legal burden on landlords if their rental properties contain lead paint that harms children.

That proposal is now DOA — dead on arrival.

Indeed, Holt’s credibility with Democratic legislators has been destroyed by his hideous comments and intentions. Easing landlords’ liability for lead-paint poisoning on their rental units is a terrible idea.

Who’s responsible for not taking steps to encapsulate or remove the lead paint in these rental units? Holt’s proposal would turn those who are poisoned, and their parents, into the culprits while freeing landlords from their clear responsibility.

It’s idiotic and gives the appearance Holt is pandering to the whims and desires of landlords.

Reductions in Lead Poisoning

Over the past 20 years, Maryland’s lead-paint laws have led to a steep, dramatic drop in  poisoning cases, from 14,546 in 1993 to just 371 cases in 2013.

Hogan's Holt Problem

Flaking lead paint can poison children.

The law is working and the children living in low-income rental housing are being protected. Why in the world would Holt move to weaken this law without even researching the topic?

It raises major questions about Holt’s fitness for the cabinet-level post. He had no low-income housing expertise when he took the job. It shows.

What an embarrassment for Hogan and his administration. Is this the sort of pro-business “reform” the governor has in mind?

Holt’s blunder pretty much closes the door on legislative changes coming from his department. Indeed, it puts a bull’s eye on just about anything Hogan proposes in the next legislative session that would weaken existing laws designed to protect the public.

Bad Timing

The timing of Holt’s indiscretion doesn’t help, either. It looks more and more like the Hogan administration is hostile to Baltimore City and its minority citizens.

The vast majority of lead-paint poisoning cases are in Baltimore, and nearly all the victims are African Americans.

Hogan also refused to allocate $11 million in sorely needed school funds to Baltimore City, where the vast majority of underperforming students are African Americans.

Then he killed the $3 billion Red Line rapid-rail project designed to help Baltimore’s inner city residents reach job centers and greatly improve their transportation options. The vast majority of citizens who would have benefited from the Red Line are black.

Just to rub it in, Hogan snubbed city officials in announcing the closing of Baltimore’s detention center. He didn’t even give the mayor the courtesy of a phone call before his announcement, which was highlighted by his harsh and gratuitous condemnation of his predecessor, Martin O’Malley.

Anti-City?

The Holt fiasco adds to the impression Hogan’s administration is anti-city and anti-black. At the least, it gives weight to the notion that the governor and his staff are insensitive and uncaring — and not well informed — when it comes to urban problems.

The best thing Holt could do to help the governor is make a quiet exit from state government later this year.

He’s become Enemy No. 1 to a large number of Democratic legislators. Everything he says or does from now on will be put under a microscope. He’s dragging the governor down.

Hogan, meanwhile, has yet to take any major step that shows he understands the state has a significant role to play in uplifting and improving life and economic opportunity in Baltimore.

Fortunately, it is still early in the governor’s tenure.

The situation in Maryland’s only urban center cries out for strong leadership and assistance from Annapolis. That is Hogan’s most complex and perplexing challenge, one he has yet to confront.

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Sharfstein’s Scarlet Letter

By Barry Rascovar

August 11, 2014 — For a 44-year-old, Josh Sharfstein has accomplished much: Baltimore City health commissioner, Maryland health secretary and chief deputy commissioner at the Federal Drug Administration.

Josh Sharfstein

MD Health Chief Joshua Sharfstein

Yet when Sharfstein leaves his state post at year’s end, his many achievements will be eclipsed by one giant failure: Maryland’s terribly botched health insurance exchange rollout.

This glitch-plagued rollout — the costliest debacle in Maryland state history — was a monumental disaster that should have been foreseen.

There were plenty of warning signs in the year leading up to the Oct. 1, 2013 enrollment opening. The exchange’s computer software immediately crashed — and remained dysfunctional for months.

Standing Tall

To his credit, Sharfstein shouldered the public blame for this immense fiasco. The other chief culprits, Gov. Martin O’Malley and Lt. Gov. Anthony Brown, deflected criticism to protect their political futures.

Even worse, they connived with legislative leaders to cover up the true story by avoiding an in-depth accounting of what went wrong until mid-2015. This intentional lack of transparency and accountability will remain an indelible blot on the O’Malley-Brown administration. It will haunt both of them in the years ahead.

Sharfstein took the fall at legislative hearings. He was the only one connected with this ill-fated project to apologize and take responsibility for a truly screwed-up rollout.

It is ironic this happened on Sharfstein’s watch because he’s known as a hands-on micro-manager who drives underlings crazy with his detail-oriented obsessions.

Loss of Control

This time, though, Sharfstein ran afoul of a bone-headed decision by O’Malley and Brown to set up the new Maryland health exchange as a separate, independent agency — instead of wrapping it neatly into Sharfstein’s health department.

That twist meant huge additional expenses — a separate set of backroom jobs had to be created and filled that could easily have been tacked onto existing services within the health department.

The biggest problem in giving the exchange its independence was loss of control.

MD Healthcare Connection

Sharfstein never gained direct authority over the health exchange because O’Malley set up the new agency outside the health secretary’s purview.

Yes, he co-chaired the oversight board with Brown, but that group served as a rubber-stamp for whatever Rebecca Pearce, the insurance executive hired to run the exchange, suggested. The panel didn’t challenge her assessments — a serious mistake.

Even worse, there were no traditional checks and balances to make sure the pivotal choice of technology contractors didn’t veer off-course (sadly, it did).

Nor were the health department’s seasoned computer experts in position to monitor the exchange’s faltering software development.

The department was left on the outside with no authority to intercede or blow the whistle on the prime contractor’s inept performance and failure to meet deadlines.

Righting the Ship

Sharfstein, a pediatrician whose entire career has been in government and public health, was ill-prepared to act as overseer of a highly complex information-technology project.

But as an experienced manager, and with a wealth of IT expertise available in his department, he probably could have avoided the computer crash that proved so costly.

To his credit, Sharfstein accepted responsibility for the disaster. He worked tirelessly to find a work-around and a fix (the first succeeded, the second didn’t). Now the old exchange system is being junked and a new one that is functioning well in Connecticut is being superimposed — at an enormous cost.

The health secretary will stay on to see if this latest stab at building a health insurance exchange works. He wants to walk away without leaving a health exchange headache on his successor’s desk.

That determination says a lot about Sharfstein’s commitment to righting the ship.

He can take pride in the fact that despite horrendous obstacles, over 400,000 people (mostly Medicaid recipients) signed up for health insurance through the exchange. If the Connecticut software system works in Maryland, that number should grow in Year Two.

Moving to Hopkins

We haven’t heard the last of Josh Sharfstein.

He’ll take up residency at Johns’ Hopkins’ Bloomberg School of Public Health as an associate dean with a full workload, but the urge to serve the public could lure him back, especially during a Hillary Clinton presidency.

If that’s the case, he’ll still have to explain what went wrong that led to Maryland’s costly health exchange snafu. It’s a scarlet letter he will wear, whether deserved or not.

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Cannabis, Politics & Public Health

By Barry Rascovar

May 27, 2014 — According to the mother of the man who recently crashed his stolen dump truck through the doors of WMAR-TV and stormed through the TV station claiming he was God —  her son was a heavy marijuana user and that’s what caused his latest  psychotic episode.

Psychotic man crashes dump truck into WMAR-TV

Psychotic man crashes dump truck into WMAR-TV

The near-calamity brings new focus to the marijuana legalization debate in Maryland’s June 24 gubernatorial primary.

One candidate, Democrat Heather Mizeur, champions marijuana legalization. She claims its use “is less harmful to the body than alcohol or tobacco.”

A Maryland with legalized, regulated, and taxed marijuana will mean safer communities, universal early childhood education, and fewer citizens unnecessarily exposed to our criminal justice system,” her campaign website states.

Del. Heather Mizeur

Del. Heather Mizeur

Note the one area Mizeur does not mention — the impact legalization might have on public health.

The WMAR incident is only the most glaring example of what might happen in the public health arena under cannabis legalization.

Marijuana Concerns

As luck would have it, the most recent issue of Columbia Magazine from Columbia University arrived in the mail recently with a lengthy article on pot legalization and what the university’s researchers have to say.

Writer Paul Hond raised these questions: “What are the harms to individuals from using cannabis? Will legalization lead to more use? Will the roads be less safe? And what about the kids?”

All those concerns require careful examination before entertaining Mizeur’s desire to make pot legal in Maryland.Columbia Magazine

Hond first spoke with Margaret Haney, who has run Columbia’s Marijuana Research Laboratory for 15 years.

When chronic marijuana smokers were asked to quit as part of the lab’s studies, here’s what occurred:

“Sleep disruption is one of the most robust withdrawal symptoms,” Haney says. “The smokers had trouble falling asleep. They woke up in the night. They woke up early. Their mood, too, reflected classic drug-withdrawal symptoms: irritability, anxiety, restlessness. Food intake dropped precipitously. The first two days, they consumed up to a thousand calories less than they did under baseline conditions.”

Haney continues, “The consequences of dependence are not as severe as with alcohol, cocaine, and other things. . . . However, once you’re a daily smoker, your ability to stop becomes as poor as cocaine users’.” Haney notes that “only 15 to 17 percent are able to maintain abstinence.”

Impact on Teens

Haney is most concerned about the consequences of teens who smoke marijuana regularly. “There’s going to be a cost for teenagers doing that. . . . I do worry about the developing brain and the effect of heavy marijuana use on the brain’s cannabinoid receptors” that affect mood, memory and stress.

Herbert Kleber, director of Columbia’s Division on Substance Abuse and former deputy drug czar under President George H. W. Bush (Bush the Good), is alarmed about another aspect: Today’s tokes are loaded with much more of the potent psychoactive compound THC.Marijuana Plants

In this complex, high-pressured world, Kleber understands “a lot of people are looking for escape.” But this isn’t the marijuana of your father’s days.

Back when the Beatles’ John Lennon called marijuana’s effects “a harmless giggle,” the amount of THC in a joint was about 2 percent, Kleber says.

Enhanced Potency

“Now, the THC level of the average DEA [Drug Enforcement Agency] seizure is about 12 percent. At the dispensaries in California and Colorado, it’s 15 to 30 percent. . . It’s a very different drug. A very, very powerful drug.”

In previous interviews he has ticked off the public health hazards — “increased likelihood of cancer, impaired immune system, and increased chance of other drug problems, such as addiction to opiates. . . . Recently, substantial evidence has been published linking marijuana use to earlier onset of schizophrenia and other psychoses.”

Kleber is concerned as well about the impact pot has on the young.

Teen smoking marijuana “Marijuana does affect the brain. The younger you are when you start using it, the greater the risk that it will cause brain damage that will be with you the rest of your life.”

True, smoking weed isn’t as dangerous as a drug addiction, concedes John Mariani, director of Columbia’s Substance Treatment and Research Service. “Marijuana problems tend to be less dramatic — you’re not as ambitious, you perform less well. You probably stay home, watch TV, and eat ice cream. The disorder is about the absence of things — what doesn’t happen.”

Is that the brave, new world that awaits Maryland in a Mizeur governorship?

Pot and Driving

Another accusation is that marijuana legalization will dramatically increase highway accidents. Guohua Li, director of Columbia’s Center for Injury Epidemiology and Prevention, is studying that question. His findings indicate the alarmists are correct.

“First of all. . . the use of marijuana doubles the risk of being involved in a crash. The risk is not as great as with alcohol, which increases crash risk thirteenfold. But when a driver uses alcohol and marijuana, the risk of a fatal crash increases about twenty-four fold. So marijuana in combination with alcohol doubles the risk.”

Li’s 12-year study (1999-2010) of traffic fatalities found that marijuana involvement with car crashes tripled during that time.

Li also took on Mizeur’s main legalization thrust — that marijuana does less bodily harm than  alcohol. “If you argue that because alcohol is worse than marijuana. . . then marijuana should be legalized, that’s a race to the bottom, rather than a race to the top.”

Backlash to Legalization?

Even one of legalization’s supporters at Columbia, Carl Hart, a neuropsychopharmacologist, author and director of the Residential Studies and Methamphetamine Research Laboratories, worries these public safety and public health issues will lead to what Hond calls “a spirited backlash to legalization in the near future.”

Columbia University Prof. Carl Hart

Columbia University Prof. Carl Hart

In the past year, we’ve witnessed in Maryland a stampede among some politicians in Annapolis to give a younger generation of voters what they want — legal pot — even before they examine the possible consequences.

What we’re missing is a frank discussion of the wide-ranging ramifications legalization could have on society. The scientific results from Columbia University are not encouraging.

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Stonewalling MD Health Exchange Probe

By Barry Rascovar

April 7, 2014 – The Maryland General Assembly concludes its 2014 session Monday in good shape – except for one monumental omission: the mystery surrounding Maryland’s fatally flawed health exchange, which has squandered uncounted tens of millions of dollars.

It’s now clear both Gov. Martin O’Malley and Lt. Gov. Anthony Brown are content to stonewall and impede any detailed investigation of what went wrong in setting up the Maryland Health Benefit Exchange until well after the June 24 primary election.

Gov. Martin O'Malley

Gov. Martin O’Malley

Is there a cover-up going on?

Judge for yourself.

On Thursday, the state’s legislative auditor told lawmakers he had been thwarted in his attempt to conduct a meaningful review of the health exchange.

Because the exchange’s leaders only gave state auditors what was available to the public, “We don’t have the complete story,” said the chief auditor, Thomas Barnickel III. “There’s a lot we don’t know.”

Heavily Redacted

The documents auditors received were heavily redacted — a sure sign things are being hidden from view.

It’s also not in line with accepted auditing practices of state government agencies.

But when the governor and lieutenant governor want to make sure no one gets to the bottom of this historic debacle any time soon, the administration knows how to obfuscate.

No Sign of Rebecca Pearce

For instance, the exchange gave auditors 600 emails to or from Health Secretary Josh Sharfstein — the administration’s spokesman on this issue — but nary a single email involving Rebecca Pearce, who ran the troubled exchange until December.

Could such an astounding omission have been accidental?

The redactions were so numerous in the 14,500 documents that auditors couldn’t determine if the controversial contract awards were done legally or appropriately.

MD Healthcare Connection

MD Healthcare Connection

Auditors also couldn’t figure out how the exchange went about selecting the vendor who screwed up the exchange’s computer program — Noridian of North
Dakota — or how in the world the exchange opted to buy off-the-shelf software — as opposed to customized software — from IBM.

This software proved incapable of doing the job.

Auditors did learn from documents there was confusion within the exchange over points of contact, meeting schedules, lack of a program manager and even a lack of details about the project plan.

They made one definitive finding: The exchange conducted no performance testing whatsoever.

Is it any wonder this lemon of a software program crashed on Day One and has yet to fully recover?

Limited Document Release 

Exchange leaders also saw to it auditors didn’t get enough information to figure out who made those horrendously poor decisions, who was really in charge and who should be held to account for this debacle.

Democratic leaders in the legislature aren’t in any hurry, either, to pin some of the blame on Brown because that would hurt his campaign for governor.

So no one was indignant when it became clear last Thursday at a hearing in Annapolis that the legislature’s own auditors had been stonewalled.

Earlier in the week,  O’Malley and Brown laid out their own line of attack: We’re not at fault because it’s the evil contractors who messed up.

And who, exactly, hired those contractors? Aren’t those the ones who ought to be fingered?

What was Brown’s role as co-chair of the exchange’s oversight committee?

Lt. Gov. Anthony Brown

Lt. Gov. Anthony Brown

Didn’t he have to approve those contracts? Or was he only a figurehead?

It’s clear now the prime contractor never should have been chosen in the first place. Is that the contractor’s fault or the O’Malley-Brown administration’s?

What genius decided to launch the state’s most complex and expensive IT project with off-the-shelf software?

Is it IBM’s fault the O’Malley-Brown administration decided to take the cheaper route  and ended up with a turkey that was never designed for the tasks assigned it by the exchange?

Bait-and-Switch Tactic

Is it Noridian’s fault the O’Malley-Brown administration pulled a bait-and-switch?

Exchange leaders signed a fixed-price contract with Noridian that included 261 requirements for the software program — and then later added 227 new requirements, changed 28 of the original requirements and dropped 73 of the mandates Noridian had bid on.

O’Malley seems content to blame IBM for what went wrong. Yes, IBM made the off-the-shelf software, but it was never tailored for the complicated interfaces envisioned by the IT gurus in Maryland government. Yet IBM is now the governor’s fall guy.

Now IBM is pushing back. The computer giant says it went the extra mile to fit a round peg into a square hole, but it couldn’t “overcome the state’s failure to properly manage the implementation of the exchange.”

We may never know if that’s true because O’Malley won’t launch an impartial investigation. Indeed, he’s not launching any investigation into how potentially hundreds of millions of tax dollars were wasted.

This is the guy who wants to run for president?

Permanent Stain?

What an unmitigated calamity. No authority figure in Maryland state government wants to get to the bottom of this disgrace. No public group is pressing for action, either.

We’re left with an appalling mess.

The lack of accountability, transparency and responsibility — if not remedied — will become a permanent stain on the record of O’Malley and Brown. History will not remember this episode kindly.

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Obamacare Accountability — Oregon, not MD, Got It Right

By Barry Rascovar

March 31, 2014–Today’s the deadline for folks in Maryland to start the application process for health insurance under the Affordable Care Act. If you miss this deadline, you face a tax penalty next year.

The good news is that tens of thousands of people have health insurance who couldn’t — or wouldn’t — obtain it before.

The bad news is that Maryland’s health exchange has been an unmitigated disaster — a painfully small number of people actually applied and paid their initial insurance bill.

MD Healthcare Connection

MD Healthcare Connection

Those responsible for this stupendously costly debacle aren’t going to be held accountable.

Those at the top of Maryland’s political food chain still stonewall this issue hoping it fades from public view.

State legislators have ordered a slow-motion assessment of the damage by their own analysts. It’s doubtful this will be a detailed, CSI-style examination of what went wrong.

By the time the report surfaces in mid-summer it will be too late: The decision on what comes next — most likely connecting Maryland to Connecticut’s software system — will be made (as early as this afternoon).

And by the time that legislative report appears, the June 24 primary will have come and gone — and with it any danger Lt. Gov. Anthony Brown’s gubernatorial campaign might be fatally damaged by the findings.

It’s also possible any legislative report will be sanitized by House and Senate leaders so as not to embarrass Brown (by then he could be planning his inaugural) and Gov. Martin O’Malley, who has national aspirations.

What a shocking lack of accountability to the public.

The Oregon Way

It stands in stark contrast to the way another liberal, Democratic state, Oregon, handled its own Obamacare calamity.

Oregon, like Maryland, has a two-term Democratic governor, John Kitzhaber. It has Democratic majorities in both houses of its Legislative Assembly.

But unlike Maryland, Oregon has a strong second party. Republicans hold 26 of 60 House seats and 14 of 30 Senate seats.

With such a potent countervailing force, it’s no wonder Governor Kitzhaber wasted little time launching an independent probe of his state’s dysfunctional health exchange, known as Cover Oregon.

Oregon Gov. John Kitzhaber

Oregon Gov. John Kitzhaber

Its Oracle-based software crashed so badly on Day One that all applications were done by hand. Yet Oregon still signed up more people for health insurance than Maryland.

What the independent review in Oregon found is likely to be mirrored in Maryland — if there’s ever a similar third-party critique.

Among the Oregon findings:

–“There was no single point of authority on the project.”

–The governance structure “was not effective.”

–There were “competing priorities and conflicts between [state] agencies.”

–Cover Oregon failed to hire a prime contractor or a system integrator.

–The governor and others were repeatedly warned by Cover Oregon’s quality assurance firm, Maximus, that the project was seriously off-track. These warnings started years ago and were ignored.

–In 2011, Maximus wrote that the state was acting as its own prime contractor and thus was assuming “more of the overall project risk.” How true.

–There was no Plan B as required by federal law — but there was a backup plan in case the lights went out.

–Cover Oregon picked off-the-shelf software; Oracle claimed it required only 5 percent customization. The actual number was 40 percent.

–The selected software “was not stable” and to this day “more items are breaking than are being repaired.”

–Top state officials “did not understand or acknowledge the significance of the website issues” until it was too late.

–There was a lack of “a consistent, cohesive enterprise approach to management of the project.”

–There was “no authoritative direction.”

–There was “Ineffective and at times contentious” communications and a “lack of transparency.”

Cover Oregon

The Oregon report is highly critical of the Executive Steering Committee leading the project — similar to Maryland’s oversight panel co-chaired by Brown and Health Secretary Joshua Sharfstein:

–“Oversight authority was inconsistent and at times confusing or misinterpreted.” This led to “unclear or incorrect understanding about the true state of the project approaching the Oct. 1, 2013 deadline.”

–The steering group lacked “formal meeting notes and decision tracking and documentation.”

–Perhaps worst of all, the Oregon project did not have “a single enterprise decision-tracking tool to document and manage decisions across entities.”

When Kitzhaber received the damning 77-page report in March, he cleaned house.

He fired the state’s top health official — a longtime friend and ally — who had been running the exchange since January. The chief operating officer and chief information officer of Cover Oregon also got the heave-ho. (The exchange’s original leader had been forced out in December.)

The Maryland Way

Don’t expect such drastic action in Maryland. It doesn’t fit the image O’Malley and Brown want to project going forward. Accountability is giving way to practical political considerations.

Still, the Oregon autopsy rings many familiar bells in Maryland. What happened in Oregon seems to have happened here.

Here’s what a forensic analysis of Maryland’s failed healthcare sign-up effort is likely to show:

*O’Malley and Brown created the exchange as an independent agency unshackled from the state’s formal procurement process. Support services and the normal chain of command within state government were lacking.

*Brown and Sharfstein never gave the project the intense oversight and strong, authoritative leadership it needed.

*They hired the wrong contractor — a minor-league player in the world of healthcare IT — who then quarreled bitterly with the sub-contractor it hired to do the IT project’s heavy lifting.

*No one was riding herd on the contractor.

*The state’s IT gurus picked off-the-shelf software to save money and time, software that never had been used in this way.

*There was no back-up plan in case Plan A failed (as it did).

Quality assurance and system integration were lacking. There was no general manager and no effective tracking system.

*There was no exhaustive trial period built into the schedule. 

*There was a lack of clear and honest communication up and down the line. Transparency continues to be a problem.

What Citizens Deserve

That pretty much sums up what went wrong in Maryland — even without an impartial investigation by outside experts.

But it is worth considering whether Maryland citizens deserve the same type of no-holds barred forensic autopsy Oregon conducted into its health insurance debacle.

In a lopsided one-party state like Maryland, that may prove far too embarrassing for those in power to let it happen.

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