While we celebrate important progress here in Maryland — including the passage of Senate Bill 357 and House Bill 424, which empower the state’s Prescription Drug Affordability Board to lower the cost of high-priced medications — we cannot afford to ignore the looming threats coming from Congress. Lawmakers at the federal level are considering legislation that includes devastating cuts of roughly $700 billion to Medicaid. If passed, these cuts could result in nearly 14 million people losing health coverage across the nation — including hundreds of thousands right here in Maryland.
This is more than a budget line item. It’s a life-or-death issue for many families, especially those who have historically been pushed to the margins of our health care system. The proposed policies don’t stop with funding cuts. Lawmakers are also pushing a series of harmful measures that include:
- Expanding Medicaid work requirements, making it harder for people with irregular employment or caregiving responsibilities to access care
- Allowing enhanced premium tax credits for Marketplace plans to expire, which would make private insurance unaffordable for many
- Introducing new cost-sharing requirements, meaning those enrolled in Medicaid would have to pay more out of pocket for the care they need
These policy changes would collectively threaten the health coverage of 13.7 million people nationwide. In Maryland alone, the consequences would be catastrophic:
- Coverage loss: Even though most people enrolled in Medicaid already work or would qualify for an exemption, the red tape associated with work requirements could put coverage at risk for 44% of adults in Maryland who receive coverage under the Affordable Care Act Medicaid expansion.
- Increased costs to the state: The proposed cost shift to Maryland would total between $14 and $19 billion from 2026 to 2035. That translates to a 14–18% increase in state Medicaid costs, forcing state officials to either cut vital services or raise taxes to make up the difference.
- Service reductions: Maryland could be forced to narrow Medicaid eligibility, reduce reimbursement to providers, or eliminate optional benefits such as dental or mental health services — which are essential to maintaining healthy communities.
Black and Brown Marylanders — who already face structural barriers to health care, economic opportunity, and safe housing — would be disproportionately affected by these cuts. These communities are more likely to work in low-wage jobs that do not offer health insurance and are less likely to have flexible schedules or paid leave, making them especially vulnerable under stricter Medicaid work requirements.
Medicaid is a vital tool in addressing centuries of health inequities rooted in racism, redlining, labor discrimination, and underinvestment in communities of color. Medicaid provides essential care to:
- Children from low-income families
- Seniors who rely on long-term care services and supports
- People with disabilities
- Women of color, who face some of the highest maternal mortality rates in the nation
Without this lifeline, the health gap will only widen, especially for communities that have already borne the brunt of the COVID-19 pandemic, environmental injustice, and economic dislocation.
Since Maryland expanded Medicaid under the Affordable Care Act (ACA) in 2014, the benefits have been felt statewide:
- The uninsured rate dropped significantly, making health care more accessible for all
- About 1.3 million Marylanders now rely on Medicaid, including more than 400,000 under the ACA expansion
- Hospitals have seen fewer ER visits for preventable conditions and reduced uncompensated care costs — savings that help keep premiums down for everyone
- Rural areas, small businesses, and gig workers have especially benefited from the stability of expanded coverage
In short, when Medicaid is strong, our entire health care system is stronger. Undermining it would raise costs for everyone, stretch hospital resources, and put the health of entire communities in jeopardy.
Maryland policymakers need to stand firm in two directions — advancing the gains we’ve made locally, while resisting harmful rollbacks at the federal level:
- Support implementation of Maryland’s Prescription Drug Affordability Board as a model for health equity and cost control
- Protect Medicaid and CHIP from harmful federal proposals that threaten to unravel critical safety nets
- Advance broader policies for health equity, including affordable housing, food access, environmental protections, and economic security
Health care is a human right, not a luxury for the privileged. And defending Medicaid is about more than protecting a program — it’s about affirming the dignity and humanity of every Marylander, especially those who have been excluded for far too long.