The 25-member Maryland Health Insurance Coverage Protection Commission, revived this summer after several years of dormancy, endorsed removing the 2028 sunset date on the state's reinsurance program — a fund that reimburses insurers for a portion of the costs of patients requiring the most expensive care. The program is financed by the 1% assessment on health insurance policies.

Del. Bonnie Cullison (D-Montgomery), a commission co-chair, said the fund has kept Maryland's premium increases below national trends because it absorbs the highest-cost claims. "This is the fund that supports our reinsurance fund which has allowed our insurance premium increases to be lower than those nationally because those very high expensive costs are being supported by this fund," she said during the virtual meeting.

Extending the program would require legislation in 2027 and approval from the federal government, which can accept or reject the extension. Cullison proposed eliminating the sunset entirely so the program becomes permanent, contingent on federal agreement.

The panel also recommended that lawmakers allow the Maryland Prescription Drug Affordability Board to set "upper payment limits" for prescription drugs based on the Maximum Fair Price negotiated between federal officials and pharmaceutical companies under Medicare. The change would let the state more quickly reduce costs for non-Medicare recipients.

Sen. Cory McCray (D-Baltimore City), the other co-chair, said the proposal would let Maryland "move in alignment with our federal government." He added: "When the price is set at a certain lower price, there is no need for Marylanders to pay a higher price than what's already been established."

The recommendations come as rising health costs strain household budgets and a multibillion-dollar state budget shortfall — driven in part by higher health costs — limits how much the state can do to help. Vincent DeMarco, president of the Maryland Healthcare for All Coalition and a commission member, said there is "a desperate need for additional revenue for 2028 to keep people ensured."

Not all members supported the measures. Matthew F. Celentano, executive director of the League of Life & Health Insurers of Maryland, cast the lone vote against extending the 1% assessment, warning that the cost would be passed through to consumers. "The carriers have to oppose an assessment that only falls on carriers, purely because the costs of this assessment is going to be passed through to consumers," he said. He said the reinsurance program has had "incredible positive effects" but called for a broader conversation about spreading costs across the health care sector.

Celentano abstained on the drug pricing recommendation, noting the affordability board has not yet set an upper payment limit on any drug. The first such limits take effect Jan. 1, 2027, for two drugs covered under state health plans, and authority over private-market plans is more than a year away. He said insurers worry manufacturers may offset limits by raising prices on other drugs used by everyday Marylanders. Del. Thomas S. Hutchinson (R-Middle Shore) also abstained, saying he needed to "do some homework" on whether the federal price negotiations could reduce the number of competitive drugs covered by insurance.

The commission did not endorse several other proposals, including a "dime a drink" alcohol excise tax that DeMarco said could raise more than $200 million a year for health initiatives. He also wants lawmakers to revisit a bill that would have barred pharmaceutical companies from deducting direct-to-consumer advertising expenses from state tax returns, which he said could generate $5 million to $24 million annually for Medicaid eligibility operations and premium assistance. And he continues to push a proposal, debated this year, to assess companies that contribute to climate change to fund health programs.

DeMarco said he remains hopeful the General Assembly will take up the measures next year. While a Democrat-controlled Congress could undo some Trump administration policies that have driven up health costs, he said, a presidential veto remains a threat. "We can't take that chance of that not happening," he said. "So we desperately need this money to be raised in Maryland in 2027 so that many thousands of people don't lose their healthcare coverage in 2028."