2020 Maryland End of Session Summary

Victory in the fight against cancer requires bold new public policies that promote cancer prevention, early detection of cancer, and expand access to quality, affordable health care. Lawmakers make many decisions that impact the lives of Maryland residents touched by cancer and their leadership is vital to defeating this disease. In 2020, the American Cancer Society Cancer Action Network (ACS CAN) worked with the Maryland General Assembly in support of the following priorities:
 

Reducing the Toll of Tobacco

• Smoke-free Air:  ACS CAN monitored Maryland’s Clean Indoor Air Act law to ensure it would not be weakened. This landmark legislation was enacted in 2008 and prohibits smoking in almost all Maryland workplaces and enclosed public spaces, including bars and restaurants. During the Session, ACS CAN successfully defeated legislation HB 1283 (PG 312-20), in which would have significantly undermined the Clean Indoor Air Act by allowing for the creation of a Class B-CL License in Prince George’s County for cigar lounges to allow for the selling of alcohol and food. Currently, the Clean Indoor Air Act expressly restricts smoking in establishments licensed under the Alcoholic Beverages Articles, MD CODE ANN. HEALTH-GEN. §24-501.
• Flavored Tobacco Products Restriction: ACS CAN led the effort to end the sale of all flavored tobacco products, including but not limited to menthol cigarettes, flavored cigars, e-cigarettes, hookah, and smokeless tobacco (HB 3/SB 233). HB 3 passed the House Floor and made it to the Senate with exemptions that ACS CAN did not support. While the Senate cross-file (SB 233) remained with our model language, unfortunately, due to Session ending early because of COVID-19, time ran out for consideration of SB 233 and to remedy issues in the Senate with HB 3.

ACS CAN also lobbied against two non-comprehensive Flavors legislation: 1) SB 410 would have only prohibited the sale of an electronic smoking devise that contain natural or artificial flavor, other than tobacco; and 2) SB 54 in which would have prohibited a person from shipping, importing, or selling into or within the State an electronic smoking device to which an artificial or natural flavoring, other than tobacco, is added to import a particular aroma or taste.

While we deeply appreciated the Sponsor’s commitment to resolve the growing epidemic of tobacco use among our youth, we need to be taking a comprehensive approach and ending the sale of all flavored tobacco products, including flavored cigars, menthol cigarettes, e-cigarettes, hookah, and smokeless tobacco.

• Tobacco Taxes, Tobacco Prevention and Cessation Funding:

ACS CAN led HB 732/SB 3 to increase the cigarette tax by $2.00 per pack with an increase in the tax on other tobacco products to parallel the new rate. Increasing the price of cigarettes and all other tobacco products through regular and significant tobacco tax increases helps to keep kids from starting to use tobacco and helps adults quit.  ACS CAN also advocated for $21 million of the revenues from the tobacco taxes to be used to fund and sustain evidence-based, statewide tobacco use prevention and cessation programs.

At the end of Session, HB 732 passed which increased state tobacco taxes by $1.75 per pack on cigarettes (from $2.00 to $3.75), raised taxes on other tobacco products to 53% wholesale (from 30% to 53%), and taxed electronic smoking devices for the first time: 12% sales and use tax (retail) on electronic smoking devices and 60% sales and use tax (retail) on vaping liquid under 5mL in container beginning on July 1, 2020. HB 732 also earmarks $18.25 million toward tobacco prevention and cessation programs beginning on July 1, 2021. The remainder of the revenue from the tobacco tax will go to help pay for the Maryland Historically Black Colleges and Universities (HBCUs) Settlement and will also help with funds needed by the state to fight COVID-19.

Not only is the $1.75 per pack cigarette tax increase projected to increase annual state revenue by over $95 million, but it will also decrease long-term health care costs from adult and youth smoking declines by over $973 million. The $1.75 per pack cigarette tax increase is also estimated to decrease smoking in youth under age 18 by 18.2%. However, the legislature missed an important opportunity to tax all tobacco products at parallel rates and encourage people who use tobacco to quit rather than switch to a cheaper product. This is an important piece of a comprehensive strategy to discourage tobacco initiation. Smoking is still linked to more than one-quarter of cancer-related deaths in our state—and results in $2.7 billion per year in state health care costs. Additionally, 23% of Maryland high school students are currently using e-cigarettes, which have been linked to the use of other tobacco products.

ACS CAN also lobbied against SB 876 an industry bill brought forward by the Vapor Technology Association, JUUL, and the MD Vapor Alliance to limit the in-person sales or distributions of vaping liquid by electronic smoking devices retailers and vape shop vendors to age-restricted areas, required electronic smoking devices retail licensees and vape shop vendors selling vaping liquid to post a certain sign in a certain manner, and required a specific license who sells electronic smoking devices through a website to use third-party verification services.

It’s not an accident that e-cigarette use by high school students increased by 135% from 2017 to 2019. In addition to selling and marketing products that come in kid-friendly candy and fruit flavors, tobacco companies together with the Vapor Technology Association, JUUL, Maryland Vapor Alliance, and others continue to lobby hard to ensure these products are not regulated by evidence-based tobacco control policies. These Big Tobacco companies and their allies have created the problem, it would be foolish to trust them to fix it.

ACS CAN is encouraging states to look at proven evidence-based policy measures to address the e-cigarette epidemic, and not long-time industry supported tactics which have not been proven to address youth smoking rates. Additionally, the bill would have left significant loopholes by leaving youth appealing products on the market and accessible to Maryland youth. Due to ACS CAN’s lobbying efforts, the Bill Sponsor canceled the bill hearing for SB 876 and withdrew the bill.

• Tobacco 21: ACS CAN monitored measures to ensure that the newly increased age of sale for all tobacco products to 21 was not undermined. This legislation went into effect on October 1, 2019. During Session, ACS CAN defeated measures (SB 508) which would have weakened the Tobacco 21 law and would have allowed an  exemption to the current Tobacco 21 law for St. Mary’s County, MD to penalize youth for the purchase, use, and possession (PUP) of tobacco products including electronic smoking devices. Additionally, SB 508 would have allowed an exception for active duty military who presents a valid military identification under the age of 21 to be sold tobacco products, including e-cigarettes.
• Access to Tobacco Cessation: ACS CAN advocated for all insurance plans, including the state Medicaid program, to provide a comprehensive cessation benefit that covers individual, group, and telephone counseling and all FDA-approved tobacco cessation medications without cost-sharing or other barriers to accessing care.

Preemption

• Repealing the “Implied Preemption” Court Doctrine: ACS CAN advocated for HB 1522/SB 756 to clarify local authority, so that local governments can pass policies to protect their residents. Maryland courts adopted an inconsistent but growing theory of State preemption over local actions finding that counties may be preempted even without any State law explicitly stating so. This principle has been used to invalidate multiple local tobacco regulations like (Altadis Inc et. al vs. Prince George’s County), and more recently on local pesticide oversight, and energy facility siting. Unfortunately, both HB 1522/SB 756 were withdrawn by the Sponsors.
• Tobacco Preemption—Baltimore City: ACS CAN advocated for SB 937, in which, would clarify that Baltimore City is not preempted from enacting local laws regulating the sale and distribution of cigarettes, other tobacco products, and electronic smoking devices. Unfortunately, as Session ended early because of COVID-19 and the hearing for this legislation was right before Session ended, this legislation did not get consideration for a vote. Subsequently, it would die when Session ended.

Cancer Prevention and Early Detection

• Breast and Cervical Cancer: ACS CAN advocated to maintain funding for the state Breast and Cervical Cancer Diagnosis and Treatment Program (BCCDT) and the Breast and Cervical Cancer Program (BCCP). The BCCDT program, administered by the Maryland Department of Health, provides breast and cervical cancer treatment services to low-income uninsured and underinsured women. The BCCP program provides breast and cervical cancer screening, diagnosis, and patient navigation services to women across the state. Unfortunately, funding decreased for the BCCP from $13,243,944 to $13,230,000—a decrease of $13,944 for FY’ 21. The FY’ 21 budget includes $1.6 million for BCCDT over two years to help uninsured women receive the best available treatment protocols for breast and cervical cancer.
• Cancer Research, Screening, Detection, and Treatment: ACS CAN worked to maintain funding for local cancer screening, treatment, patient navigation programs and research at Maryland’s renowned academic medical centers (Johns Hopkins University and the University of Maryland). ACS CAN is proud to announce that funding increased for this program from $27,058,774 in FY’20 to $27,141,661 in FY’ 21—a funding increase of $82,887.
• HPV Vaccinations—Pharmacists Administration: ACS CAN supported legislation (HB 530/SB 335) to expand access to HPV vaccination by permitting pharmacists to vaccinate, while also addressing barriers to pharmacist administered vaccines. This legislation would have ensured the widest possible HPV vaccination delivery, consistent with ACS’s HPV Vaccination Guidelines to prevent cervical and other HPV-related cancers in Maryland. Unfortunately, this legislation received an “unfavorable” report in both the House and Senate.

Quality of Life

• Protecting Access to Pain Medication for Cancer Patients: ACS CAN monitored legislative proposals regarding the prescribing of opioid pain medications to ensure access to pain relief for cancer patients.

Healthy Eating and Active Living Environments (HEALE)

• ACS CAN supported policymakers to plan, implement, and evaluate HEALE priority issues, such as increasing the quantity and improving the quality of physical education in K-12 schools, supplemented by additional school-based physical activity. ACS CAN supported HB 516/SB 542, which would have established a minimum standard for each public elementary school student to be provided a daily program of developmentally appropriate moderate to vigorous physical activity of at least 150 minutes per week, including at least 90 minutes per week of physical education, with the balance made up by other activities, including recess. However, ACS CAN requested amendments for this legislation to require the 150 minutes of minimum activity come from quality physical education in Maryland elementary schools with opportunities for additional physical activity supplementing this minimum. While this bill was a first step, more work is needed to reach the State’s goals of ensuring kids are physically fit and getting the physical activity and physical education they need on a regular basis. This legislation was held in both the House Ways and Means Committee and Senate Education, Health, and Environmental Affairs Committee—subsequently dying when Session ended.

Additionally, ACS CAN supported similar legislation—HB 264 (PG 503-20) and HB 413—which also would have established a requirement that each public elementary school student be provided a daily program of developmentally appropriate moderate to vigorous physical activity of at least 150 minutes per week least 90 minutes of which would be during physical education. ACS CAN again asked that the minimum 150 minutes be during physical education.  Both bills were to be implemented in Prince George’s County, MD only. HB 264 (PG 503-20) received a “no position” report by the Prince George’s County House Delegation and was not supported by the Prince George’s County Public Schools System. Additionally, once the legislation was heard in the House Ways and Means Committee, the legislation was held. HB 264 (PG 503-20) eventually died when Session ended as a result. Likewise, HB 413 was not supported by the Prince George’s County Public Schools System and was held in the House Ways and Means Committee and died when Session ended.

Ensuring Access to Quality Care

• Medicaid: ACS CAN supported efforts to preserve and improve access to health insurance coverage provided to thousands of low-income state residents through the state’s Medicaid program. The health care coverage provided by Maryland’s Medicaid program spans the cancer continuum and affords lower income women screened and diagnosed with breast or cervical cancer access to comprehensive and affordable health insurance coverage through the end of their treatment. The FY ‘21 Maryland budget includes nearly $12.1 billion in funding, a $600 million increase over the previous fiscal year. 
• Maryland Health Benefit Exchange (MHBE): ACS CAN supported legislation (HB 196/SB 124) that required the MHBE to report specified information to the Senate Finance Committee and the House Health and Government Operations Committee on establishing individual market health insurance subsidies in the state.  This legislation, unless vetoed by the Governor, will go into effect on July 1, 2020 and the report will be due December 1, 2020.  
• Medication Access: ACS CAN advocated for legislation to standardize prior authorization/step therapy/other utilization management practices used by health insurers and allow for exceptions from these practices where appropriate with HB 1359/SB 952. Unfortunately, HB 1359 received an “unfavorable report” in the House, subsequently dying. SB 952 was held in the Senate Finance Committee and did not receive a vote. SB 952 officially died when Session ended.
• Health Insurance—Out-of-Pocket Maximums and Cost-Sharing Requirements: ACS CAN advocated for HB 1360/SB 623which would remove barriers created by copay accumulator programs by requiring all payments made by patients—directly or on their behalf - be counted toward their overall out-of-pocket maximum payment or deductible. The requirement for health insurance carriers to do so would protect Marylanders from surprise bills and treatment delays as well as allowing individuals to utilize the full benefit of co-pay assistance programs. Unfortunately, HB 1360 received an “unfavorable report,” in effect dying. SB 623 was held in the Senate Finance Committee and did not receive a vote. SB 623 died when Session ended.

Skin Cancer Prevention

• Indoor Tanning Devices: ACS CAN monitored the state’s new law that went into effect on October 1, 2019, to prohibit the use of indoor tanning devices by those under the age of 18. ACS CAN is pleased to announce that there were no attempts made to undermine the state’s comprehensive law this Session.

For more information, contact: Jocelyn Collins, Maryland and DC Government Relations Director ACS CAN  

[email protected] or (301)254-0072 (cell)  

ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard.