ON THE ISSUES
For too many Marylanders, health insurance premiums, deductibles, and co-pays keep going up, with people spending more and more of their paychecks on healthcare. Between 2010 and 2019, Marylanders’ total out-of-pocket healthcare costs rose by more than 50%, after adjusting for inflation. Today, the average family pays about $8000 for healthcare per year—nearly $3000 more than they paid in 2010.
The Affordable Care Act helped, but there are still too many people who aren’t getting high-quality care at a reasonable cost.
I’ve got a plan to get you better, more affordable care.
First, when I’m governor, we’ll launch bold policy reforms to reduce the cost of prescription drugs and health insurance in our state, including:
- Empowering Maryland’s new Prescription Drug Affordability Board (PDAB) to negotiate lower statewide prices for costly prescription drugs. This effort will initially focus on expensive drugs that have not yet shown an actual health benefit (i.e., improved patient quality-of-life or survival) and which therefore do not warrant the high price. When the health benefits of these drugs are ultimately measured, they sometimes are found beneficial but more often are not. Some even prove harmful. As governor, I’ll empower the PDAB to negotiate a substantial price discount for these drugs with pharmaceutical companies, to remain in effect until the drug has demonstrated that it actually improves patient health. Such an approach strengthens incentives for companies to complete the drug innovation process, by demonstrating a true (not just theoretical) health benefit. Estimates suggest this policy will produce healthcare savings for Marylanders of $50 to $100 million per year.
- Offering Marylanders a “Public Option” health insurance plan that is less expensive than the private insurance plans now on the market. The Public Option will achieve substantial savings by reducing over-treatment of patients with costly drugs or medical procedures that have shown no health benefit when rigorously tested (see examples here, here, and here). Participation in the Public Option by patients and healthcare providers will be entirely voluntarily, with everyone provided clear notice of the coverage policies up front. We’ll launch the Public Option initially as a sizable pilot project, and include an independent, rigorous assessment to see if it produces the expected benefits in costs and healthcare. A few other states—Washington, Colorado, and New Mexico—have already enacted public option-style laws. Maryland should do the same.
Second, we’ll expand innovations in healthcare delivery that have been tested in the real world and shown to produce important health benefits and/or cost savings. In my career, I’ve played a lead role—working with government and philanthropy—in identifying and expanding such innovations. Here are just a few examples we’ll bring to Maryland:
- A nurse-led program that cares for chronically ill senior citizens after they leave the hospital, to make sure they follow discharge instructions and take their medications. Two studies found the program resulted in about a 40% reduction in rehospitalizations and average savings of $4,500 per patient.
- A program that pairs Black barbershops with pharmacists to screen for and treat high blood pressure. In this program, when men come in for a haircut, they also get screened for high blood pressure and, if needed, get medication. This program supports people where they are, reducing the rate of uncontrolled high blood pressure—a leading killer among Black men—by more than half.
- A program that pairs nurses and first-time mothers for home visits, providing assistance in parenting, nutrition, and health. Studies show the program leads to big improvements in child health and safety, including reductions in abuse, neglect, and injuries. The most at-risk children also do better in school, and one study found the program saved the government more money in the long run than it cost to deliver.
 Based on employer-sponsored healthcare, the largest source of Marylanders’ insurance coverage.
 Many of these are drugs that the Food and Drug Administration (FDA) has provisionally approved for market, while studies to evaluate their clinical health benefit are ongoing.
In the wake of the COVID-19 recession, hundreds of thousands of Marylanders remain out of work. Our state’s current economic challenges add to a major long-term problem: For 40 years, wages among low and moderate income Marylanders have been stagnant as income inequality has grown wider and wider.
Maryland needs a leader who has the experience to get people back to work and train people for jobs in growing fields so they can support their families and raise their standard of living. A key focus of my career has been to find and expand evidence-based programs that reduce unemployment, increase economic mobility, and foster economic development. Working with both Democratic and Republican Administrations, I’ve gotten key reforms enacted into law, including a program that funds high-tech development at small businesses, and has brought roughly $200 million to Maryland businesses alone.
As governor, I would –
Help unemployed workers get back on their feet:
- Providing immediate job search and other reemployment services when Marylanders file for unemployment. Rather than have people file for unemployment and get help with their job search later, we should provide people with reemployment services during their initial contact with the unemployment office. This approach made a real difference in Nevada. As I wrote in The Baltimore Sun, people who took part in the Nevada program got jobs that earned, on average, an additional $8,460 over three years – 15% more than people who didn’t participate in the program. By moving people off unemployment and into jobs, this approach saves money for taxpayers, too.
- Offering a sizable earnings supplement to long-term unemployed workers who find a full-time job. When similar programs were tested in Milwaukee and Canada, they significantly increased employment and reduced the poverty rate by about 10 percentage points. We should try it out here, initially on a pilot basis. The idea is: if you work hard, we’ll help you move out of poverty and make a decent living in Maryland.
Address the longstanding problems of stagnant wages and economic mobility for low and moderate income Marylanders by:
- Providing high-quality job training to every young adult who wants to advance. We’d do this by creating a public-private partnership in which the state covers the cost of job training, and employers provide internships to give people real-world experience and help them land full-time, well-paying jobs. The training would be based on proven programs like one I helped bring to Silver Spring and another (operating in other states) that increased earnings of people who participated by 20-40% per year. Imagine what an extra $5,000-$8,000 per year would do for working families in Maryland!
- Supporting English language learners entering the workforce. We should invest in programs that provide language instruction, career coaching, and job training and placement for residents with limited English language training. One such program, implemented in Massachusetts, reduced the unemployment rate by 7 points and increased earnings by 15%, compared to people who didn’t participate.
My approach to job opportunity (and other challenges) is fiscally responsible in a way that should resonate with Maryland’s business community. Expansion of proven-effective programs can be accomplished, in most cases, using existing state funds. And some of these programs actually save taxpayer money – for example, by helping people move off the unemployment rolls and back into the workforce, or by reducing unnecessary and costly hospitalizations. In short, I’m not advocating a major expansion in state spending. I’m advocating smart spending on programs that really work.
COVID laid bare the fragilities and inequities in Maryland’s prosperity. Our next governor needs to chart a course that ensures all Marylanders share in the recovery.
My mother was a special education teacher in public schools. When I was young, she taught me how to read and instilled in me a love of learning. I also had the benefit of attending excellent Maryland public schools, the same ones my kids attended. I want every child in our state to have the same strong start in life – a great education and extra support when they need it.
School should be a rich and rewarding experience for all students, one where they thrive academically, are supported socially and emotionally, and graduate with the skills they need to succeed in life and become engaged members of their communities.
We have work to do to achieve that goal. More than ¼ of Maryland middle school students can’t read at a basic competency level, and more than ⅓ can’t do basic math. The learning losses due to COVID have compounded these problems. In addition, achievement gaps between white and Black students in Maryland are higher than in most other states, depriving too many students the opportunity to pursue their college or career aspirations.
To improve our educational system, it’s not enough to just invest more money in schools and school programs. We need to invest our money in programs shown to be effective.
Over the past 20 years, I’ve played a central role in identifying and expanding proven-effective education programs – through my work with the Obama Administration and Congress to enact evidence-based education reforms into law, my service on the National Board for Education Sciences, and my work as a leader at a national philanthropy.
As governor, I would bring a bold approach to improving K-12 education by funding programs tested and shown to improve student outcomes and reduce racial and income achievement gaps.
My education plan will:
- Create a Statewide Tutoring Corps to provide high-quality tutoring to every struggling first and second grader in Maryland. One of the most effective ways to boost students’ reading and math performance – and address COVID-related learning loss – is tutoring. High-quality tutoring provided in early elementary school helps struggling students move up toward grade level before their problems become more serious in later grades. To create this new program, we would recruit people throughout the community – including retirees and recent college graduates – to become tutors for a modest stipend as a public service. You can read more about my plan in my op-ed in Education Post.
- Expand Career Academy programs in high schools. To ensure Maryland has a highly-trained workforce to fill well-paying jobs and power the state’s economic success, my administration will expand Career Academy programs in high schools across the state. Career Academies are small learning communities within high schools that provide hands-on technical and career training to participating students, and have been shown to increase their long-term earnings by an average of $2,500 per year. Today, students in places like Howard County have access to such programs, allowing them to gain college credit and/or industry certification and earn higher wages long after they graduate. By expanding such Career Academy programs, we will ensure students from all backgrounds have the skills to succeed in the workforce and contribute to a thriving Maryland economy.
- Expand high-quality public charter schools like KIPP. My administration will expand public charter school models with a proven record of increasing student achievement. KIPP, for example, is a non-profit network of college-preparatory, public charter schools that serve a mainly low-income and minority population. Independent research has shown that KIPP schools substantially boost academic achievement and college enrollment for these students. While not all charter schools will meet the high bar for expanded funding, those that can demonstrate meaningful improvements in student outcomes will receive the resources to serve many more students.
- Offer “Learning Accounts” to low-income 10th graders, providing up to $10,000 in financial aid for college if they do well in high school. This program will deposit money in students’ accounts as they meet certain benchmarks – $2,500 after they complete 10th grade, $2,500 after they complete 11th grade, and $5000 after they graduate from high school. Students can then use the accumulated funds to help pay for college. When tested in Canada, this program increased both the high school and college graduation rates by a remarkable 7 percentage points. We should try Learning Accounts in Maryland, initially on a pilot basis, and expand it if successful.
Let’s do what works to improve education in Maryland.
Every Marylander deserves a safe place to live, work, and raise a family. Although our state experienced a major drop in violent crime from the mid-1990s to 2014, we’ve seen no progress since then and even a reversal in Baltimore and surrounding areas. Baltimore is now on track to see its 7th straight year with over 300 homicides – levels not seen since the crime wave of the 1990s. And Maryland now has the 11th highest rate of violent crime in the nation.
Maryland needs a leader who can act urgently and swiftly to halt this alarming trend. When I’m governor, my violence prevention plan would (1) identify the most promising strategies from around the country for stopping violent crime; (2) work with local officials to tailor them to local needs; (3) implement and rigorously test them to see which are most effective; and (4) expand the ones shown to work. Importantly, these strategies must be coordinated with Maryland’s ongoing police reform efforts, as reducing racial bias in policing is key to increasing community trust and reducing crime. Here are examples of promising programs we should implement, test, and expand if successful:
- Focused Deterrence – This strategy, recently adopted in Baltimore by Mayor Scott and Police Chief Harrison, is based on highly promising results obtained in Oakland and other cities. Recognizing that a relatively small number of individuals (e.g., repeat violent offenders and gang members) commit most violent crimes, the program invites them to meet with community leaders, social service agencies, and law enforcement. The meetings offer positive support, such as jobs and counseling, while also making clear that continued violence will prompt a strong, focused response from law enforcement.
- Baltimore City Drug Treatment Court – This voluntary program seeks to reduce recidivism among adults convicted of non-violent, drug-related offenses by offering drug abuse treatment services following their conviction while keeping them under intensive supervision. It has been found to produce long-term reductions in arrests and convictions of more than 30%.
- Prison Therapeutic Community – This strategy creates a separate community within a prison for inmates with drug problems scheduled for release, provides counseling for up to a year after release, and is staffed by highly committed role models of recovering substance abusers. When tested in California, this type of program reduced the rate of reincarceration by 9%.
- Interventions for At-Risk Youth – Certain therapies for youth at risk of gang involvement and criminal behavior – specifically, Functional Family Therapy and Multisytemic Therapy – have been found to be very promising, reducing criminal activity by 35% or more in some cases. However, I do not support Baltimore’s planned expansion of Roca – a behavioral change program for high-risk youth – until results of the recently-completed evaluation of this program in Massachusetts are publicly released, so we can gauge its success.
Keeping our neighborhoods safe must be a top priority. When I’m governor, we’ll reduce violent crime in our state with programs that are tested and proven to work.
My career over the past 20 years has focused on underserved communities across the United States, with the goals of closing social and racial gaps in education, economic opportunity, healthcare, and other areas. In our own state, such gaps between Black and white Marylanders have persisted for decades and are unacceptably large. Currently, for example, the poverty rate of Black Marylanders is nearly 50% higher than that of the overall Maryland population, and Maryland has had consistently larger achievement gaps between Black and white students than the U.S. average.
Closing these gaps will be a top priority for my administration. However my approach will be very different from the other candidates’. In particular, it recognizes that, to make progress, it’s not enough to simply roll out yet another unproven plan or program. However well-intentioned, many of these plans and programs just don’t work, as we’ve seen too often when the results are actually measured. To make progress, we must zero in on solutions that have been tested in the real world and shown to make a real difference for underserved communities and people of color.
Over the past two decades, I’ve led the charge to identify and expand proven-effective programs for underserved populations – through my work with the Bush and Obama Administrations and Congress to enact major evidence-based reforms into law in education, employment, healthcare, and other areas, and my work as a leader at a national philanthropy.
As a result of my work and many others’, there are now a growing number of programs that have been rigorously shown to make a big difference for underserved communities and people of color. When I’m governor of Maryland, we’ll expand these programs statewide in order to finally close the gaps that are damaging the lives of millions of people in our state.
The following are illustrative examples of highly-effective programs we would expand in education, economic opportunity, healthcare, and criminal justice.
- High-quality tutoring for struggling first and second graders, which has been shown to move them up toward grade level before their problems become more serious in later grades. We would expand effective tutoring statewide by recruiting people throughout the community – including retirees and recent college graduates – to become tutors for a modest stipend as a public service. Shown effective in diverse studies, some of which had student populations that were over 80% Black or Hispanic.
- Career Academy programs in high schools. Career Academies are small learning communities within high schools that provide hands-on technical and career training to participating students, and have been shown to increase their long-term earnings by an average of $2,500 per year. Based on this evidence, my philanthropic team funded a major expansion of Career Academies in California. Shown effective in a student population that was 86% Black or Hispanic.
- Proven-effective public charter schools like KIPP. KIPP is a non-profit network of college-preparatory, public charter schools that serve a mainly low-income and minority population. Independent research has shown that KIPP schools substantially boost academic achievement and college enrollment for these students. My nonprofit’s work with the Obama Administration and Congress led to a $50 million federal grant to expand KIPP nationally. Shown effective in a student population that was 95% Black or Hispanic.
- Proven-effective job training programs such as Year Up and Per Scholas, which we would expand to every young adult in our state who wants to advance. If done right, job training can make a big difference, increasing earnings by 20-40%. The key to these programs’ effectiveness is two-fold: (i) they focus their training on well-paying jobs in fast-growing sectors of the economy, such as information technology and healthcare; and (ii) they work closely with local employers to design the training, and the employers provide the trainees with paid internships. My philanthropic team funded the expansion of Per Scholas from its home site in the Bronx to Silver Spring, Maryland; it has since expanded to Baltimore. Shown effective in populations that were 85-90% Black or Hispanic.
- An anti-poverty program that provides a sizable earnings supplement to long-term unemployed workers who find a full-time job. When similar programs were tested in Milwaukee and Canada, they significantly increased employment and reduced the poverty rate by about 10 percentage points. We should try it out here, initially on a pilot basis. The idea is: if you work hard, we’ll help you move out of poverty and make a decent living in Maryland. Shown effective in a population that was 78% Black or Hispanic (Milwaukee, Wisconsin).
- Nurse-Family Partnership (NFP). NFP is program that pairs nurses and first-time mothers for regular home visits that provide assistance in parenting, nutrition, and health. Studies show the program leads to big improvements in child health and safety, including reductions in abuse, neglect, and injuries. The most at-risk children also do better in school, and one study found the program saved the government more money in the long run than it cost to deliver. My nonprofit played a central role, working with the Bush and Obama Administrations, in creating a $400 million per year federal program to expand NFP and other evidence-based home visitation programs nationally. Shown effective in a population that was 92% Black (Memphis, Tennessee).
- Blood pressure reduction in Black barbershops. This is a program that pairs Black barbershops with pharmacists, so when men come in to get their hair cut, they also get screened for high blood pressure and, if needed, get medication. This program supports people where they are, reducing the rate of uncontrolled high blood pressure – a leading killer among Black men – by more than half. Shown effective in a population that was 100% Black.
The deaths of George Floyd, Freddie Gray, and many other Black individuals as a result of police violence have shocked the nation and exposed systemic inequities in our criminal justice system. This is an issue of basic human rights and, in some cases, life and death. Addressing it effectively would be a top priority for my administration.
I’m proud of the Maryland General Assembly for enacting major police reforms over the past year, and believe they have brought us to a pivotal moment when we can finally make significant progress on this issue. But I believe an additional piece is needed to ensure these reforms reach their full promise: We need to implement them using evidence about what works and what doesn’t — a critical focus that I will bring to this issue as governor.
For example, the new law calls for an expansion in police training, of which there are many different types – such as use-of-force training, de-escalation training, procedural justice training, and implicit bias training. Each of these training programs sounds promising, but we don’t yet know which work best in practice to reduce police use-of-force and build community trust. So, as these programs are expanded, we must rigorously test them and, over time, focus our resources on those that are most effective, and revise or phase out any that are not succeeding.
In other areas of criminal justice, my administration will expand programs and policies that have been tested in the real world and shown to be effective, such as –
- Drug Treatment Courts. This voluntary program seeks to reduce recidivism among adults convicted of non-violent, drug-related offenses by offering them – as an alternative to incarceration – drug abuse treatment services while keeping them under intensive supervision. It has been found to produce long-term reductions in arrests and convictions of more than 30%. Shown effective in Baltimore in a population that was 89% Black.
- Effective programs for At-Risk Youth – Certain therapies for youth at risk of gang involvement and criminal behavior – specifically, Functional Family Therapy and Multisytemic Therapy – have been found to be very promising, reducing criminal activity by 35% or more in some cases. Functional Family Therapy was found effective in a population that was 97% Black or Hispanic; Multisystemic Therapy has been found promising in diverse studies with varying populations.
Finally, the policies I’m proposing in all of these areas cannot succeed without an administration that truly understands the needs of Black Marylanders. That’s why I will appoint a cabinet that reflects the racial diversity of our state. My commitment to Black Marylanders is to listen to and include Black voices in the highest levels of decision-making, to be a partner to Black communities, and to work tirelessly to address racial and social inequality in our state.
Since the start of the pandemic, over 10,000 Marylanders have died from COVID-19. While our country and our state have made great progress in fighting this disease over the past two years through vaccination and social distancing, we are still at risk of a new wave of COVID from Delta or future variants.
The good news is that, at this point, COVID hospitalizations and death are almost entirely avoidable. Vaccines are a proven solution to the problem – they are extremely effective in preventing serious illness and death, and reducing COVID transmission. The hospitalization and death rate of vaccinated adults and youth is less than one-tenth that of unvaccinated individuals.
I’m proud of the fact that Maryland is one of the most vaccinated states in the nation. But our contest is not with other states – it’s with the virus. As of November 1st, 38% of all Marylanders are not yet fully vaccinated, and until those numbers improve, we remain vulnerable to new waves of COVID.
We need a governor who will provide strong leadership on this issue. I’ve called on Governor Hogan and other state and local officials to require vaccines for –
- Healthcare workers in indoor settings, who may be exposed to immuno-compromised patients.
- School staff, to minimize the risk of COVID transmission to other staff and to children who may not yet be vaccinated.
- Students age 16+, for whom the FDA has given full approval for vaccination. This requirement would be similar to longstanding requirements for students to be vaccinated against other serious diseases, such as measles and polio. We should expand this requirement to younger children as the FDA extends full approval to these age groups.
- State employees and contractors.
I’ve also urged state and local officials to –
- Launch pop-up vaccine clinics at all public schools to encourage students age 5+ to get vaccinated with parental consent. Similar clinics have proven very effective at increasing flu vaccination rates.
- Encourage private businesses to require proof of vaccination to enter indoor facilities like bars, restaurants, entertainment venues, and gyms.
Please see also my recent Baltimore Sun op-ed about how to address COVID-related learning loss and unemployment.
Let’s do what works to end the pandemic and accelerate healing in education, the economy, and other areas.
Throughout U.S. history, higher education has offered a path to economic opportunity and upward mobility for millions of Americans. Every young adult in Maryland should have opportunities to pursue this path, regardless of background or financial situation.
The good news is that there are programs that provide financial, academic, and/or mentoring support that have been tested and proven to significantly increase college completion rates (two-year or four-year) for low and moderate income students. My philanthropic team funded a number of the key studies, as well as the expansion of some of these proven approaches to several sites across the country.
Now it’s time to bring these proven programs to Maryland, and expand them statewide to eventually reach all eligible students. When I’m governor, we’ll scale up proven solutions such as –
- Bottom Line – a comprehensive, one-on-one advising program for low-income students. Bottom Line provides students with personalized advising on the college application and selection process during high school, and continued advising in college on such items as course selection and financial aid. Rigorous testing shows that Bottom Line increases bachelor’s degree completion by a remarkable 8 percentage points.
- Accelerated Study in Associate Programs (ASAP) – a comprehensive community college program for low-income students. ASAP, developed by the City University of New York, provides academic, personal, and financial support to low-income students needing remedial education. It has been demonstrated to increase degree completion by 11 percentage points.
- “Learning Accounts” for low-income 10th graders, providing up to $10,000 in financial aid for college if they do well in high school. This program deposits money in students’ accounts as they meet certain benchmarks – $2,500 after they complete 10th grade, $2,500 after they complete 11th grade, and $5,000 after they graduate from high school. Students can then use the accumulated funds to help pay for college. When tested in Canada, this program increased both the high school and college graduation rates by 7 percentage points. We should try Learning Accounts in Maryland, initially on a pilot basis, and expand it if successful.
We have proven tools to significantly increase college graduation rates for young adults across the state. Let’s do what works!