Maryland — like so many states nationwide — has lost thousands to overdoses over the past decades, devastating families and entire communities. Recent declines, though, have sparked hope: In 2024, fatal overdoses in our state fell 38% from the previous year. This extraordinary progress is proof that prevention, treatment and recovery efforts are working.
But now, that progress is under threat.
Most immediately, Marylanders with incomes between 100% and 400% of the federal poverty level will see their health insurance premiums increase by an average of more than 13% for 2026 as a result of Congress failing to extend enhanced tax credits. These significant increases will make it more difficult for those with commercial health plans to retain their coverage and hence, access to addiction treatment services.
On top of that, H.R. 1, the federal spending bill enacted by Congress and President Donald Trump this past July, slashes federal funding for Medicaid and imposes more frequent eligibility determinations as well as harsh work reporting rules that are predicted to push millions nationwide off of this lifeline health plan. As the largest payer of substance use care in the country, the stakes are enormously high. In Maryland, as many as 175,000 residents could lose coverage when the new rules kick in, meaning that thousands of our friends and neighbors who rely on Medicaid to obtain lifesaving medications, treatment services and recovery supports may no longer be able to afford the care they need.
Starting in January 2027, H.R. 1 will require all adults nationwide who gained coverage through Medicaid expansion to report at least 80 hours per month of work or other community engagement activities. But we know from other states that have already employed such rules that work requirements do not increase employment. (Moreover, most Medicaid recipients are already working: In Maryland, 72% of adults on Medicaid are employed while many of the others are exempt.) Rather, the most prominent result of these rules is the gutting of eligible people’s health coverage, cutting off access to care for those who need it most, including people with substance use disorders (SUDs).
Fortunately, there is still time to act and mitigate the harms of H.R. 1. A recent Legal Action Center report outlines strategies that all states, including Maryland, can adopt now to shield people with SUDs and those in recovery from losing their health coverage due to H.R. 1’s federally mandated work reporting requirements. The law allows exemptions from the requirements for individuals who are “medically frail,” including those with SUDs, or individuals who are in addiction treatment programs. We can save lives if we work together to ensure that Maryland interprets these exemptions as broadly as possible.
As a certified peer recovery specialist and executive director of REACH Health Services, we know coverage and care access go hand in hand, and that recovery takes time, compassion and a strong foundation. Threatening people with the loss of health coverage does nothing to help them heal or maintain stability — it only makes recurrence and overdose more likely. LAC’s report offers commonsense solutions to faithfully implement H.R. 1 while preserving access to affordable health care for those most at risk.
But we need to work together to do it right. People with lived experience, health care providers and advocates are ready and eager to partner with policymakers to keep Marylanders covered and sustain our success in combating fatal overdoses.
We all have the same goal of improving people’s health and saving lives, and together, we can achieve this. We should celebrate — and build on — Maryland’s progress in reducing overdose deaths by not allowing shortsighted federal policy to undo or stymie it. We — Maryland legislators, regulators and all of us in the community — must act now to protect each other and keep Maryland moving forward.
