These supplemental benefits aren’t luxuries — they’re essential to living healthy, independent and dignified lives. Vision care helps prevent falls. Dental care can stop infections that lead to emergency room visits. Transportation ensures seniors make it to the doctor. Healthy food stipends help prevent chronic disease. Together, these benefits keep Maryland’s seniors thriving — not just surviving.

That is why the growing instability of the Medicare Advantage program should alarm every Marylander. The system that has served our seniors so well is now under serious threat.

Three years ago, I warned that this crisis was coming. Today, it has arrived. More than 50,000 of Maryland’s most vulnerable seniors are scrambling to find a Medicare Advantage plan that meets their needs. Options are dwindling. Benefits are being scaled back. And anxiety is spreading among those who can least afford uncertainty.

Last week, more than 250 Marylanders crowded into a meeting of the state’s Health Services Cost Review Commission — a gathering that normally draws little public attention. The turnout spoke volumes. Seniors and advocates across the state, particularly in Baltimore City, are deeply worried about what’s coming next.

The problem lies not with the health plans themselves but with a federal payment system that fails to account for Maryland’s unique health care model. Unlike other states, Maryland regulates hospital prices under an all-payer system — an approach that has saved money and expanded access for decades. But the federal government’s Medicare Advantage payment formula doesn’t recognize that difference. As a result, plans operating here are reimbursed at lower rates, forcing them to make painful trade-offs that threaten coverage, networks and benefits.

We cannot afford to wait for Washington to fix this. The federal government’s dysfunction and gridlock have already left too many critical issues unresolved. Meanwhile, the health and well-being of Maryland’s seniors hang in the balance.

Maryland must act — and act now.

Our state has long been a national leader in health care innovation. From our hospital rate-setting system to our groundbreaking global budgets, Maryland has never hesitated to chart its own course when Washington falters. Now we must summon that same spirit again — this time, to protect our seniors and preserve the lifeline that Medicare Advantage provides.

State leaders should bring together health plans, health care providers and senior advocates to stabilize the program in Maryland. That could mean temporary state-level solutions — such as bridge funding, targeted incentives or regulatory flexibility — that allow plans to continue offering robust benefits. At the same time, Maryland must continue pressing the federal government to revise its payment structure to reflect the realities of our health care system.

This isn’t just about policy. It’s about people — real Marylanders whose health, security and independence depend on these plans. It’s about the grandmother in West Baltimore who relies on her grocery benefit to manage diabetes. The retired bus driver in Prince George’s County who uses his vision benefit to maintain his independence. The widow on the Eastern Shore who depends on transportation services to get to her doctor. For them, Medicare Advantage isn’t an abstract debate — it’s the foundation of their daily lives.

Maryland’s seniors deserve more than the bare minimum. They deserve stability, dignity and peace of mind. They have spent their lives contributing to this state — raising families, paying taxes and strengthening communities. Now it’s our responsibility to protect them.

This is not the moment to walk away from a system that works. It’s the time for bold, compassionate leadership — the kind Maryland has always been known for. Let’s bridge the gap, safeguard these vital benefits and ensure that every senior in our state can continue to live with health, independence and hope.

Maryland has led before. We can lead again. Let’s act now — before the lifeline our seniors depend on begins to fray.

Rev. Alvin C. Hathaway Sr. is the founder of the Justice Thurgood Marshall Amenity Center. He was pastor of Union Baptist Church from 2007 through 2021. 

The board’s main lever — the so-called upper payment limit — sounds like a fix on paper. In reality, it’s a distraction. These limits don’t touch the true reasons families struggle with medication costs: skyrocketing insurance deductibles, confusing coinsurance rules and the shadowy role of pharmacy benefit managers (PBMs) who quietly dictate what patients pay. By focusing on list prices instead of these structural problems, the PDAB is fighting the wrong battle — and Marylanders are paying the price.

The disconnect between theory and lived experience couldn’t be clearer. A recent survey found that even patients paying as little as $0 to $10 a month still described their medicines as unaffordable — because of insurance design, medical bills and benefit restrictions. Every single patient who stopped taking medication due to cost cited these insurance barriers, not the drug’s list price. Yet the PDAB continues to ignore this reality. If the board truly wants to make a difference, it must shift its focus — urgently — from abstract price limits to the actual pain points families face every day.

Doctors and patients alike are sounding the alarm. Nearly 90 percent of Maryland specialists say the PDAB’s approach will limit treatment choices and make it harder to care for patients effectively. Meanwhile, patients describe a system that is opaque and exclusionary — public meetings that are hard to access, decisions that are hard to understand, and policies that seem to happen to them, not for them. The very people the PDAB was meant to help feel silenced and sidelined.

Other states have learned these lessons the hard way. New Hampshire recently repealed its PDAB after five years of wasted effort and zero savings for patients. In Colorado, even health plans warn that the administrative burdens of upper payment limits could outweigh any potential benefits. Maryland shouldn’t repeat these costly mistakes — it should learn from them.

This isn’t just a policy debate; it’s a moral one. Maryland’s African-American communities already face the highest burdens of chronic illness — especially heart disease and hypertension. Black Marylanders die from heart disease at far higher rates than their white counterparts, and in Baltimore City, they make up nearly three-quarters of all heart disease deaths. Nationally, Black Americans are 20% more likely to have high blood pressure and less likely to have it under control. The last thing these communities need is another bureaucratic barrier between them and lifesaving treatment.

Real solutions exist — and they don’t come from price controls. Maryland should instead target what’s actually driving out-of-pocket costs: a lack of transparency among PBMs, insurance rules that shift costs to consumers and benefit structures that punish those with chronic conditions. By expanding direct support for families — especially in communities of color — we can deliver genuine affordability, not just political talking points.

After six years, the verdict on Maryland’s PDAB is undeniable: It has failed to make medicine more affordable. It’s time to stop pretending otherwise. Maryland doesn’t need another layer of bureaucracy — it needs real reform that lowers out-of-pocket costs, safeguards access to essential treatments and closes the health equity gap once and for all.

Marylanders deserve better. They deserve affordable prescriptions, transparent systems and policies that work for people — not against them. It’s time to move beyond the PDAB and toward real solutions that deliver real relief.

The Rev. Alvin C. Hathaway Sr. is the founder of the Justice Thurgood Marshall Amenity Center. He was pastor of Union Baptist Church from 2007 through 2021. 

Tragically, these institutions, and our city itself, are under an unprecedented assault from Washington, D.C. Steep cuts to research and haphazard layoffs of federal employees have already eliminated thousands of jobs. And unfortunately, it seems likely there is still more to come, with recent federal legislation including reductions to Medicaid and Medicare and further slashing research investment, which threatens Baltimore’s residents and economic future.

Against this backdrop, it is heartening to see Mayor Brandon Scott join with the leaders of Johns Hopkins, UMMS, MedStar Health, Loyola University, LifeBridge Health, Mercy Medical Center, Ascension Saint Agnes Hospital, MICA and Notre Dame of Maryland University to sign a five-year agreement that provides critical funding to our city government and safeguards our leading anchor institutions.

In short, the mayor’s leadership in renewing the voluntary nonprofit payment in lieu of taxes (PILOT) has produced a plan that protects Baltimore.

This is a balanced agreement. It recognizes the contributions of our “eds and meds” institutions to our city:

Providing nearly one-quarter of our city’s private sector jobs; investing billions of dollars in capital projects that benefit companies and neighborhoods throughout the city; offering more than $100 million in scholarships to Baltimore students and in partnership with the city’s public schools; providing more than $1 billion in community health benefits, such as health professional education, free medical services and other economic benefits; and paying millions of dollars in energy, telecom and parking taxes, as well as property taxes on non-exempt and leased properties — plus employee income taxes.

Additionally, many of these institutions do not rely on public services, providing their own street and lighting maintenance, snow removal, public safety and trash removal, while paying millions of dollars in city sewer and water fees.

At the same time, Baltimore is one of only five of the top 50 cities — and the only place in Maryland — where nonprofit institutions have voluntarily agreed to a formal PILOT, generating millions of dollars not available to other jurisdictions to invest in priorities like education and public safety.

This new PILOT agreement will double the annual contribution from these institutions from $6 million to $12 million over five years, resulting in a total $48 million in revenue for city government.

Nonprofits have always been tax-exempt in America, for good reason. I led one such institution for many years, Union Baptist Church, and now lead another, the Justice Thurgood Marshall Amenity Center, honoring the legacy of Supreme Court Justice Thurgood Marshall and serving our community into the future. Our mission is not to generate private profit but to provide public benefit, saving government significant costs that it would otherwise have to bear.

Mayor Scott and the leaders of our anchor institutions deserve credit for crafting an agreement that serves the public good on all fronts. They are standing together to stand up for Baltimore in the face of Washington’s attacks. And they are building the foundation for Baltimore’s future economic growth, which will make our high aspirations for our city more attainable.

Rev. Alvin C. Hathaway Sr. is the founder of the Justice Thurgood Marshall Amenity Center. He was pastor of Union Baptist Church from 2007 through 2021. 

On Nov. 9, MDOT and the Maryland Aviation Administration recommended Landover-based New Market Development for the award of BWI’s concessions management contract. As a Marylander and member of their team and advocate for workforce development, I could not be happier to see a local, minority-owned firm recommended for this important contract.

The airport’s recommendation for award, which must now be ratified by the Board of Public Works, is a triumph for diversity, equity and inclusion goals for the state. For too long and in too many corners of private-sector dealings, the inclusion of minority-owned firms has been controlled by the largest companies and subject only to their charitable impulses. I am encouraged to see MDOT and MAA “walk the walk” to support the agenda of our state leaders to provide meaningful and significant opportunities to small, local and minority-owned businesses.

State-controlled public spaces must provide economic opportunity for Marylanders and, where possible, in under-represented communities. New Market Development itself is made up of both and their plan for small and minority-owned firms is ambitious and unprecedented in the industry. Indeed, their stable of partners is comprised of who’s who in high-level minority-owned local firms. After an elaborate and thorough procurement process, MDOT now seeks BPW approval in order to advance New Market Development’s vision for small and minority-owned economic development worthy of Maryland’s ambitions and in keeping with our government leaders’ goals.

During my earliest discussions with New Market Development President Major F. Riddick Jr. and his team, I was impressed by their vision for engaging with the community — not as a strategy for winning the contract, but as a moral business imperative. They were willing to come right into the community where I am located and explain their vision and really hear about the work my team is doing to offer opportunities in under-served communities. When you have an organization that has their capacity and experience but also the willingness to listen and work with you and collaborate, that’s really a fantastic thing.

I would also like to point out that MDOT and MAA have not compromised on experience or credentials in choosing New Market Development. Members of the New Market Development team have over a hundred years in this business and specifically more experience at BWI than any of the foreign-owned companies bidding for this contract.

In managing this procurement, MDOT and MAA have so far done the right thing. The selection of a highly-qualified, Maryland-based company, made up of industry leaders familiar with our state, our goal, and our communities is a victory that should be celebrated. Gov. Larry Hogan has been very vocal in his support of disadvantaged local businesses from the beginning of his service to the state. It is absolutely appropriate for his administration to finalize this contract before the end of his term. I hope the voting members of the Board of Public Works support the hard work done by the state agencies and approve their award recommendation without delay.

— Alvin C. Hathaway Sr., Baltimore

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Of all the partners with whom we collaborate, none is more engaged and determined to improve conditions than Wheelabrator Baltimore.

Wheelabrator runs the city’s waste-to-energy facility south of M&T Bank Stadium. The facility takes solid waste and converts it under controlled conditions into renewable energy. Despite well-accepted data to the contrary, some activists insist the facility’s emissions are responsible for Baltimore’s asthma problems.

As gatekeepers for our communities, we have vetted Wheelabrator just as we would any partner. The company’s representatives are credible, transparent, committed to the community and unafraid to do the hard work necessary to transform many Baltimore neighborhoods plagued by illegal dumping and consistent littering.

Some who want Wheelabrator to close are promoting a “zero waste” initiative in Baltimore. We applaud this ideal, but we also recognize the vast shortcomings of the proposal currently before the Baltimore City Council. What has been presented is not a viable near-term solution to the city’s waste management challenges. We are in the midst of a full-scale emergency that has many of our neighborhoods drowning in trash. We need an immediate and comprehensive response.

The community creates more than 1.5 million tons of trash in Baltimore each year. The most generous estimates are that our residents recycle about 20% of that waste. Further, the U.S. Environmental Protection Agency indicates that only about 75% of American refuse is actually reusable. Even if every city resident miraculously changed his or her behavior and began recycling overnight, hundreds of thousands of tons of materials we use each year in Baltimore won’t be recycled — because it can’t be.

Throwing all our trash in landfills isn’t a solution, but that’s exactly what zero waste proponents say we should do until we can recycle everything we use. Landfills emit large quantities of methane, which is a powerful greenhouse gas that has an exponentially greater impact on global climate change than carbon dioxide.

Our local landfill capacity is limited. The city already loads hundreds of thousands of tons of our trash on tractor-trailers to haul it to landfills in other areas. Those trucks emit exhaust that all credible research indicates is the leading cause of air pollution in Baltimore and other urban areas.

The sooner our landfill space is exhausted, the sooner the city will have to build transfer stations and use even more fossil fuel-consuming means to transport more of our trash to distant landfills. That’s more trucks on our roads — and more pollution in our air. It will also require tens of millions of dollars per year that the city doesn’t have — and taxpayers can’t be expected to absorb.

This isn’t our opinion. These are among the findings of the city’s own 10-year waste management plan, which states that “long-haul truck transfer … is a cost prohibitive and environmentally degrading option.” Opponents of Wheelabrator may not like this reality, but can they credibly dispute it.

Those who favor zero waste should partner with Wheelabrator. Working with our congregants, Wheelabrator Baltimore has established a team of “green ambassadors” that have knocked on thousands of doors to educate city residents about recycling. The company has distributed more than 1,400 free recycling bins citywide. And each year the company recycles tens of thousands of tons of metals that are delivered to its facility and would otherwise go unrecycled: all this in addition to hauling away thousands of gallons of trash on our streets during weekly community cleanups.

Baltimore has problems that require significant resources and dedication to solve. Wheelabrator is a valued partner whose employees work alongside our community members to improve our neighborhoods.

For those who are concerned about asthma in Baltimore, we would ask you to check the facts. The trash that fills our alleyways and sidewalks isn’t just blight. It attracts rodents and promotes the growth of mold, both of which Baltimore’s contributes to people’s asthma problem.

Together we should work to reduce fossil fuel consumption, traffic-related air pollution and methane emissions and protect our neighborhoods from grime and asthma-causing pathogens by removing trash others leave behind.

It is time for us to unite arms, discuss equitably our differences, and chart a fair and reasonable path forward to solve one of Baltimore’s most daunting challenges.

Bishop J.L. Carter (pastor@arkchurch.com) is senior pastor of The Ark Church in East Baltimore and Rev. Alvin C. Hathaway Sr. (alhathaway@gmail.com) is senior pastor of The Union Baptist Church in West Baltimore.

It’s time to break this cycle. It’s time to shine a light on the good works the fine people of this great city do to make Baltimore an exceptional place to live, work, worship, learn, play and visit.

Yes, our city’s challenges are real — but so are the steps Baltimoreans are taking to overcome them.

For those who are concerned positive change isn’t underway in Baltimore simply because the headlines don’t announce it on a daily basis, please be reassured. One personal example: The Ministers’ Conference of Baltimore and Vicinity recently began partnering with city residents, officials and businesses as part of an innovative campaign to change the perception — and the reality — of our neighborhoods, street by street and block by block.

We have joined the We Can Bmore campaign, a public awareness and engagement initiative that invests in waste reduction efforts. As part of the program, we have established teams of Green Ambassadors that have cleared more than 20,000 gallons of litter from city streets in just a few short weeks. Through our ministries and our partnership with Wheelabrator Baltimore, we are rapidly expanding We Can Bmore throughout the city.

We know from our work with the Baltimore Police Department that cleaner streets are safer streets. By participating in and supporting We Can Bmore, we are addressing two issues — crime and grime — that significantly impact the quality of life of our neighbors and the perception of our city.

We Can Bmore is a grassroots movement. It is a demonstration of the pride Baltimore residents take in our city and the effort we are willing to put forth to enhance our neighborhoods. The program started in July at Union Baptist Church in West Baltimore, where I am proud to serve as pastor, and has quickly expanded to include areas surrounding Ark Church in the Oliver neighborhood, Liberty Grace Church of God in Ashburton, Bethany Baptist Church in Brooklyn and the Community Outreach Ministry in Westport.

We Can Bmore is a means of supporting environmental justice. Participants in the campaign, including the Green Ambassadors, are empowering people with knowledge and providing them with the tools they need in order to facilitate change in their everyday lives.

Despite decades of recycling education in Baltimore, the city’s recycling rate remains less than 20%. We are committed to increasing recycling participation in the city. Local street teams funded by Wheelabrator are working with local residents to go door-to-door to educate community members about recycling waste and encourage people to recycle. The teams are distributing free recycling bins, educating residents on what products can be recycled and notifying neighbors of recycling collection days.

Prior to reading this, you may not have known there is a grassroots effort to reduce litter, foster environmental justice and improve public safety in Baltimore. Now that you do, make it part of the narrative you share about your hometown.

As Baltimoreans, we have the ability to influence what is said and written about our city. We have an opportunity to engage in causes that make a difference in our lives and the lives of our neighbors. We have the potential to demonstrate how much we care about Baltimore — and how much others should care also.

But don’t just get involved. Once you do, spread the word.

Believe it or not, the world is listening.

Alvin C. Hathaway Sr. is pastor of Union Baptist Church in Baltimore. His email is alhathaway@gmail.com.

Violence and poverty are psychological nightmares, but they also are biological toxins that affect how the brain works. Scientists have shown that extreme stress, especially during childhood, biologically changes how cells in the brain function by modifying how genes are turned on and turned off, and these changes can last for years, altering how we think and interact with others. Toxic stress in childhood also increases risk for many medical disorders later in life, including heart disease, diabetes, cancer, depression, drug abuse and suicide. Inner city violence and poverty is not just a threat to life and state of mind, it is a biological time bomb.

Numerous studies support the tragic realities of health care disparities among ethnic minority groups. More recently, researchers reported that African-American youth have higher suicide rates than whites. This finding turned long held assumptions about racial imbalances in mental illness on its head; this high suicide in African Americans could not be explained by economic circumstances.

In responding to this new data about suicide in African Americans, few experts have discussed the possible genetic causes for the uptick in frequency. Instead, the discussion tends to remain focused on environmental and social factors. But we know that many mental illnesses, such as suicide and depression, manifest through an interplay of genetics and environment early in life, even as early as prenatal development. For example, emerging research from the Lieber Institute for Brain Development, located on the medical campus of Johns Hopkins, finds that genes expressed in the placenta and pregnancy complications combine to increase the likelihood of the baby developing schizophrenia later in life.

Learning that pregnancy complications might cause a newborn to develop mental illness later in life should cause some alarm. African-American women have much higher rates of pregnancy complications. The most notable statistic is mortality, as black babies die at twice the rate of white babies. Again this is not explained solely by socioeconomic factors. In short, a higher rate of pregnancy complications likely puts newborn African Americans at increased risk of later mental illnesses, and this could explain the noticeable rise in suicides. But we need cutting edge research devoted to finding possible genetic factors in African Americans to figure this out.

Together with our clergy colleagues, we believe that we must fight back against these health disparities. Fighting back means that we must activate leaders across society to ensure greater representation of African Americans in genomic research that will lead to personalized treatments and cures that disproportionately impact this community.

Working together, we must shift the paradigm to ensure that research directly addresses the medical needs of African Americans, particularly related to brain disorders. At present, few African Americans are represented in genetic studies that form the foundation of personalized medicine. As well, African Americans are underrepresented in clinical trials that test new drugs, even in cases where the disease being studied disproportionately affects African Americans. In brain research, studies are conspicuously lacking in African American participants.

That’s why we have launched the African American Neuroscience Research Initiative within the Lieber Institute as a much needed effort to understand how genomic risk for brain disorders influences the development and function of the brain and to ensure personalized medicine serves the needs of all persons.

Earlier this year, a group of Baltimore ministers established the African American Clergy Research Initiative to support the effort, knowing that the need for such research has never been more clear, and Baltimore is the perfect location for it.

Dr. Daniel R. Weinberger (drweinberger@libd.org) is director of the Lieber Institute for Brain Development and a Johns Hopkins University professor in the departments of psychiatry, neurology, neuroscience and in The Institute of Genetic Medicine. Alvin C. Hathaway Sr. (alhathaway@gmail.com) is senior pastor at Union Baptist Church in Baltimore.