ELKTON — In the midst of heated talk about immigration and changes to the Affordable Care Act, U.S. Sen. Ben Cardin (D-Md.) spent his Friday morning meeting with county business and Union Hospital leaders to learn how these national issues affect life in Cecil County.

The senator was greeted by County Executive Alan McCarthy and County Council President Bob Meffley at the Elkton Central Library, for a roundtable discussion about local business growth. The Cecil County Chamber of Commerce invited a score of education advocates, business representatives and county government officials to join the talk.

Cardin playfully commended McCarthy and the council for their work, noting that they often serve on the frontlines for accountability of county issues.

“Bob and Alan have the hardest job. When you represent the county, there’s no one to punt the work toward. I can punt it to the state, and the state can punt it back to the county,” Cardin said.

Jack Reitnauer, general manager of Warwick Mushroom Farm, kicked off the conversation by talking about “temporary protected status” (TPS) and how it would hinder his operations if President Donald Trump’s efforts to revoke it succeeded.

TPS is a provision under which the U.S. government grants protection from deportation to people from certain countries affected by natural disasters, war, or other dangerous conditions. Under Trump, it’s been reported that 300,000 people have lost TPS protection.

“There’s a stigma with agriculture and it seems to only attract a certain kind of people, and I don’t know why because there are farms that offer competitive wages. Now that demographic is under pressure to be eliminated, and it’s a certain piece of our work,” Reitnauer said.

Cardin believed that the tightening labor market was the biggest challenge local businesses faced today, especially those that don’t have the resources to recruit new employees or train the staff on hand to have the skills.

The “broken immigration system” is exacerbating the workforce situation, Cardin said.

“Our system is old, and doesn’t reflect the current challenges we have with future generation of immigrants coming to America,” he said. “We need to fix the system, but one of the casualties is that we haven’t fixed it for workers that want to come to this country.”

At Union Hospital, top leadership later told the senator that immigration may put some pressure on them when it comes to recruiting physicians. Under the J-1 Visa Waiver Program, international medical graduates can pursue residency or a fellowship in other states, typically up to seven years.

In Maryland, there are 30 slots in the J-1 Visa Waiver program. Union Hospital is competing for 10 of them, according to officials.

“To compete in the marketplace, we don’t have the bells and whistles other facilities have to attract those positions,” Ryan Geracimos, Union Hospital’s chief medical officer, told Cardin. “It’s a challenging environment to recruit specialists, especially in primary care. The landscape has changed. There’s certain expectations that exist now that weren’t present 30 years ago.”

Union Hospital has signed a letter of intent with Christiana Care Health System, with the hope to execute the arrangement a year from now. With a multi-million-dollar hospital that does offer residency options, the hope is that it can recruit more physicians to Elkton.

While meeting with business leaders, Cardin reiterated his support for the Affordable Care Act, claiming that small businesses were “the big winners,” since it ended large insurance premium hikes in the long run and slashed the list of pre-existing conditions and coverage restrictions.

Nick Cusmano, an insurance agent of Colonial Life who attended the business roundtable, frankly disagreed.

“I can tell you with absolute certainty that the workforce is a short-term issue, but the effects of Obamacare are going to devastate small businesses over the long term,” he said. “The entire population is being crushed by the additional costs that come from all those new agencies.”

Cardin invited Cusmano to join him to his trip to Union Hospital later that morning, where its top leaders talked at length about how ACA, and Maryland’s unique Medicare All-Payer hospital waiver, affected the county’s only hospital.

Under the state’s waiver, all third-party payers — Medicare, Medicaid or private insurance — pay the same rate.

A new 10-year state Medicare waiver passed in 2014, split into five-year blocks, has been updating the state’s regulation and reimbursement system with the Global Budget Revenue (GBR) model.

“No one really understood the Maryland program, and now it’s looked at as a potential national model for how health care should be. We really are in the spotlight,” Cardin said.

But neighboring Delaware has retained 100% coverage under ACA, and while reimbursement rates are lower in Maryland, there sometimes proves to be a contracting issue with Delaware hospital while billing Maryland Medicaid, according to Zack Royston, a Union Hospital senior vice president.

With 50% of Union Hospital’s population with insurance portability heading to Christiana Care for its array of services and the other half on Medicaid and Medicare, that presents a challenge for the revenue side.

Royston also pointed out that in some cases, the state Medicaid status can limit opportunities for care. In one case, a patient who was delivered with complications was transferred to Christiana Care. But since Christiana had exceeded its capacity, the patient was transferred to Nemours/Alfred I. duPont Hospital in Wilmington only to be transferred to Johns Hopkins because of the family’s Maryland Medicaid status.

“I have a Cecil County family that could access care 25 minutes up the road but now has to make arrangements and find a way to the Baltimore health care system,” Royston said. “It can be extremely disruptive in their ability to manage other determinants and challenges to their livelihood.”

The ACA once again is being tested in court this month. The Fifth Circuit Court of Appeals in Texas heard arguments on whether the elimination of the health insurance penalty — known as the individual mandate — was constitutional.

Cardin said the judicial panel was “hostile” toward the ACA and he wasn’t sure what would happen, but he said it had a “better shot” if it heads to the Supreme Court if it’s found unconstitutional.

The senator also hinted that a “dramatic bill” that would put caps on out-of-pocket Medicare beneficiary drugs would soon come out of the Senate Finance Committee on which he serves on.

Cardin pushed back on the idea that putting a cap on prescription drug costs would stop innovation of drugs, claiming that the pharmaceutical industry spends astronomical money on marketing rather than research.

“We need to get a handle on it because we’re overpaying dramatically in America versus the rest of the world,” the senator said. “You hear frequently that if we come down too hard on the drug industry, we’ll limit innovation. But it’s the most profitable industry in the United States.”

During his trip in Cecil County, Cardin also fielded questions on business financing programs and his hopes to improve community college involvement and trade schools. He promised that he and U.S. Sen. Marco Rubio (R-Fla.) — both who serve on the Senate Committee on Small Business and Entrepreneurship— had completed re-evaluations of Small Business Administration programs.

Both senators had six targeted for termination and one for significant reforms. This would help maximize their productivity and reduce spending to benefit local businesses, he said.

Cardin lauded small business in Cecil County, as well as elsewhere in America, because they have the ability to reach customers directly and overcome obstacles in unique ways.

“Small business is the growth engine of America,” he said. “That’s where the jobs are created. It’s where innovation takes place, the real creativity.”

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