Its legislative season again. Every year hundreds of suits travel to Annapolis to engage and influence Maryland’s future. Some travel to defend or advocate for an issue of professional passion; others go to Annapolis to influence issues of community and self interest. They come to talk about family farm preservation, k-12 education, prisons, taxes, snow removal budgets and the Chesapeake Bay. They also come to influence healthcare, and they come to advocate for mental healthcare. We as a nation are in a fascinating time for healthcare policy and we are in a dynamic time in consideration of state government roles in this process. Thomas Jefferson was a founding father with strong interest in states rights. He opined that the federal government should be limited to the provision of a common defense and a common justice system. States, which are closer to the people and to their needs, would have responsibility for other functions that should be provided by a common government in a civilized and enlightened society. These functions include education, social support, local law and order and healthcare.   Several significant attempts to create a federally administered healthcare system have resulted not in a single system, but in incremental programs. Since the outset of our capitalistic democracy, and with the “support” of labor unions, employer-based health insurance that provides fee for services to private physicians and hospitals has been the most common source of healthcare financing for Americans. Medicare originated as a part of early social security for widows and infirm soldiers. It was enacted as a federally administered and financed program in the Johnson Administration as a relatively small federal program. (Medicare would be small in terms of numbers of potential beneficiaries and small because healthcare was not expensive 50 years ago.) A second major program, Medicaid, was also enacted in the Johnson Administration as a component of the War on Poverty. Like Medicare, it was conceived to be a program that would impact only the most poor who were unable (children and mentally retarded) or not expected (young unwed mothers) to work. Unlike Medicare, Medicaid was to be administered as a state-federal “partnership” in terms of funding and benefit design.   Both Medicaid and Medicare have had explosive growth over the last 50 years in terms of numbers of recipients and  costs of healthcare services. Back to our state capitol, the legislative season, and Kery and myself having coffee at Rams Head Tavern in Annapolis. The suits in the bar with us and walking by on the street are very new, and don’t fit that well. (No doubt, purchased off a rack, in a hurry, and maybe a few pounds ago.) Tucking in, and the Windsor knot don’t appear to be a practiced skill. This is not a generation of people who are necessarily comfortable in formal business attire, but that is part of the Annapolis protocol.  The MPS is in Annapolis and engaged with the legislative process in many ways.  Our leads are the Legislative Committee, this year ably chaired by Drs Teitelbaum and Zimnitzky. This committee is advised by a new lobbyist dynamic duo, Lisa Harris Jones and Sean Malone. While we have not formally opposed legislation authored by an ER physician-legislator that might enable legal access to smokable marijuana, our position statement has been made available to a number of influential individuals. We attend legislative hearings and organize testimony on issues where our experience and expertise is useful. We attend receptions such as the Mental Health Association legislative reception that brought Kery, myself, Steve Daviss and John Urbaitis on this day. Several of our members are active in leadership positions in the state mental health department. These include Dr’s Brian Hepburn, Gayle Jordan Randolph, Lisa Hovermale, Al Zachik and Peter Cohen. Academic department chairmen such as Dr’s DePaulo, Lehman and Lyketsos, and CEOs such as Dr. Steven Sharfstein are other MPS members who are often involved in the Maryland process.   Although there has been much recent attention on an expansion of the federal role in healthcare, state government continues to play a tremendous part in the actual implementation, insurance regulation and financing of health and mental healthcare. Your organization, MPS, is right there with those suits. We are engaged and advocating, and we could use your help. Please help us, help yourself and your profession by getting engaged with MPS. We are your voice in Annapolis.