By establishing a health benefit exchange and expanding Medicaid coverage, Maryland is on a path to extend access to affordable healthcare to hundreds of thousands of individuals, families and small businesses. A key root cause of high health care spending in Maryland—and across the country—is a lack of balance in our healthcare system. The system has provided ample reimbursement for high-tech care for complicated illness while underpaying for the primary and preventive care needed to support people in health and wellness.