At first, the bill addressing the role of racism in health disparities in Maryland laid out the context plainly: “Racism is rooted in the foundation of America, from the time chattel slavery began in the 1600s, to the Jim Crow era, to the declaration of the war on drugs that eventually led to the mass incarceration of Black people, and it has remained a presence in American society while subjecting Black, Indigenous, and People of Color to hardships and disadvantages in every aspect of life.”

But after Republicans and some conservative Democrats quietly complained, lawmakers struck all 11 references to racism, past and present.

Sen. Delores G. Kelley (D-Baltimore County), the chair of the Senate Finance Committee, said the goal was to move the bill forward without a drawn-out fight on the Senate floor.

“We were going to lose the vote on the floor if we didn’t remove the preamble,” Kelley said in an interview. “And the devil works in mysterious ways. . . . I think they thought we would let the whole bill die.”

Amid a national reckoning on structural racism and disparities exposed by the coronavirus pandemic, the decision shows the difficulties of confronting and addressing historic bigotry — even in a liberal legislature where Democrats hold veto-proof majorities in both chambers.

“The truth of the matter is in order to end racism in this state we have to be willing to call it out and see it in print,” said Sen. Mary L. Washington (D-Baltimore City), the bill’s sponsor.

The action also is evidence of the push and pull at play in the Senate, where more conservative senators now lead the Republican caucus and Senate President Bill Ferguson (D-Baltimore City), a young liberal, is adjusting to his role after decades of Thomas V. Mike Miller Jr. leading the chamber.

The bill, named for former state senator Shirley Nathan-Pulliam, would create a commission to examine the health of Maryland residents and the impact of various factors, including access to affordable housing, educational attainment and employment, on health outcomes. The commission would advise the state government on racial, ethnic, cultural or socioeconomic disparities in health, and set goals for health equity.

It came to the floor last week with the references to racism intact. But, in an unusual move, Kelley, who is Black, asked for the measure to be sent back to her committee to deal with a last-minute amendment.

“Why?” Sen. Malcolm L. Augustine (D-Prince George’s) asked when the committee took up whether to delete the introductory passages about racism’s role and impact throughout U.S. history. “Why? Why would we do that?”

Sen. Brian J. Feldman (D-Montgomery), the vice chair of the committee, who was running the meeting, turned to Sen. J.B. Jennings (R-Harford) for an answer.

“There are issues in the preamble,” Jennings said. “We just want to focus on the actual bill.”

The preamble said that “racism unfairly disadvantages specific individuals and communities while unfairly giving advantages to other individuals.”

It continued: “The American Public Health Association, National Association of County and City Health Officials, and the American Academy of Pediatrics have declared racism as a public health crisis.”

Jennings and Sen. Stephen S. Hershey Jr. (R-Queen Anne’s) both voted in favor of the version of the bill with the preamble when it was approved by the committee the first time. Jennings noted that there had not been much discussion before that vote. And he and Hershey told their colleagues that several members of the Republican caucus supported creating the commission but they were “uncomfortable” basing it on racism.

“There was concerns about some of the specifics in the clauses,” Hershey said.

Senate Minority Whip Michael J. Hough (R-Frederick) did not return a call for comment.

Kelley said she thought it was best to move the bill forward, especially since the legislature is also wrestling with major legislation on police accountability and other issues.

“I would just say if you don’t have an earthshaking reason, we’d like to get this back on the floor and move other bills,” she said at the committee meeting.

Sen. Antonio L. Hayes (D-Baltimore City) said he was sensitive to the Senate’s full agenda and agreed with her on ensuring that the bill passed without a protracted debate. But, “for me, and I can only speak for me . . . but this country has the issue of racism, right? And it’s taken a long time for us to acknowledge that.”

He said he wouldn’t vote to remove the amendment if a roll call was taken. Feldman ultimately asked for a voice vote.

Hershey said the amendment was “not meant to erase history or to not acknowledge that these conditions aren’t out there. It’s just do they need to be in writing in uncodified language in a bill that we all supported? This was just a request that our caucus made to say, ‘Can we find a way to take it out, bring it back to the floor, we’ll all vote in favor of it, and we’ll be done with it.’ ”

Experts in health and Black history said it was disappointing that Maryland lawmakers missed an important opportunity.

“You can’t compromise on racism,” said Naa Oyo A. Kwate, an associate professor of Africana studies at Rutgers University, who has studied how racism directly and indirectly affects Black health. “Striking that language is not cosmetic. It’s fundamental to what they are setting out to do and for what they are supposed to achieve.”

Natalia Linos, the executive director of the François-Xavier Bagnoud (FXB) Center for Health and Human Rights at Harvard University, said: “We know as epidemiologists that when we’re seeing these stark inequities between Black Americans and White Americans it isn’t because of inferiority or biology reasons. This is because of our structures and our policies.”

“This is because of racism, past racism and ongoing exclusion that people face in poor housing or environmental racism.”

A similar bill in the House of Delegates has been approved by a House subcommittee. It has the preamble.

If the Senate bill passes, the measure will be taken up in the House. If the House puts the preamble back in, they will have to ultimately hash out the differences in a conference committee.

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