State of Maine: There’s no fast fix when it comes to health care

“An Act to Lower Health Care Costs” seems like it would be a sure winner in Augusta, but not so fast. It was accepted as an emergency bill by the Legislative Council on Oct. 23 by a 6-4 vote split on party lines.

Then came the process of writing a large, complex policy bill resulting in the bill appearing in print only recently, on Feb. 18, when it was referred to the Committee on Health Coverage, Insurance and Financial Services.

Senate President Troy Jackson is the sponsor. There are seven Senate co-sponsors, all Democrats, and just two House co-sponsors, also Democrats. One is House Speaker (and U.S. Senate candidate) Sara Gideon. The other is Denise Tepler, who chairs the House committee in possession of the bill.

One-party sponsorship never bodes well for a bill. A cynic might call this a win-win for Democrats. Either the bill will pass, in which case the party can claim bragging rights on one of the hottest issues in Augusta, or it will fail and Democrats can spend the fall reminding voters of who wanted to reduce health care costs and who wouldn’t go along.

The bill is big — 16 pages big — and therein lies the rub. With just six weeks left in the session, it is difficult to do justice to a bill that makes sweeping policy changes in that short amount of time. A bill in a hurry means a bill that may skip some important steps in the legislative process.

This bill that was referred to committee on Feb. 18 went to public hearing on Feb. 25. As is customary at this point in a session, the Legislature has abandoned the usual two weeks’ notice for public hearings. Augusta lobbyists had to scramble to read, research and digest the proposal. Because this is what they do, they were able to come up with an initial reaction to the health care bill of bills. The rest of us? Not so much.

The results of the hastily convened hearing were not surprising. Two citizens with budget-busting personal medical bills testified in favor, as did organizations representing citizen interests such as AARP, Consumers for Affordable Health Care and Maine Equal Justice.

The health industry was less enthusiastic. Though the committee discussed ideas for controlling health care costs in meetings between sessions, some major players were not brought along. Testifying against the bill were the Maine Hospital Association, Maine Medical Association, MaineHealth (an integrated health care system and the state’s largest private employer) and Northern Light Health. They expressed strong support for the goal of lowering health care costs but had concerns about “administrative burden,” “underpayment by government payors” and “mandatory, artificial growth targets.”

Jeffrey Austin of the Maine Hospital Association summed it up. Though MHA supported other reform bills, “This bill is too big, has too many unknowns and is not really targeted to what Maine needs.”

Also opposed was the Maine Department of Professional and Financial Regulation, which would have additional responsibilities under the plan. Said DPFR: “The Bureau [of Insurance] does not have the resources or expertise to staff the Commission, even for a short period of time, as envisioned by the bill.”

LD 2110 would establish an 11-member Commission on Affordable Health Care that would restrict health care cost growth, set health care quality goals, enhance provider transparency, protect patient access to health care services and set spending targets for public payors and prescription drug spending.

In addition to the 11-member board, the bill proposes a 12-member Advisory Council with members from the administration (Administrative and Financial Services, Corrections, Health and Human Services, Attorney General’s Office) and the Maine Education Association, Maine Municipal Association, University of Maine and Maine Community College System.

The commission’s scope of work is massive. There would be “health care cost growth benchmarks” established. There would be annual “public cost trend hearings.” Factors would include “unanticipated events” (disease outbreaks, natural disasters), “severity or complexity of patient conditions,” “unanticipated administrative costs,” new pharmaceuticals or technologies, specialty services and costs related to government regulations. There would be an annual report.

Entities that exceed established cost growth benchmarks would be required to submit a “performance improvement plan.” A fine of up to $500,000 would be imposed for failing to make a “good faith effort” to develop such a plan.

Just two days later, on Feb. 27, the bill had its first work session, at which the bill was summarily tabled without discussion. This could signal a behind-the-scenes effort to negotiate with the opposition. Leadership’s deadline for getting bills out of committee cometh (March 10). Adjournment is April 15.

Sen. Jackson deserves credit for taking health care costs head-on, but the bill should come back in next year’s Legislature to get the consideration it deserves.

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Jill Goldthwait

Jill Goldthwait

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.

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