Maine earned a dubious, and little noticed, distinction late last year: It posted the largest, one-year decline of any state in the United Health Foundation’s annual America’s Health Rankings report.
In 2015, Maine’s overall health ranking — which reflects a combination of health indicators such as smoking, obesity and health insurance coverage rates — was 15th in the nation. In 2016, Maine dropped to 22nd.
The rankings, released in December, highlight a number of issues Maine has failed to adequately address: its higher-than-average and generally worsening infant mortality rate, its higher-than-average and highest-in-New England adult smoking rate (19.5 percent vs. 17.5 percent nationally), and its higher-than-average and highest-in-New England rate of residents under age 65 who lack health insurance. Some 10.8 percent of Maine adults under 65 are uninsured, according to the U.S. CDC, compared with 4.7 percent across New England and 10.5 percent across the nation.
In the face of these disappointing health statistics, Gov. Paul LePage has proposed a two-year budget that would continue to chip away at Maine’s public health infrastructure, nearly eliminate the main source of funds that pay for tobacco prevention and cessation initiatives, and leave more Maine people without health insurance.
Among the 500 state employee positions LePage has put on the chopping block in his budget proposal, for example, 11 would come from the state’s public health nursing program, which the LePage administration has already decimated in recent years by leaving more than half of its budgeted positions unfilled.
Maine’s public health nurses used to be a critical component of the state’s efforts to prevent infant deaths and ensure that infants got off to a healthy start in life. Public health nurses would commonly visit new mothers and their babies at home, monitor newborns and mothers for potential health problems, help new mothers become accustomed to breastfeeding, and address any breastfeeding-related issues.
As of January, however, only 23 of the program’s 48 budgeted positions were filled, according to the Legislature’s nonpartisan Office of Fiscal and Program Review — and the nurses remaining in the field were spending more of their time with adult patients, particularly high-cost Medicaid patients.
The LePage budget also amounts to a white flag in the war against tobacco.
The governor proposes to take $5.7 million Maine spends each year on smoking prevention and cessation efforts (compare that with more than $40 million annually in tobacco company marketing), and spend it instead on Medicaid payments to health care providers. The governor has the same plan in mind for $4.7 million the state spends each year on school-based health centers and on local organizations that work to improve public health in their communities.
That money comes from the amount Maine receives each year from the nation’s tobacco companies through a legal settlement with 46 states in the late 1990s. Unlike many other states, Maine has long spent much of that money on efforts to prevent young people from taking up smoking. The efforts paid off, but they need sustained attention in order to work.
Under the LePage budget, however, the state would simply use the tobacco settlement money to reduce the amount of taxpayer dollars needed to pay for Medicaid. Health and Human Services Commissioner Mary Mayhew says the money would be targeted to helping Medicaid patients stop smoking. But budget documents show the money would simply flow into the state’s Medicaid budget, replacing taxpayer money dollar for dollar.
Not only does this mean less money spent on prevention, which saves money on health care services in the future, it means spending at odds with state law, which states that Maine’s tobacco settlement money should be used “to supplement, not supplant, appropriations from the General Fund.”
The LePage administration’s approach to public health is reminiscent of its incessant efforts to cut services and make life harder for the state’s poorest residents. For the LePage administration, it’s somehow preferable to save some taxpayer money today, rather than spend money on assistance — whether health coverage for low-income parents or welfare payments for families in poverty — that could prevent a crisis situation tomorrow.