August 23, 2019
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What ‘Medicare for all’ could mean for Maine hospitals

Yuri Gripas | REUTERS
Yuri Gripas | REUTERS
Members of the audience greet Senator Bernie Sanders (I-VT) during an event to introduce the "Medicare for All Act of 2017" on Capitol Hill in Washington, U.S., September 13, 2017.

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A version of the “Medicare for all” bill championed by Democratic presidential candidate Bernie Sanders, several of his rivals for the nomination and the two Democrats in Maine’s congressional delegation is getting its first committee hearing on Tuesday.

It won’t happen without full Democratic control of Washington, D.C., but the party is increasingly rallying around the concept — alongside less sweeping ones such as public options — as it tries to map a movement that will oust President Donald Trump in 2020.

Such a plan would ostensibly cover the 28.5 million estimated by the U.S. Census Bureau to be uninsured at cost estimates that vary widely but are generally above $3 trillion per year, though tax increases for many could be offset by reductions in premiums and other health care expenses.

Lost in some of the debate is the impact on the health care system. Maine’s economy is the most reliant on hospitals among U.S. states, according to the American Hospital Association, and a recent study published in the Journal of the American Medical Association predicted a negative revenue impact on hospitals from Medicare for All plans.

The impact of a Medicare for all plan would likely vary because of the different proportions of government and private insurance payors. The JAMA study, released earlier this month, found that hospital profit margins could go from 9 percent to 7 percent in the negative under a Medicare-for-all plan, assuming that the Medicare fee schedule was extended to all people. Currently, the fees paid by Medicare and Medicaid are less than the services cost to deliver, so patients with private insurers pay higher prices to subsidize that care.

The American Hospital Association opposes the Medicare for all concept, with a top official saying in February it would “disrupt coverage for the more than 180 million Americans who are covered by employer-sponsored health plans.” The Maine Hospital Association has been quieter on it, but Jeff Austin, a lobbyist for the group, said it agrees with the national group.

Austin’s group said in 2017 that Medicare and Medicaid paid about 53 percent of hospital bills then, while private insurers and self-pay patients paid 47 percent, though the latter group only constitutes about 39 percent of utilization. That payer mix was roughly in line with national estimates from 2014. However, those figures vary widely by region.

The payer mix in Franklin Memorial Hospital in Farmington was 80 percent governmental and 20 percent commercial and self-pay, according to a 2013 review. Maine Medical Center in Portland got 37 percent of payments from private payers in that fiscal year. The ones with more commercial payers have more to lose, though it’s also probably unlikely that a plan would pass without accounting for that move in funding.

Austin said that phenomenon is largely why Maine hospitals “have big concerns moving from payers who more than cover their costs,” though he said “cleaning up” the numbers of uninsured people would have positive impacts for hospitals. Hospitals also could offset some of this impact with administrative efficiencies. All of this underscores the future nuance of the debate over Medicaid for all as it gets more serious.

The two Democrats in Maine’s congressional delegation are supporting the ‘Medicare for all’ bill, though they have taken slightly different paths. In a statement, a spokesman for U.S. Rep. Chellie Pingree of the reliably liberal 1st District said her boss is “focused on solutions that will both reduce costs and ensure quality coverage for all Americans.” She is a longtime supporter of a Medicare for all concept and joined a caucus aimed at promoting it last year.

U.S. Rep. Jared Golden of the more conservative 2nd District, is also sponsoring the bill and has released a “roadmap” for health care that gets to Medicare for all after steps including Medicaid expansion and a Medicare buy-in option for people between the ages of 50 and 64. His spokesman didn’t respond to a request for comment on Monday.


Mills talks climate change

Gov. Janet Mills has scheduled a media event at noon today to talk about the Maine Climate Council. The Democrat has made combating climate change a priority of her administration since she was sworn in.

To date, most of that focus has been talking about how her administration will approach the issue, although she did commit the state to the U.S. Climate Alliance in February. Mills also used her second executive order to end a moratorium on many new wind projects that was put into place last year by former Gov. Paul LePage, her Republican predecessor who essentially put a state response to climate change on hold during his tenure.

We expect to hear more details from Mills today, as she takes questions on the Maine Climate Council a week after progressive Democrats had their day in the sun with a legislative hearing on Maine’s version of the Green New Deal.


Today in A-town

The House and Senate convene this morning, and legislative committees will take up bills to ban the sale of flavored tobacco products and increase state oversight of opioid manufacturers. Proposals to control brown tail moth and other pest infestations are also ready for votes in the agriculture committee, and a handful of property tax relief bills for veterans could be voted on by the taxation committee.

The Judiciary Committee could vote on a bill from Senate President Troy Jackson, D-Allagash, that would bar prescription opioid manufacturers and distributors from falsely advertising a medication without abuse liability, distributing a quantity of medication or failing to report orders that are “not medically reasonable,” according to the bill language. Failing to abide by these terms would result in a civil violation that the attorney general could investigate and applies retroactively to January of 1985. Tune in here.

The Health and Human Services Committee could vote on several bills, including one from Sen. Rebecca Millett, D-Cape Elizabeth, that would ban the sale of flavored tobacco products, including cigars, in Maine. Listen here.

The innovation and economic development committee could vote on a bill from Rep. Mattie Daughtry, D-Brunswick, to establish the Maine Workforce, Research and Development and Student Achievement Institute. Part of its role would be to provide recommendations to the Legislature on workforce development and economic advancement across the state. It sounds quite similar to a task force created in 2013, the last time Democrats controlled both chambers. Listen here.

Daughtry and Rep. Maureen Terry, D-Gorham, also have bills before the health coverage committee to allow women and children receiving supplemental food assistance to more easily purchase food from farmers markets. Listen here.


Reading list

— In an effort to protect endangered whales, federal regulators proposed rules that would drastically affect lobster fishing. The Associated Press reports that a team organized by the federal government recommended last week that the number of vertical trap lines in the water be reduced by about half. The interstate Atlantic States Marine Fisheries Commission met Monday outside Washington to discuss the implementation of the new rules, which are designed to reduce serious injuries and deaths among whales by 60 percent. The effects of the rule changes are likely to be felt most heavily in Maine, which typically accounts for four-fifths of the total U.S. lobster catch.

— Maine lawmakers again took a stance against limiting where people can bring their guns. Maine Public reports that the Legislature’s State and Local Government Committee on Monday voted to recommend against passage of a bill that would allow cities and towns to ban guns at polling places and public meetings. The fact that some Democrats on the committee joined Republicans in opposing the measure signals that it’s likely to fail when it moves to floor votes in the House and Senate.

— A woman accused of killing a 4-year-old who was placed in her home by Maine child welfare authorities will learn her fate today. This afternoon, Superior Court Justice William Stokes is scheduled to hand down the verdict in the murder trial of Shawna Gatto, who is accused of killing Kendall Chick, 4, the grandaughter of her fiance, at home they shared in Wiscasset.


Salad days

Pasta salad is a staple dish at my family’s cookouts, especially in the summer. It’s usually prepared by my aunt Jane, who tosses fusilli, chopped onions, bell peppers, bits of salami, mild cheddar, celery and diced cherry tomatoes in a balsamic vinaigrette. It is not healthy, but its varied texture and flavor provides a welcome complement to grilled hamburgers and hot dogs, plain Lays potato chips, and my grandmother’s deviled eggs. It is not uncommon to find me standing over the bowl with a fork after everyone has had their fill.

I broach this topic confidently because of a heated disagreement yesterday at the State House between myself, my colleague Mike Shepherd and our beloved boss, Robert Long. Part of acclimating to this beat, I’ve found, is mastering the ability to actually work while debating inconsequential topics in Slack, many of which are food related.

“Pasta salad is bad and should never be made,” Mike said, admitting he’s only now just coming around to potato salad, which he makes with sour cream, a bit of mayo, dill, mustard, celery, onion and lemon.

Robert quipped that the “only time pasta salad should ever be served is at large gatherings after funerals.”

They’re both wrong, and I told them in so many words, but the debate remained healthy and respectful. Here’s your soundtrack. — Alex Acquisto

Today’s Daily Brief was written by Michael Shepherd, Alex Acquisto and Robert Long. If you’re reading this on the BDN’s website or were forwarded it, click here to receive Maine’s leading newsletter on state politics via email on weekday mornings. Click here to subscribe to the BDN.

To reach us, do not reply directly to this newsletter, but email us directly at mshepherd@bangordailynews.com, aacquisto@bangordailynews.com, and rlong@bangordailynews.com.



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