May 26, 2019
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History shows that enacting universal health care in Maine faces long odds

Kate Collins | BDN
Kate Collins | BDN
In this photo from 2006, Gov. John Baldacci serves pizza to supporters at Baldacci's restaurant on Election Day. He presided over Maine's last step toward universal health coverage.

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Maine legislative committees will hold Thursday hearings on several Democratic proposals aimed at ensuring universal health care coverage through a variety of different methods — from single-payer systems to public options.

Universal coverage is something that Maine — one of at least 19 states considering single-payer bills this year — has discussed more than most states. The idea is having a moment in the national spotlight amid high-level Democratic support for a “Medicare for all” concept.

But it is a difficult issue and likely to be only studied more in the short term: Maine’s 2003 try at universal coverage fell far short of that goal for reasons including expensive premiums and unpopular funding methods. Vermont ended a more ambitious try at a single-payer system in 2014.

Maine has pursued universal coverage in the past and continued to study it in a restrained manner during the LePage administration. Single-payer bills have been a perennial discussion among progressives in the Legislature, but they have never gotten far because of the complexity of implementing such a system and Republican opposition to the concept. Still, Maine has probably gotten farther than any state but California and Vermont.

A 2002 study for the Legislature said a single-payer system “appears to be economically feasible for Maine,” giving several scenarios under which administrative savings could be found while also warning that the challenges of implementing one “should not be overlooked.”

This helped lead to the 2003 formation of the Dirigo Health program, which was seen as a step toward universal coverage with a goal of covering 130,000 uninsured people. It covered 40,000 by the time it was phased out in 2013 on the heels of the federal Affordable Care Act.

The list of reasons for that are long. The program — designed to give individuals, employees of small businesses and self-employed people affordable coverage — was voluntary, unlike the Affordable Care Act. The New York Times reported in 2007 that the comprehensive benefits weren’t affordable and under Gov. John Baldacci, the state had trouble gaining support for funding mechanisms that included a beverage tax rejected soundly by voters in 2008.

When Gov. Paul LePage took over in 2011 alongside fellow Republicans, they passed a health care law that allowed Mainers to purchase insurance across state lines, let small businesses band together to purchase coverage and create a high-risk pool for expensive claims.

This law was also short-lived because of the Affordable Care Act, but an actuarial analysis for the state in 2011 found it would lower premiums for 80 percent of people in the first year, though older people and those who lived in more rural areas would pay more.

Universal coverage continued to be studied in the Legislature during the LePage administration, but a report last year from a bipartisan task force was a tepid one that only included actions with wide support. It did, however, ask lawmakers to authorize the task force again.

There is progressive momentum behind the idea, but it is late in the 2019 legislative session and expect the Democratic governor to be cautious. The nine proposals up for public hearings before a legislative committee on Thursday would take a variety of approaches, from setting up new single-payer systems to allowing people to buy coverage from existing public programs and implement the recommendations of last year’s task force. Still, lawmakers are unlikely to do much on this topic in 2019 except for authorizing more specific study.

There is barely a month left in the legislative session. While Gov. Janet Mills moved quickly to implement the voter-approved Medicaid expansion that LePage let languish and has called health care a “human right,” she hasn’t advocated for a single-payer system and listed more incremental health care goals on her 2018 campaign site.


Today in A-town

The House and Senate will convene for the third day this week to vote on several heavy-hitting bills. It’ll likely be a more eventful day in the Senate, where lawmakers could vote on measures to repeal all nonmedical exemptions for immunization requirements, allow MaineCare to be used to cover abortion services, make Election Day a state holiday and whether to allow a carbon emissions impact study of the proposed Central Maine Power hydropower transmission corridor. At this stage of the session, decisions about what bills will go to vote are often made in the moment. Listen here.

A few emergency bills needing two-thirds majority support are due for votes in the House this morning, including one to allow the indoor production of industrial hemp, and one to restrict the number of caseloads a Department of Health and Human Services child welfare caseworker can take on at a time. Listen here.


Reading list

— Maine is on a path to become at least the 17th state to ban counseling practices aimed at changing a person’s gender identity or sexual orientation. The House of Representatives on Wednesday voted 91-46 in favor of a bill from Assistant House Majority Leader Ryan Fecteau, D-Biddeford, that would ban conversion therapy, which has been widely discredited. After almost three hours of floor debate, five independents and five Republicans joined all of the House Democrats to support the measure, which now moves to the Senate.

— A U.S. Senate committee on which both Maine senators serve has subpoenaed the president’s son. The Senate Intelligence Committee has subpoenaed Donald Trump Jr., calling him in to answer questions about his 2017 congressional testimony. The committee has renewed interest in talking to President Donald Trump’s eldest son after Trump’s former lawyer, Michael Cohen, testified in February that he had briefed Trump Jr. approximately 10 times about a plan to build a Trump Tower in Moscow. Trump Jr. told the Senate Judiciary Committee in 2017 he was only “peripherally aware” of the proposal. Meanwhile, the president asserted executive privilege in an effort to ward of congressional Democrats’ efforts to procure an unredacted version of special counsel Robert Mueller’s report on Russian interference in the 2016 election.

— Design details for a new class of frigates that Bath Iron Works hopes to build have been released. The Maine shipyard, working with Spanish ship designer Navantia, on Monday displayed for the first time its proposed design for the guided missile frigate FFG(X) at an industry convention in Maryland. The frigate design, based on the F100 by partner Navantia, was presented during the annual Sea-Air-Space industry exposition. The lead ship will cost an estimated $1.3 billion, with follow-on frigates to be closer to $950 million and, ideally, nearing $800 million, the Navy has said. The construction contract would reportedly be worth about $15 billion to the company that wins it.

— For the first time since she took office, Belfast’s mayor got to vote at a city council meeting, and she was delighted to do so. At Tuesday night’s council meeting, Mayor Samantha Paradis voted to break a 2-2 deadlock on her proposal to have the city participate in the Build Maine 2019 conference. “Do I get to vote on this tie?” she said, while laughing excitedly. “Wow. All right. Well, I will cast a vote in favor, so the motion passes three to two.”


Remedial education

It’s National Teacher Appreciation Week. I’ve unintentionally irritated some teachers by trying to be funny in writing about them in the past. So I won’t now.

Come to think of it, I should have known better because I used to irritate my teachers in school when I tried to be a smart aleck. I am a really slow learner.

We entrust teachers to do the hard work to prepare our children for the world, but we usually only notice them when something goes wrong. It’s a compliment — but not really a good way to show appreciation — that we assume they will do right by our kids.

In the political realm that we inhabit, teachers are too often foils for competing agendas. Earlier this week, lawmakers again debated what should be reasonable starting pay for people entering the profession in Maine. Cumulatively, the Legislature’s education committee spends hundreds of hours each session sorting through proposals that aim more to win ideological points than to make our schools better. And the notion that broad political action can make all schools better is naive, missing the key point that learning is nuanced, sometimes student-specific and often impossible to measure with rigid standards.

We all seem to know what’s best for the way our children are taught. But we happily leave it for someone else to do.

Maybe instead of designating a week to tell teachers how much we appreciate them as a short respite from telling them how they can do their jobs better and how much more we need from them, we should take the time to just listen to them. Here is your soundtrack. — Robert Long

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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