Statehouse Report: Senate leader proposes panel to guide affordable health care

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Maine could get a new state Commission on Affordable Health Care if legislation proposed by Senate President Troy Jackson, D-Allagash, is enacted.

The state has lacked such a commission since the Dirigo health program was repealed in 2011, at the outset of the LePage administration, and Jackson said it’s time to launch another effort.

“Last year, when we were working on the opioid epidemic and prescription drug legislation, we realized there wasn’t anything tying it all together,” Jackson said. “We need a framework to be able to look at everything, but especially the costs, which keep rising.”

Jackson cited the work of commissions in Massachusetts and Vermont as demonstrating the value of what can be done at the state level, especially since there’s no overall federal plan guiding spending and access to health care.

Vermont’s Green Mountain Care Board regulates rates at 14 hospitals, and attempts to address the needs of rural hospitals it has found are at significant risk of closing; nationwide, 113 have shut down since 2010. The board’s creation followed an unsuccessful effort to create a statewide “single-payer” system that would have replaced private insurance.

In Massachusetts, the Health Care Policy Commission has set spending targets since 2012, an outgrowth of a statewide program to achieve universal insurance coverage passed under former Gov. Mitt Romney that later became a model for the federal Affordable Care Act.

David Seltz, the Massachusetts commission’s executive director, met with the Legislature’s Health Coverage, Insurance and Financial Services Committee on Tuesday to provide an overview of the ins and outs of various methods to contain costs and improve care.

Jackson said his ideas for a Maine commission track the Massachusetts approach more than Vermont’s, but he’s open to any and all suggestions.

“It’s obvious to most of us that what we’re doing isn’t working,” Jackson said. “Costs keep going up every year, and a lot of the increases are falling directly on consumers.”

The numbers from the Massachusetts commission bear this out. Since 2000, personal income in the Bay State has increased 86 percent, but health costs have gone up much faster. Employer premium contributions have gone up 176 percent, but employee contributions have skyrocketed by 276 percent. 

Maine had a Health Care Finance Commission, authorized under the administration of Gov. Joseph Brennan in 1983, that for five years regulated hospital income through mandatory caps, and held increases well below the national average. It was abolished at the behest of the Gov. John McKernan administration. Dirigo Health, authorized under the Gov. John Baldacci administration in 2003, used voluntary caps for hospital compliance.

Maine now has the 14th highest costs among the 50 states, a status Jackson said cannot be afforded in a state where incomes are substantially below the national average. Out-of-pocket costs for consumers, he said, are a particular problem.

When he joined the state health plan as a freshman legislator in 2003, Jackson said, the co-pay for a hospital emergency room visit was $25. Now, it’s $300.

“That a real barrier for anyone who needs health care over a weekend in rural areas,” he said. “There are no urgent care centers in Allagash, and the ER in Fort Kent is the only place to go.”

The commission legislation currently exists only in draft form, LR 2890. It will be formally introduced later and scheduled for a public hearing before the Health Coverage Committee.

Sen. Geoff Gratwick, D-Bangor, a physician who serves on the committee, said from what he’s seen the commission’s proposed membership may not produce the “outside-the-box” thinking he believes is necessary.

“Expecting the people in the Executive Branch who are now administering the program to change the program may not work,” Gratwick said.

Previous legislative study committees have shown that Maine has “very bright, very good, very knowledgeable” experts who can provide workable new ideas, he said. Lawmakers should listen to them, “otherwise, we risk perpetuating all the problems of our current system.” 

While time is short before adjournment in April, Jackson said it’s vital to put a commission in place now. “We can set it up, identify funding, and put it to work,” he said. “We can’t afford not to.”

Douglas Rooks has covered Maine issues for 35 years as a reporter, editorial writer, columnist and former editor of Maine Times.