To say it’s been a wild ride for Jeanne Lambrew might be an understatement.
When Lambrew went to work as commissioner of the Maine Department of Health and Human Services in January 2019, her top priority was expanding MaineCare to cover tens of thousands of low-income families and individuals – a step that had been resisted by the previous administration for nearly six years.
“My first day in office, (Gov. Janet Mills) directed me and my department to expand Medicaid,” Lambrew recently recalled. There was no room for hesitation or doubt.
And in retrospect, that step was what made the difference between the scrambling every state endured while responding to the pandemic, and the chaos of the public health system Lambrew encountered after taking charge.
Lambrew shared her thoughts in her first extended interview with a Maine media outlet since she assumed the DHHS helm 2 1/2 years ago.
COVID-19 arrived just over a year after that “first day,” and the public health system has now been substantially, but not entirely, rebuilt. Implementing the Medicaid expansion and a companion health care reform bill rapidly wasn’t easy, Lambrew said: “That was a major challenge the state had, and it’s been a lifeline during the pandemic.”
Initial estimates pegged the likely signups at 45,000, but in the end, 80,000 Mainers signed up for coverage as unemployment soared and countless families lost access to private insurance. In all, Lambrew estimated, 100,000 Mainers have received new health services.
“There could not be a more important need,” she said. “Because we did it at the very beginning, it set us up for success.”
The expansion was a lifeline not only for health access but for the state budget. “We’re receiving 90 percent federal support,” Lambrew said. “Without it, that would have been uncompensated care,” burdening hospitals and other providers.
Coordination paid off
Given Maine’s enviable budget position today, it’s hard to recall the predictions that greeted the pandemic’s arrival.
“A survey by The Economist said Maine was the most vulnerable state,” Lambrew said, due to its aging population and dependence on tourism. “We’ve gone from the prospect of curtailment” – automatic budget cuts governors are empowered to make – “to a healthy budget surplus.”
Averting that outcome took a coordinated effort across departments. Early protective measures such as masks and physical distancing, and then an aggressive approach to vaccinations paid off. Maine has the nation’s fourth-lowest COVID-19 death rate and the third-highest percentage of vaccinated residents.
“In times of crisis, people put aside the fights and the politics for the greater good,” Lambrew said. “That’s not unique to the pandemic, but it shone through here. People were scared and confused. We were vigilant about keeping the appropriate science at the forefront, and we never sugar-coated things.”
That’s vital in convincing individuals to take recommended steps during a crisis, she said: “They felt they could trust the information we were providing. We could be flexible in our approach (as national guidelines changed).”
Focus on jails, prisoners
From early in the Mills administration, Lambrew formed a working group with the commissioners of Public Safety (Michael Sauschuck) and Corrections (Randy Liberty) focusing on the incarcerated or those at risk of being sent to jail.
“We’ve been at this from day one,” she said.
The behind-the-scenes work, Lambrew believes, is about to pay off. One of the facets of the just-signed supplemental budget is a Justice and Health Initiative, which focuses on the mental and behavioral health issues that can often land people in jail. It will set up mobile units that “allow us to move into the field as co-responders with law enforcement,” she said.
Overall, the new behavioral health budget will nearly double the available funding – what Lambrew called “significant money.” It will be administered by the bureau’s new director, Jessica Monahan Pollard, a licensed psychologist who Lambrew said is doing “amazing work.”
The pandemic has taken a big toll, and “it’s upsetting to see the statistics,” she said. Drug overdose deaths set a record in 2020, and are on pace to exceed it in the first half of 2021. But Lambrew thinks that trend can be turned around.
The availability of providers, however, still limits rapid expansion of treatment programs. “There was a serious shortage before the pandemic,” Lambrew said, “and it’s not a field a lot of people want to enter right now.”
Health care changes
Maine’s Medicaid program was drastically in need of an overhaul, and Lambrew pointed to signs of progress.
“It’s not acceptable that some providers were getting paid 30 percent of the Medicare rate, or that others hadn’t seen their reimbursement rate increased in 10 years,” she said. “We want to make this a viable, sustainable option for all providers.”
Reshaping the program will include expanded dental benefits for adults, now that lawmakers have agreed with the administration’s plan – a seemingly unattainable goal advocates had sought for 20 years.
What made the difference this time?
“It was an idea waiting for the right moment, and the moment happened to come,” Lambrew said, thanks to the large budget surplus.
She said she expects that preventive dental care will eventually pay for itself since the state already provides expensive emergency-only care. But its value goes beyond that.
“Poor dental health hurts people’s self-image,” Lambrew said. “It affects their prospects to get a job and live a fulfilling life.” She called the policy changes “a real win-win.”
So too with a special diabetes prevention program DHHS launched when the pandemic disrupted access to insulin treatments. Prevention saves money, and the program will likely be made permanent.
A rebuilt Public Health Nursing program – ordered by the Legislature in 2017 after the number of visiting nurses had fallen by half – has also aided the pandemic response.
And this fall, the state will launch its own Affordable Care Act health insurance exchange, replacing the federal model Maine has used since 2014. This will allow it, among other things, to tailor offerings to meet public health needs.
Children, families
A series of deaths of young children in June refocused attention on the Office of Child and Family Services. Lambrew commissioned a report from Casey Family Services to provide an independent assessment.
She doesn’t, however, favor a response several legislators have proposed: splitting off the programs into a separate department.
“The reality is that for every child who becomes involved, their parents have different service needs, from behavioral health to job support. We’re able to integrate that within the department,” Lambrew said. “By separating it, we’d make services less cohesive, and divert resources into the bureaucracy.”
The “wrap-around” services DHHS has been trying to build, she said she believes, would be disrupted by an abrupt change in structure.
‘A starter home’
Lambrew does look back, occasionally, on the foundation for health care she helped build while advising President Barack Obama.
Does she think the United States will ever achieve what some see as the holy grail, an integrated federal and state-directed system? Lambrew weighed her words for a moment.
“I believe we will have a universal, fair, affordable health care system,” she said. “Hopefully in my lifetime.”
She said it’s important to recognize that there are many paths to a national system, which she has written about extensively: “Some systems are fully public. Some are publicly financed and privately delivered. Some are privately financed. There is no one model.”
With that noted, she said, “I was humbled to work with President Obama on the Affordable Care Act, and we have made strides forward.” And echoing Obama, “This is a starter home. There’s plenty more to do.”
While the ACA has delivered insurance access to at least 30 million Americans, its success in moderating costs is less clear-cut.
“We did make progress, certainly, in the first five years,” Lambrew said. “But you have to keep working at it, doing it again and again. One of the most important things now is to make sure those gains aren’t lost.”
Douglas Rooks has been a Maine editor, commentator, reporter, and author since 1984. His latest book is “First Franco: Albert Beliveau in Law, Politics and Love.” Visit douglasrooks.weebly.com/#/ or e-mail [email protected].
From a health care family to caring about public policy
Jeanne Lambrew returned to Maine in 2019 to become commissioner of the Department of Health and Human Services – by far the largest state agency – after many years in Washington, D.C., and academia.
One of the first things she did was seek advice from her predecessors – “Everyone who took the time to meet with me,” she said. “It’s the only way you learn about something as big and complicated as DHHS.”
Asked about Kevin Concannon, commissioner during the Gov. Angus King administration who also headed human services departments in Oregon and Iowa, she said, “I knew Kevin growing up (in Cape Elizabeth). His brother was our parish priest.”
Their paths often crossed during the administration of President Barack Obama, when Lambrew was a key adviser to the president in implementing the Affordable Care Act and Concannon was an undersecretary in the Department of Agriculture.
“We were happy to cross paths,” she said.
Lambrew’s return to Maine was much heralded, and she wasn’t alone. Four other states, including Wisconsin and Michigan, have Obama administration alumni heading human services departments after working on the Affordable Care Act.
In keeping with her methodical approach, Lambrew then visited all 19 regional DHHS offices to learn from long-time employees. “Washington can be a very abstracted environment,” she said. “It’s important that you meet people on the front lines, where services are delivered every day.”
Previously, she served on President Bill Clinton’s health care team and then several budget and economic positions, before taking teaching positions at the Lyndon B. Johnson School of Public Affairs at the University of Texas and the George Washington University School of Public Health. Lambrew is a prolific writer for academic journals and has several books to her credit.
She came to Maine when she was 9 years old; her father was a cardiologist recruited to work at Maine Medical Center in Portland, while her mother was a registered nurse. Two aunts were also nurses, and an uncle was a dentist. She loved to sail on Casco Bay, but health care was in her blood.
By the time she attended college, however, Lambrew knew her path would be different.
“I made a conscious choice that my skills, which were often in research, and numbers, and idea development, might better be put to those ends of helping people through public policy rather than individual practice,” she said. “You can really make a difference at the aggregate level rather than the individual level.”
The trick, however, lies “in really understanding why you’re doing it, and what that means at the individual, family, and community levels,” she added.
Working as commissioner represents an ideal melding of the several sides of health care theory and practice, Lambrew said: “Maine is a relatively small state, and people feel connected. We get thousands of suggestions a month.”
After working through more than two tumultuous years, with the pandemic continuing, she was asked if there were days she’d prefer to be back in Washington.
She had a simple answer: “No.”
— Douglas Rooks
