Appropriations Committee Agrees Unanimously to Final Hospital Payment Plan, Refinancing Liquor Contract

Posted on June 11, 2013. Filed under: Uncategorized | Tags: , , , , , |

Appropriations and Financial Affairs Committee members hard at work in May.

Appropriations and Financial Affairs Committee members hard at work in May.

After Governor LePage on May 24 publicly vetoed LD 1546, which had provisions for expanding Medicaid, refinancing the liquor contract and paying the last payment on the hospital debt (that the Democrats have been paying down since 2006 under former Governor John Baldacci), it was back to square one for the three issues.

The first, LD 1066 “An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding” has now passed the Senate as amended and is working its way to the House, with expectations that it will be debated later this week- if not tomorrow.

That left the hospital debt and the liquor contract, in the form of Governor LePage’s bill LD 1555 “An Act To Strengthen Maine’s Hospitals and To Provide for a New Spirits Contract” as its own stand alone bill (it was referred to Appropriations and Financial Affairs committee on May 31).

tv hall of flagsSince then, the Governor has been impatiently tapping his toe, waiting and waiting and WAITING in frustration for his bill to come up for a vote in the Legislature.

To alleviate his boredom, LePage even went to Best Buy and got himself a new entertainment center on the taxpayers. The day after the bill was referred to AFA, the Governor in his weekly radio address demanded that Democrats “stop their deceitful gamesmanship”.

It needs to be noted that this statement by LePage was released to media on the same day as the committee was assigned the bill, with the Governor’s address embargoed until the following day, Saturday June 1- when the Legislature was not in session.

Who’s zooming who, Governor??

Earlier this afternoon, his office decided to nag a bit more with a late press release that read in part:

lepage head 2Governor Paul R. LePage today reminded Mainers that the hospitals still haven’t been paid.

    “It’s been 150 days and counting,” said Governor LePage. “How much longer must the hospitals wait? It is time to end the political games and get our hospitals paid. Democratic leadership has not allowed an up-or-down vote on my plan. Let’s get that vote, let’s get the hospitals paid, and let’s get our fiscal house in order so I can release job-creating bonds before the entire construction season ends this summer.”

    House Republican leaders Tuesday joined Governor LePage calling on Democratic leadership to bring forward the bipartisan measure to pay off Maine’s hospital bills without delay.

Within an hour of the Governor’s latest missive came word that the Appropriations Committee has unanimously passed an agreement on LD 1555. Here is part of their press release:

    Lawmakers on the State Legislature’s Appropriations and Financial Affairs Committee on Tuesday afternoon unanimously approved a measure to make a final payment on Maine’s hospital debt and refinance the state’s liquor contract.

    dawn hill“Today we are one step closer to another attempt at paying back the hospitals,” said Senator Dawn Hill, D-York, the Senate Chair of the Appropriations Committee. Recently, the governor vetoed our last effort. We all agree that we need to make the final payment to our hospitals, and it’s important we make the payment in a timely manner.”

    The bill is the second measure passed this session to make a final payment on Maine’s hospital debt. Governor Paul LePage vetoed the first, LD 1546, last month. This bill makes the final payment to Maine hospitals totaling $485 million in state and federal dollars. By paying the hospitals prior to October 1, 2013, the state will save $5 million. The payment would trigger a federal match of $298 million, completing final payment to Maine’s hospitals.

    peggy rotundo“This final payment closes a decade long chapter of repaying our debt to Maine’s hospitals,” said Rep. Peggy Rotundo, D-Lewiston, the House Chair of the Appropriations Committee. “Our hospitals are key to the health of our community and this final payment makes good on the lifesaving work that our nurses and doctors do for Maine families.”

One wonders how the Governor will react to getting his way… as well as the Republicans that supposedly continue to support him.

Will we see a continuation of “Chain of Fools” or will someone from his party finally get through about the value of “R-E-S-P-E-C-T”?

Stay tuned…

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ICYMI: Maine Speaker of the House Mark Eves Urges Passage of Medicaid Expansion Bill LD 1546 (Video; Text)

Posted on May 28, 2013. Filed under: Uncategorized | Tags: , , , , , , , , , , , , |

(On Wednesday (5/29/13), the House is expected to take up LD 1546 again in an evening session. Here again is the floor speech of Speaker of the House Mark Eves (D-N Berwick), urging his colleagues in the House join him in supporting this important bill. ~AP)

(Over 50 clips of individual House members rose to deliver testimony both in support and in opposition last night, as the bill LD1546, “An Act To Strengthen Maine’s Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract” got its first reading and roll call votes in the House. More to follow. ~AP)

Below is the full text of Speaker Eves’ remarks as prepared and released to media. Note: House Majority Leader Seth Berry (D- Bowdoinham) served as Speaker Pro Tempore. Video link here.

    “Thank you Mr. Speaker pro-tem.

    Ladies and gentlemen of the House, I rise this evening to speak to an issue of great importance to me, and to the people of the state of Maine.

    Speaker of the House Mark Eves gives a rare speech from the floor, urgung members to join him in support of LD 1546, "An Act To Strengthen Maine's Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract"

    Speaker of the House Mark Eves gives a rare speech from the floor, urgung members to join him in support of LD 1546, “An Act To Strengthen Maine’s Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract”

    I rise to speak in favor of the pending motion to accept the majority ought to pass as amended report, and by doing so, accept a comprehensive measure that would make a final payment on Maine’s hospital debt and reduce future hospital costs by accepting federal health care dollars to cover tens of thousands of Mainers.

    Today lawmakers have an opportunity to pay back the debt owed to our hospitals and contain the rising costs of health care for our people and our hospitals.


    We have an opportunity together to do three things in one bill:

    Help our hospitals, help working Mainers who need health care, and help our economy.

    For 4 years, I served on the Health and Human Services Committee where we would consistently hear about the amount of charity care and bad debt the hospitals absorbed and then shifted onto working families with insurance and onto Maine businesses.

    When people without insurance get sick, they often end up getting care in the emergency room — where it is the most costly, least efficient way of providing care. Just last year, the Maine Hospital Association reported that Maine hospitals provided $450 million dollars in charity care and bad debt.


    The hospitals can not afford this and neither can we!

    In the proposal before us, not only do we pay back our hospitals, but we also ensure that thousands of Mainers can see a doctor when they are sick. By doing so, we reduce the charity care costs and bad debt that are cost drivers for our hospitals. This is a win for our hospitals and for every family in Maine who has insurance today.

    For several months, we’ve talked about the nearly 70,000 Mainers, many of them who are working but can’t afford health insurance, who would be eligible for coverage under this legislation.

    The number is so large and has been repeated so often, it’s easy to forget what it actually means.

    We could cut the number of people in Maine without health insurance in half.

    Seventy thousand people: That’s equivalent to the population of Aroostook County. Or Somerset and Piscatiquis counties together.

    The county by county numbers are compelling.

    Residents and hospitals in Maine’s most rural counties have the most to gain.

    · In Washington: 2,601 people would gain health care;$9.3 million in economic activity

    · In Somerset: 3,590 people would gain health care; $12.9 million in economic activity

    · In Waldo: 2,629 people would gain health care; $9.7 million in economic activity

    · In Oxford: 3,806 people would gain health care; 13.7 million in economic activity

    · In Aroostook: 4,615 people would gain health care; 16.8 million in economic activity

    · In Piscataquis: 1,067 people would gain health care; $4.0 million in economic activity

    · In Franklin: 1,878 people would gain health care; $6.9 million in economic activity

    · In Knox: 2,317 people would gain health care; $8.6 million in economic activity

    · In Hancock: 3,235 people would gain health care; $12.9 million in economic activity

    · In Lincoln: 1,817 people would gain health care; $6.6 million in economic activity

    · In Androscoggin: 5,829 people would gain health care; $20 million in economic activity

    · In Penobscot: 8,447 people would gain health care; $31.6 million in economic activity

    · In Kennebec: 5,997 people would gain health care; $20.8 million in economic activity

    · In Sagadahoc: 1,456 people would gain health care; $5.3 million in economic activity

    · In Cumberland: 12,018 would gain health care; $46.6 million in economic activity

    · In York: 8,196 would gain health care; $29.7 million in economic activity

    Now think of one of those 70,000 Mainers. Take Marie from Bangor. She has a part-time job that doesn’t provide health insurance. She also has a serious heart condition that doesn’t allow her to work full time. Without health insurance for her or her family, she is forced to choose between putting gas in her car and paying her medical and utility bills.

    This is not a hypothetical scenario. They are the hard facts for too many Mainers. And THIS is an ethical and moral dilemma for all of us.

    Unfortunately, Marie is one of tens of thousands of Mainers – many of your constituents – who are unable to afford health insurance.

    The personal stakes are high for thousands of people who could receive life-saving access to health care. But there is also a tremendous opportunity for our entire state.

    The Maine health care economy is the largest single job provider in the state of Maine. Healthcare jobs account for 1 in 4 jobs in Maine. By accepting these federal health care dollars we will inject $250 million dollars into our health care economy, creating more than 3,000 jobs.

    It is estimated that Maine hospitals would receive $163 million each year in additional revenue if we were to accept the federal dollars. This will help alleviate the current burden hospitals are facing and make sure we prevent future debt from accumulating so that we avoid a situation like this in the future.

    Maine’s hospital debt is a symptom of our high health care costs.

    This comprehensive measure pays the debt and helps fix the underlying problem that contributes to high health care costs in the first place. We don’t just treat the symptom; we treat the problem.

    The federal government has agreed to fully cover the cost for health care for tens of thousands of Mainers for the next three years, and gradually lowers its payment to no less than 90 percent of the cost over a decade. There is no cost to the state — in fact, we will save money.

    Maine is projected to save $690 million in the next 10 years if we accept the federal dollars, according to the nonpartisan Kaiser Foundation. These numbers are also confirmed by the conservative Heritage Foundation.

    We are one of 10 states that will actually see our Medicaid expenditures go down!

    If we want to save money in our Medicaid account, which I believe we all do, we must accept these federal health care dollars.

    This could change the lives of tens of thousands of Maine people who fear getting sick because they can’t afford to see a doctor when they need it most.

    Accepting these federal funds to increase health care coverage for more working Mainers is morally and economically the right thing to. And it makes sense to do it as part of a comprehensive package that repays Maine’s hospital debt. It both addresses the costs of health care for our hospitals and our people. To do one without the other, would leave the job half done.

    It’s a good deal. One we cannot walk away from!

    That’s why Republican governors across the country have sized up the proposal and have decided to accept the funds.

    Republican Governor Jan Brewer of Arizona has said turning away federal Medicaid dollars would increase human suffering and further cripple hospitals and other health care providers that care for the uninsured.

    Gov. Brewer recently said, “Being governor is tough — you have to make tough decisions and you have to look at the whole state, you have to do what’s right. Without expansion, “we would’ve had to go in and get people off of Medicaid, they would still be in our hospitals, you would still be paying for them.”

    Gov. Brewer’s bill to accept these federal dollars is accurately called the Arizona Health Care Cost Containment Measure. Gov. Brewer gets it!

    In New Jersey, Republican Governor Chris Christie has made a similar case:

    He said in a speech before the legislature unveiling his budget. “It’s simple. We are putting people first.”

    “Expanding Medicaid is the smart thing to do for our fiscal and public health” and will “ensure New Jersey taxpayers will see their dollars maximized.”

    Gov. Christie gets it!

    This should not be a political issue. We all agree we should pay the hospitals.

    But we are at an impasse over health care for tens of thousands of Maine people.

    The members of this body have a choice to make. Will you support a plan that pays the hospitals and accepts federal health care dollars to cover more Mainers? Or will you chose to deny and delay health care for tens of thousands of Maine people — putting politics ahead of the people’s health and our hospitals?

    I urge you to see this for what it is — a compromise that would benefit the state as a whole.

    This is how state government should function.

    In a divided government, neither party can get anything done by demanding all or nothing.

    I urge you to join me in supporting the pending motion. Now is the time to act.

    Thank you.”

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Maine Senate Republicans Floor Speeches Opposing LD 1546: “Washington Politics” and Mixed Messaging on Medicaid Expansion

Posted on May 26, 2013. Filed under: Uncategorized | Tags: , , , , , , |

(UPDATED: Links to more GOP floor speeches from the follow day’s second reading in the Senate are now found at the bottom of this original post. ~AP)

lepage veto 1546Originally, the intention was to simply share the various clips taken of the LD 1546, “An Act To Strengthen Maine’s Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract” floor debates in the Senate and House as stand-alone posts without comment. Then a funny thing happened: in reviewing them, a clear separation of messaging became apparent between the members of the GOP in the Senate and the Governor’s “Office Du Jour” (see: Washington Post, Huffington Post, Talking Points Memo).

So, let’s take a look.

First Reading in the Senate, 5/20/13

Consistent GOP themes: LD 1546 is “Washington Politics”, “Welfare expansion”, myriad concerns over costs and having to hire either 83 new people (per Senator Mason) or 93 new people (per Senator Thibodeau) and general distrust of the federal government.

(Side note: If a business were to open in their district with 83-93 new jobs, Mason and Thibodeau would loudly cheer and claim “this was proof that Governor LePage’s policies work to help business.” Sigh…)

In short, everything Maine rejected from this party in the November election results.

So let’s go to the clips:

1. Senator Garrett Mason (Androscoggin)

    (:36) “… back room, Pelosi-style, Washington politics on full display, in the State House.”
    (:50) “… LD 1066, (“An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding”)is a massive welfare expansion that will cost Maine untold millions of dollars, not only over the next year, but over the life of the program.”
    (2:20) “… welfare expansion
    (2:47) “… So, what is this bill? Well, it’s a massive welfare expansion, to seventy thousand people…”

Perhaps some of the greater moments of irony came at the 1:20 mark, when Senator Mason claimed that the bill’s creation and process was “rude and disrespectful” of the VLA Committee and then further comments (2:00) that LD 1546 “was ram-rodded through”.

Um… anyone else remember LD 1333/ PL 90 from the 125th Legislative session? When Republicans openly admitted that they had not even read the bill? The bill that really WAS “ramrodded through”?

Republicans also claimed that it would pay for Maine’s 133,000 uninsured citizens and lower insurance costs. Um- not so much.

Onward.

2. Assistant Minority Leader Senator Roger Katz (Kennebec), Part 1

    “Linking these two bills together that have nothing to do with one another is just what people complain about when they see it happening in Washington. Unfortunately, that kind of strong-arm politics has migrated north.

    Governor LePage is in the middle of negotiations with the federal government to try to get us a better deal on Medicaid expansion. Maybe he will be successful and maybe he won’t. But if he is, that could save the state tens of millions of dollars. If we say yes to Medicaid expansion now, we lose our negotiating leverage.”

An ongoing “negotiation” since last July that has gotten Maine nowhere… nor this past March, when the Governor demanded a ten year waiver rather than three- something no other state has been granted by the federal government. In fact, Maine is no closer that it was in February 2012. Not exactly working to close the deal but rather putting off as long as he can.

Again- onward.

3. Senator James Hamper (Oxford)

Summary: Senator Hamper is concerned with the costs, especially in light of the reported DHHS shortfalls, inabilities to pay their bills past June 12th and budget projections for FY 14-15. Yet he urges that Maine not “rush through” with Medicaid expansion. Shame that the Governor thinks that “The Administration has not been entertained”and is now putting an unilateral gag order onto any within his administration that would go before the Appropriations committee to speak regarding the proposed budget and that he and he alone will be the one to speak to the committee.

    (5:48) “Slow down.
    (6:00)“We’re saying, ‘Don’t play Washington politics‘…”

As Hamper concluded: “Fool me twice… shame on me.

Indeed.

4. Senator Doug Thomas (Somerset)

“Charlie Brown’s football being hauled away by Lucy”. Um, okay. Not even gonna touch this one.

5. Senator Brian Langley (Hancock)

Now here is where it gets interesting- until this point, all of the GOP lawmakers have been on the same page of “Washington politics” and together poo-pooed the idea of expanding Medicaid at all. But at the 0:45 mark, we hear this from Senator Langley, who urges the bill be separated, rather than simply voted down- a far different position than all of the other Republicans that have spoken before him:

    “… because I am not opposed to it. What I am opposed to is the way it is being done here today.”

Interesting… and contrary to what Governor LePage said when he vetoed LD 1546.

    “Democrat leadership has spent the past week forcing this bill through the legislative process, over the objections of Republicans and Democrats alike. This unadulterated partisanship tied two different issues together in a quest to force welfare expansion upon the Maine people. I have said all along this bill would receive a veto when it reached my desk, so this letter should be no surprise.

    That is why I have filed a Governor’s bill today reflecting the parts of LD 1546 we all agree on—paying the hospitals and ensuring the liquor business provides the best return for the state—without the forced expansion of MaineCare. The Legislature will have the opportunity to vote up or down to pay the hospitals—I trust you will do the right thing.”

6. Minority Leader Senator Mike Thibodeau (Waldo)

Assistant Minority Leader Thibodeau, same as Rep. Ken Fredette would do later in the House, attempts to delay the vote with a series of procedural questions regarding the bill’s formation and combining of separate elements. Senate President, as Speaker of the House Eves would also do later in the session the next evening, explained his ruling. Thibodeau then speaks, first complaining on timelines elapsing in what he feels is a premature time frame, and then referring to items that the Democrats claimed were ramrodded through in the 125th Legislature.

He then quoted this PPH article penned by Maine Hospital Association president Steve Michaud:


    “Medicaid expansion is a centerpiece of the federal Affordable Care Act. While hospitals support the Medicaid expansion, we vehemently disagree that the expansion should be tied in any way to whether or not the outstanding bills get paid. Hospitals don’t control whether MaineCare gets expanded; they shouldn’t be punished if the expansion fails.”

What he failed to read was the following paragraph by Michaud:

    “This kind of leveraging of one issue versus another issue is bad policymaking. It is a common tactic in Washington, D.C., and one of the hallmarks of its dysfunction.”

And at the 5:10 mark, Thibodeau echos the phrase “Washington style politics”.

Wait, five “Washingtons”? BINGO!!

Oh wait… one of them was from the PPH article. Maybe we’ll get lucky with the next speaker.

7. Assistant Minority Leader Senator Roger Katz (Kennebec), Part 2

We already got Senator Katz down for a “Washington” mention. But we can add the good Senator from Kennebec as now a second supporter of Medicaid expansion! Note the 2:25 mark:

    “Personally speaking for myself, I have an open mind on the expansion.”

Moving along.

8. Senator Pat Flood (Kennebec)

Well, well! Add another senator who thinks (0:40) that expanding Medicaid is a good thing! His issues are similar to Senator Langley’s in that he would prefer the bills be examined and worked upon separately.

9. Senator David Burns (Washington)

(2:10)

    “Don’t be guilty of Washington politics.”

We even get a bonus, just to be sure (2:20)!

    “…don’t get caught up in the process of Washingtonian politics.”

Okay, there it is. BINGO!

Second Day Floor Speeches

1. Senator Pat Flood (Kennebec)

2. Senator Garrett Mason (Androscoggin), Part 1

3. Senator Garrett Mason (Androscoggin), Part 2

4. Asst Minority Leader Senator Roger Katz (Kennebec) Part 1

5. Senator Garrett Mason (Androscoggin) Part 3

6. Senator Andre Cushing (Penobscot)

7. Asst Minority Leader Senator Roger Katz (Kennebec) Part 2

8. Minority Leader Senator Mike Thibodeau (Waldo)

9. Senator Doug Thomas (Somerset)

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Maine Governor Paul LePage Vetoes LD 1546, Medicaid Expansion Bill (Video)

Posted on May 24, 2013. Filed under: Uncategorized | Tags: , , , , , , , , |

At a Hall of Flags ceremony surrounded by GOP legislators, Governor LePage on Thursday signed the letter to veto LD 1546, characterizing LD 1546, “An Act to Strengthen Maine Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract,” as “tied payment of the hospital debt to welfare expansion” and then announced plans to reintroduce his own bill in its place.

    “Democrat leadership has spent the past week forcing this bill through the legislative process, over the objections of Republicans and Democrats alike. This unadulterated partisanship tied two different issues together in a quest to force welfare expansion upon the Maine people. I have said all along this bill would receive a veto when it reached my desk, so this letter should be no surprise.

    That is why I have filed a Governor’s bill today reflecting the parts of LD 1546 we all agree on—paying the hospitals and ensuring the liquor business provides the best return for the state—without the forced expansion of MaineCare. The Legislature will have the opportunity to vote up or down to pay the hospitals—I trust you will do the right thing.”

Press secretary Adrienne Bennett provided copies to the press of the letter the Governor read.

lepage veto lettr

The governor then informed those assembled of his plans to continue to hold the voter-approved bonds hostage unless his bill is passed through the Legislature, in what a press release categorized “a gesture of good faith”:

    The Governor also directed the State Treasurer to prepare the voter-authorized bonds for his signature. “I will sign them as soon as this new Governor’s Bill is enacted,” the Governor stated.
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Maine State Reps Sirocki (R-Scarborough), Malaby (R- Hancock) LD 1546 Opposition Speeches (Video; Text)

Posted on May 24, 2013. Filed under: Uncategorized | Tags: , , , , , , , |

(NOTE: Representative Heather Sirocki (R-Scarborough shared the texts of these prepared speeches last night on my personal FB wall; sharing here with the videos taken from the floor of the House. ~AP)

FLOOR SPEECH OF REP. HEATHER SIROCKI (R-SCARBOROUGH) (VIDEO)

    Mr Speaker, Ladies and Gentlemen of the House,

    I rise in strong opposition of the pending measure.

    Some may feel that combining bills from different committees is an efficient way to move forward, but the People of Maine are ill-served by considering legislation without input from the public.

    The question was posed, “ Is this bill properly before the body?”

    We were told that a public hearing was held. But I checked online, and found that no public hearings were scheduled.

    Before casting votes, most of us listen to testimony, read and research the issue, and consider the views of our constituents. I do not like being asked to pass bills first before I find out what is in them.

    LD 1546, the bill before us, did not follow the usual path of thoughtful consideration.

    The process of working this bill has been violated at its most basic level…two bills combined into one that did not receive any input from the public. As a matter of fact, there is not one piece of public testimony posted for this particular bill. Not one.

    There are, however, 69 documents of public testimony on the Medicaid expansion bill. But the Health and Human Services Committee is the only committee to have heard from the public regarding the expansion of Medicaid.

    I am very uncomfortable knowing that the sitting members of the Veterans and Legal Affairs committee, the committee of jurisdiction for this bill, have not had the opportunity to seek public input on this very important portion of LD 1546.

    Mr Speaker… How can we vote to move this bill forward when the process has been violated in this manner?

    Ramming a bill through a committee where the members did not have the opportunity to even read about the details, and where they did not hear even ONE minute of public testimony, is wrong.

    This violation of the process at the committee level is unacceptable.

    Regarding other reasons to vote No on this bill, let’s start with fiscal irresponsibility.

    Negotiating the liquor contract is time sensitive. If we miss the deadline, it will cost Maine’s hardworking taxpayers an additional $5 million. The clock is ticking.

    If we had paid our hospitals as the debt accrued, we would have been able to take advantage of a higher federal dollar match rate.

    My back-of-the- napkin calculations show that this delay has already cost us tens of millions of dollars.

    Thus, if we miss this deadline, that number bumps an additional $5 million.

    Let me repeat – tens of million dollars.

    Money that we could have spent towards services for … perhaps… disabled individuals who have been placed on waitlists.

    Mr. Speaker you are correct this is a moral and ethical issue.

    Mr. Speaker, I implore this body to recognize that the expansion of Medicaid is a separate bill with a separate timeline. Currently, that bill sits on the table in my committee- the Health and Human Services committee. The expansion should not be rushed. As a matter of fact, it is in Maine’s best interests to take our time, because rushing the expansion, may in fact, cost us more money, potentially, a lot more money. An audit is currently underway and is expected to be complete within a month. We do not have firm promises from the federal commission of health and human services yet.

    I urge each member of this body to think carefully before voting today.

    Please recognize that LD 1546 should go back to its roots. We need to bifurcate LD 1546. These are two separate bills, the one that was assigned to the Veterans and Legal Affairs Committee and the other bill to consider expanding Medicaid, which still sits on the table over in the Health and Human Services committee, where it rightfully belongs.

    For these reasons I cannot support LD 1546.

    We need to pay our hospitals now.

    We need to take our time negotiating with the federal government on further expansion of Medicaid.

    Two separate bills.

    Two separate time lines.

    Two separate votes.

    Thank you.

FLOOR SPEECH OF REP. RICHARD MALABY (R-HANCOCK) (VIDEO)

    Mr. Speaker, Ladies and gentleman of the House, I rise in opposition to the pending motion.

    As a member of the Joint Standing Committee on Health and Human Services, I would love to see that everyone in Maine with an Income below 138% of the Federal Poverty Level has true health insurance. It would likely save money for our health care providers and would hopefully improve health care outcomes. Who could not vote for that?

    Unfortunately that is NOT what we are voting on. The Medicaid Expansion under the Affordable Care Act is neither Health Insurance nor is it fiscally responsible for the state of Maine.

    Medicaid and our healthcare delivery system are clearly broken. And more of the same won’t fix it. Expanding Medicaid is the wrong prescription for a broken system and a faulty diagnosis invariably leads to the wrong treatment. Medicaid needs to be reformed prior to any expansion. We need to design a system that aligns consumer actions with societal goals while decreasing costs……… increasing access ……..and promoting quality. The bill before us will increase access at the expense of increasing costs and will do nothing to promote overall quality.

    I would gladly vote to reform Medicaid, a program designed in 1965 and rife with perverse incentives both for the consumers and the providers! I just can’t see how burdening the people of the state of Maine with hundreds of Millions of dollars of ongoing and future expenses for a program with no demonstrated efficacy in terms of health care outcomes is going to help anyone. At its very heart Medicaid encourages people to over consume and undervalue health care. With no copay or premium for health care in a system with unknown prices or information about quality is it any wonder that health care costs keep rising out of control? And isn’t that our real problem?

    Likewise Medicaid encourages providers to overbill for services. If patients are not paying for the health care services they receive, then they are unlikely to shop for quality and value. Consequently providers whether hospitals or doctors have no incentives to keep prices low in order to compete-as in any other market place- and hence the provider is incented to maximize their revenue and income based on the reimbursement model. Isn’t that why we owe our hospitals $484 Million for 2009 and 2010? And why is is that this bill requests $490.2 Million dollars when we owe the hospitals $484 Million? Is it the intent of the sponsors to repay the debt after October 1, thereby receiving $5 million less in FMAP match? Is that not irresponsible?

    The previous Medicaid expansions in which eligibility had been increased and optional services added currently costs the state of Maine $177 Million annually in General Fund dollars. Those who urged the past expansion of Medicaid promised it would reduce the number of the uninsured, reduce charity care, lower ER usage and have low and predictable costs. In reality health care costs have grown 4 times the rate of inflation, enrollment has exploded, there has been a gigantic increase in charity care and programs are now “capped” as the state has no money to pay for those seeking services. The state has even started to tax hospitals and nursing homes in pursuit of those federal dollars. I find that incredibly shameful.

    I support paying our hospitals that which we owe them. The state made a deal and the hospitals have lived up to their end of that bargain. I would support a true health insurance program for our low income population, but insurance is something you buy in a competitive market place where prices are known and competition is real and buyers shop based on value and price. I can’t support the poorly conceived expansion of Medicaid now being urged by so many. Expanding a financially failed program simply does not make sense.

    The hard working Maine taxpayers understand that we need to control spending. It is our job as legislators to prioritize our spending needs. What about all those people we currently have on waitlists for services who legally and morally deserve those services? The expansion will not address their needs. I am embarrassed by our inability to take care of the truly needy. Prioritizing spending during tough economic times requires leadership. For too long we have taken the easy way out by saying yes to more and more federal dollars. This has resulted in a never ending cycle of growing waitlists for our disabled population, increased pressure to repeatedly raise taxes, ongoing and annual supplemental budgets and crowding out of the true investments the state should be making. It is time to say no.

    Thank you Mr Speaker.

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Maine Senate Passes Historic Medicare Expansion, Hospital Repayment Bill LD 1546 Along Party Lines

Posted on May 21, 2013. Filed under: Uncategorized | Tags: , , , , , , |

Yesterday in a 20-15 vote, the Senate passed an historic measure to repay Maine’s hospital debt and accept federal funds to expand healthcare coverage for nearly 70,000 Mainers.

As passed, the bill (LD 1546) also makes the final payment to Maine hospitals, totaling $485 million in state and federal dollars. Maine hospitals will also receive an additional $163 million a year in federal dollars for treating newly insured Maine residents if Maine accepts the federal health care dollars.

100_5426Nearly 70,000 Maine people can receive healthcare coverage as soon as Maine accepts the federal government’s offer. The federal government has agreed to pay 100% of the cost for covering all newly eligible people for the first three years and then gradually lowering its payment to no less than 90 percent of the cost by 2020. Maine is projected to save $690 million in the next 10 years when it accepts the federal dollars, according to the nonpartisan Kaiser Foundation and the conservative Heritage Foundation. Maine is also one of 10 states that will see Medicaid expenditures go down over the next 10 years. Nearly 70 percent of Maine people support accepting federal health care dollars to increase access to health care, according to the nonpartisan Maine People’s Resource Center.

According to the Maine Hospital Association, both bad debt and charity care cost $450 million last year, an increase of $32 million from the previous year. Insuring nearly 70,000 Mainers will reduce hospital charity care and bad debt costs. The Maine Hospital Association has stated its support for paying back the hospitals and accepting federal health care dollars. According to the Maine Center for Economic Policy, accepting federal dollars would inject an additional $250 million of federal funding into Maine’s economy and create more than 3,100 jobs with more than 1,700 jobs in the healthcare industry alone.

During Monday’s debate, many Senators shared personal stories of people’s lives that will be impacted if the state accepts the federal government’s offer.

    “The time for delaying and denying healthcare to thousands of Maine people has passed. The time for action is now,” said Senator Margaret Craven of Lewiston. “Too many Mainers are one illness or accident away from financial ruin. It doesn’t have to be that way.”

    “Passing this bill is fiscally responsible, medically responsible, and morally responsible,” said Senator John Cleveland of Auburn. “The legislature can make that decision. We have it in our power to pay our debt to the hospitals and provide healthcare to the poorest in our communities.”

    Assistant Majority Leader Troy Jackson of Allagash spoke about two neighbors in his hometown who had health problems similar to his own. “Of the three of us, I was the only one with health insurance, I could afford to get the care I need, and I’m the only one who is alive. I can’t help thinking that’s the reason: I had health insurance. We should be throwing people like them a line, not pulling up the ladder behind us.”

    Senator Emily Cain of Orono reminded the body that, Fundraisers are not health care. People are not widgets. We must accept this offer.”

    “To be absolutely clear, medical insurance is not welfare. Medical insurance keeps people healthy. The patients who come to see me with insurance do much better than those without,” said Senator Geoff Gratwick of Bangor, who is also a practicing physician. “From my perspective as a physician, voting against this bill is a vote to cripple Maine, both literally and figuratively. Maine hospitals and Maine people both win with this bill. Maine’s hospital debt is a symptom of our high healthcare costs. Not only do we have to pay back our hospitals, but we have to address how we got here. By ensuring that thousands of Mainers can see a doctor when they are sick, we will keep the healthy at work. We will reduce the charity care costs and the debt our hospitals are accruing. To pay the hospitals without reducing their costs moving forward would leave the job half done.”

    “We are addressing the costs of health care for Maine people and hospitals,” said Senate Majority Leader Seth Goodall of Richmond. “What’s more, we’re doing it all in one fell swoop. That’s efficient. That’s good government. That’s what we were sent here to do.”

More clips in support of LD 1546 of Democratic Senators John Tuttle of Sanford, Chris Johnson of Somerville, John Patrick of Rumford (Part 1) (Part 2) and Independent Dick Woodbury of Freeport.

The bill, LD 1546, “An Act To Strengthen Maine’s Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract,” faces additional votes in the House and Senate.

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Senate Majority Leader Goodall Introduces LD 644, An Act to Strengthen Maine’s Wholesale Liquor Business (Video; Text)

Posted on March 12, 2013. Filed under: Uncategorized | Tags: , , , , , , |

Yesterday Senate Majority Leader Seth Goodall (D-Richmond) introduced before the Veterans and Legal Affairs Committee public hearing his bill, LD 644, “An Act to Strengthen Maine’s Wholesale Liquor Business”. The following summary of the bill was provided to media by the Senate Majority office.

    In addition to paying back the hospitals, the specifics of Senator Goodall’s liquor plan, LD 644, is as follows:
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  • It retains the business within the private sector–eliminating all financial risk to the state and without adding any additional costs to state government.
  • It stipulates a strict timeline for issuing the RFP, including an award date by July 15, 2013.
  • It mandates an open and transparent RFP bidding process to ensure the best value bidder is qualified with necessary financial, technical, management, operational, and marketing capacity.
  • It provides two options on how to bid: either through one upfront payment or multiple upfront payments but both with additional annual payments growing over the length of the ten year contract plus profit sharing with the state as the business grows. Specifically, the bidder could choose between an initial payment of $200 million to be paid no later than June 30, 2014 or payments totaling $200 million to be paid within the biennial budget with at least $100 million being paid before June 30, 2014.
  • The bill corrects the longstanding inequity with the state’s retail partner, the agency liquor stores, in terms of price and return of products. It will raise an additional $6.1 million for the state’s 480 liquor agents.
  • The bill prevents a disruption of service to the state, consumers and liquor stores if for some reason the state is unable to properly administer the RFP process by allowing the existing contract to be extended for one year for not less than $34 million.
  • The bill appropriates $100,000 annually to the Department of Substance Abuse to help reduce underage drinking by funding the Enforcing the Underage Drinking Laws Program.

Here is Senator Goodall’s testimony as prepared:

        Testimony of State Senator Seth Goodall

      LD 644 – An Act to Strengthen Maine’s Wholesale Liquor Business

    Chairman Tuttle, Chairman Luchini and members of the Joint Standing Committee on Veterans and Legal Affairs, I am State Senator Seth Goodall and I am here today to introduce LD 644 – An Act to Strengthen Maine’s Wholesale Liquor Business.

    Beginning today, your committee will consider two options for operating the State’s $400 million liquor business. Governor LePage has put forth his plan and I am now introducing mine. We may disagree on our approaches, but let me be very clear – I agree with the Governor, we must pay our bills and pay back our hospitals.

    IMG_2944I also agree with the Governor’s urgency. Now is the time to pay our hospitals and our liquor business provides us the funds to do just that. But we must get the liquor contract right. We cannot rush to judgment as was done in 2003. By getting the liquor contract right, we will ensure timely payment to our hospitals.

    Prior to 2003, the State operated the liquor business and by all accounts it was underperforming. The complaints about service, delivery, and product-selection were endless. When the contract went out to bid, the value of the business was not well known. It was negotiated under pressure to fill a budgetary hole and as a result we did not capture the appropriate value for our asset, an asset owned by the people of Maine.

    Since then, the business has significantly increased in value, the number of agency stores has nearly doubled and complaints are nearly non-existent. To be clear, as a Democrat, I believe strongly that there are many things that state government does better than the private sector, but in this instance, history proves otherwise.

    My proposal unequivocally keeps the management and operation of the state’s wholesale liquor business in the private sector, with the experts. It eliminates all financial risk for the taxpayer and incentivizes the private sector to partner with the state to grow the business.

    The Governor’s plan takes back operation of the liquor business, including the financial risk, while retaining the right to issue service contracts to administrate the business.

    The differences are stark, the goals are hopefully the same and it is now up to you to get the job done.

    The specifics of the proposal:

    First, it retains the business within the private sector, eliminating all financial risk to the state and without adding any additional costs or positions to state government by issuing a new RFP on a strict timeline to have a contract awarded by July 15, 2013 and as a result repaying the hospitals by September 30th of this year.

    Second, it mandates an open and transparent RFP bidding process that will ensure that the “best value” bidder is qualified with the necessary financial, technical, management, operational and marketing capacity, amongst other qualifications. The qualifications required ensure service optimization and provides security to the State and its taxpayers because they will know that their asset, a $400 million business, will be run with the experience and knowledge and the wherewithal to perform.

    This is a very common bidding process accepted by the business community. Today, my brother runs the company that he and I started as teenagers. When he goes out and bids on municipal snowplow contracts, towns have similar, rigorous requirements, in order to insure that the contractor can perform. In fact, they often require site visits to inspect his equipment and financial assurances to minimize risk. Trust me, he is not bidding on $400 million contracts, but I would hate to think that the bidding qualifications to plow snow would be more rigorous than those for our State wholesale liquor business.

    I have met all of the bidders that are public to date. In my opinion, they are all qualified to bid and run the business. They all know the value of the current business, almost all the data is public. And because of this pencils will be sharpened, bids should be close and as a result, the state will receive the right and best value for its business.

    Third, my proposal provides two options on how to bid, either through one upfront payment or multiple upfront payments, but both with additional annual payments growing over the length of the 10-year contract, along with sharing revenue with the State as the business grows.

    Specifically, my amendment allows a bidder to choose between an initial payment of either $200,000,000 to be paid no later than June 30, 2014; or payments totaling $200,000,000 to be paid no later than June 30, 2015 with $100,000,000 being paid before June 30, 2014. Bidders will still be required to specify the amount of the guaranteed fixed annual payment, the formula for sharing revenue with the State during the life of the contract and the minimum profit margin the entity would need to be guaranteed to make its bid feasible.

    Fourth, and much to misunderstanding of many, this proposal allows prices to be lowered in order to compete with New Hampshire, but they must be lowered with respect to structure of the contract awarded to the private business. Maine is a control state. We set the prices. We should not be allowed to lower prices below a level that undermines the terms of the deal for which we just signed on the dotted line.

    Fifth, this bill corrects the longstanding inequity with our retail partners – the agency liquor stores both in terms of price and return of products. For too many years, agency liquor stores have received an inequitable return for their role as our partner. Floor space in stores is valuable, return on investment is important. Just like with lottery sales, our partners do not receive fair compensation and in turn the system lacks the proper incentive to help our overall business grow. And my bill makes this much needed course correction.

    My proposal will raise an additional $6.1 million for our 480 liquor agents. It is not a promise, nor a commitment to fix in rule making. It will be the law. If adopted, it is a statutory and immediate legal commitment of the State. The Governor’s proposal guarantees no return but his administration promises to address it through rule making. I have served on this committee before; I have heard the requests from agents for too long. I have visited their stores. It is time to fix this inequity and we shouldn’t trust rulemaking to get it right, now is the time.

    Sixth, this bill creates a contingency for our State, liquor stores and consumers. Too often our State has failed at properly administering RFP processes and as a result potentially jeopardized service and millions of dollars, as is currently the case with the lottery services contract which is costing the state millions and millions due to the challenges. If the State is unable to get a new contract in place by July 1, 2014 then after a public hearing the existing contract may only be extended for one year and only after they have received a value of not less than $34 million. A newspaper recently called this “scary,” I call it prudent planning.

    Seventh, my bill as amended appropriates $100,000 annually to the Department of Substance Abuse to help reduce underage drinking by funding the Enforcing the Underage Drinking Laws Program (EUDL). This program will provide grants to agencies to lower underage drinking and increase enforcement to help eliminate the sale of alcohol to minors. I did not include language in my bill to further address enforcement; however, this committee needs to take this issue on and now is the time, and that also applies to tackling substance abuse.

    The sale of liquor and substance abuse are directly connected and as a control state we must also acknowledge the impacts pricing may have on consumption. In fact, our Director, Gerry Reid, acknowledged this fact in a recent presentation before you, and I quote: “control jurisdictions are able to serve their citizens with a broader and more flexible range of policy options for promoting moderation in the consumption of alcohol beverages and minimizing incentives for predatory pricing that can, and have led to alcohol abuse.”

    Lastly, we must use the upfront revenue we receive from the liquor contract to repay the hospitals. If you as a committee and we as a Legislature do this right, our outstanding bills to Maine’s hospitals will be repaid by September 30th of this year, under the watch of this Legislature and this Governor. Now is the time.

    We must put this debt behind us, so that we can work together with the hospitals on reform focused on improving and lower the cost of health care for our citizens.

    This proposal guarantees payment to the hospitals without borrowing debt to pay off another debt, it avoids any constitutional uncertainty, it makes payment no later than September 30th this year and, as a result saves the state $5 million.

    It is a straightforward plan with zero risk to the taxpayer, no borrowing from Wall Street. It is fiscally responsible and a sure way to pay back the hospitals.

    The Governor’s plan is risky, constitutional questions remain unanswered, there is no timeline and it costs nearly $45 million more than our plan as a result of interest and fees for borrowing and not paying off the debt before October 1st of this year.

    The proposal that I am proposing today gets the job done without question and with certainty.

    Lastly, I would encourage this committee to think long and hard about funding other priorities in this state with the annual payments that will still be available after any upfront payment. I support Senator Flood’s long-term efforts to fund water and sewer and roads and bridges. I personally believe that these need to be funded. But we also have to consider other priorities such as education and health care. After we pay the hospitals, I believe we have the opportunity to support Senator Flood’s efforts, along with making investments in education and health care.

    This opportunity comes around once every ten years and we must get the liquor contract right so that we can pay and make investments in our future. This isn’t about one party or one campaign, it’s about getting it right and doing our job.

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LePage’s LD 239 “Act to Improve Return to State on Spirit Sales, Provide Source of Payment for Hospitals”

Posted on March 11, 2013. Filed under: Uncategorized | Tags: , , , , |

The text of the Governor’s prepared remarks:

IMG_2876

    Senator Tuttle, Representative Luchini and members of the Veterans and Legal Affairs Committee. We are all here today to address a vitally important matter for th State of Maine and its future.

    On January 15, I announced a plan, emergency legislation, that pays nearly half a billion dollars in unpaid bills to 39 Maine hospitals.

    Maine needs serious welfare reform so it can afford to pay for a quality safety net for our most needy. But that does not change the fact that the State owes $484 million on Maine’s hospitals- debt that dates back to 2009.

    Paying this bill is the right thing to do. It will place Maine in better financial standing and enable the State to invest in bonds for hundreds of projects across Maine.

    I recently discovered that Mainers’ earnings are lowest in New England. This income is a critical measurement of economic prosperity and demonstrates how Maine’s economy is doing.

    Maine is struggling right now and Mainers deserve someone to push this jobs bill forward.

    IMG_2879

    Our plan before you will create jobs in the health care and construction industries. I have letters from nearly every Maine hospital and the message is echoed:

  • Hospitals have been forced to lay off employees and keep positions vacant.
  • Hospitals have been forced to deplete savings and some have relied on lines of credit to pay their own bills.
  • Hospitals have delayed payment to local vendors impacting the financial status of of hundreds of small businesses in local communities.
  • The hospital debt has delayed construction projects which could create hundreds of critically important construction jobs for Maine’s economy.

    I have a plan that will pay back the hospitals, make the state’s liquor business more competitive with New Hampshire, and release millions to pay for clean water, transportation projects and start setting aside money for our depleted rainy day fund.

    Under my plan, about $700 million would surge into Maine’s economy- and it could happen by this spring’s construction season.

    I am not a fan of political games and the tactics used to derail this plan, which benefits not only hospital employees and construction workers, but also Maine consumers, small businesses and retailers, have frustrated me.

    So, yes, I am frustrated. And I am passionate about our state’s future. I know firsthand now tough it is to go without a job, how scary it is to live without a safety net and how chilling it is to pile up bills that cannot be paid. I don’t want any Mainer to have to suffer like that, and I don’t want my state to operate that way.

    IMG_2880I’ve dedicated my life to improving private-sector businesses, and I’ve spent years helping my fellow Mainers through public-sector service, which I consider a person’s highest calling.

    If we are going to have a prosperous state government and make it affordable and efficient for everyone, if we are going to manage our finances responsibly and run our state like a business so we can help all of our customers- our fellow Mainers- then we must make the tough choices. We must make the right decisions.

    We cannot play politics with people lives, and we cannot wait any longer.

    Thank you.

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