Health and Healthcare Policy Articles

2018

How Well Is Maine Doing? Comparing Well-Being across Maine Counties

Author(s): Daley, Angela; Crawley, Andrew; Rahman, Muntasir; Demosthenes, Jake; Lyons, Erin

Maine Policy Review 27(2): 30-37

Maine has experienced major challenges over the last decade including recession, stagnant recovery, and industrial and population decline. But by some measures, Maine is still seen as one of the best in the United States for well-being. In this paper, we critique the notion of what well-being is and how it is measured. Based on the Organisation for Economic Co-operation and Development’s Better Life Initiative, we then propose and construct an index to compare well-being across Maine counties. Our work gives new insights on the types of challenges counties are facing and provides policymakers a new way of empirically understanding these problems.

Improving the Health of Communities through Population Health Assessments

Author(s): Deprez, Ron; Manchester, Chloe

Maine Policy Review 27(2): 51-59

This paper describes a comprehensive, science-based approach for conducting a popu­lation health assessment (PHA), a process for identifying upstream nonmedical, social and economic determinants of health in a community, including risk factors associated with poor health status. A PHA focuses on diagnosing and improving population health disparities using public, private, and community-based strategies and resources. The paper traces the evolution of PHAs from community health needs assessments and community benefits planning. It describes the PHA process, methods, data, and analyt­ical techniques that permit the identification of specific underlying factors in a commu­nity that adversely affect health. It also suggests criteria to prioritize health issues and strategies that help communities implement sustainable policy, infrastructure, or services improvements.

2017

Electronic Cigarettes in Maine: Health Effects, Marketing, Use, and Regulation

Author(s):        David E. Harris, Barbara Lelli, Sarah Mayberry

Maine Policy Review 26(1) : 72-84,

Electronic cigarettes (e-cigarettes) are electronic nicotine-delivery systems (ENDS) that deliver a vapor of nicotine and other potentially dangerous chemicals to the user; nonusers are also exposed. Driven by a well-funded advertising campaign, use of e-cigarettes has increased in Maine until it now exceeds the use of combustible cigarettes among youth. In 2015, 14.5 percent of female high school students and 18.8 percent of male high school students in Maine reported current use of e-cigarettes. Maine laws and city ordinances restrict e-cigarette use in some places where combustible cigarettes are banned, but legislative gaps remain. Most Maine schools, colleges, and hospitals also ban e-cigarettes, but again gaps remain. This article explores the marketing and use of e-cigarettes nationwide and in Maine and proposes policies to restrict access and use, particularly by youth.

2016

Population Health Improvement: It’s Up to the Community—Not the Healthcare System

Author(s):  Ron Deprez and Rick Thomas

Maine Policy Review 25(2) : 44-52

Despite the growing interest in population health on the part of health professionals, policy analysts, and government agencies, there is no widely accepted definition of the term nor agreement on how to apply the concept in health improvement planning. In this article, Ron Deprez and Rick Thomas clarify the definition, attributes, and applications of population health, tracing its history and evolution to its current form and assess the roles of communities and health systems in advancing a population health approach.

Patterns of Drug-induced Mortality in Maine, 2015 Update

Author(s):  Marcella H. Sorg, Margaret Greenwald, and Jamie A. Wren

Maine Policy Review 25(1) : 34-46

Drug addiction and drug-induced mortality have received a good deal of attention nationally and in Maine in recent years. The authors review overall trends in the patterns of drug overdoses that have continued for nearly two decades, including those involving opioid pharmaceuticals, and discuss the recent resurgence of the illicit drugs heroin and non-pharmaceutical fentanyl.

2015

Maine’s Initiatives in Geriatric Medical Care: Commentary from the Front Lines

Author(s):           Singer, Cliff; Renfrew, Roger

Maine Policy Review 24(2): 89-98

Cliff Singer and Roger Renfrew write from their perspectives as medical practitioners and leaders in geriatric medi­cine to examine issues affecting health care and outcomes for older adults in Maine. Focusing on the acute and primary care systems, they highlight issues and policy recommendations they think are most urgent or helpful.

Shaping the Health and Long-Term-Care Infrastructure Serving Older Adults: Historical Trends and Future Directions

Author(s): Fralich, Julie

Maine Policy Review 24(2): 99-110

Over the last few decades, federal and state policy have been driving a shift away from nursing facility-based long term services and supports (LTSS) toward home and community-based services (HCBS). As Maine’s aging demographics generate increasing demand for LTSS, the state faces a number of significant challenges as it tries to make living at home longer a viable option for more and more older adults who need assistance in order to do so. This article reviews the confluence of demographic and policy shifts that will shape the future of Maine’s LTSS system.

2013

Lessons from Health Reform

Author(s):           Riley, Trish

Maine Policy Review 22(2): 8-10

Maine’s Dirigo Health reform is a microcosm in the current sea of health reform, but a full decade after its enactment the similarities to the Affordable Care Act (ACA) are striking. Both reforms created subsidized, private health insurance, negotiated by an independent entity; both expanded Medicaid and included strategies to improve quality and lower cost; and both met with strong, well-organized conservative opposition. This essay briefly explains the politics surrounding the Dirigo reform and the compromises that allowed Dirigo to continue under two governors and serve over 41,000 people and nearly 1,000 small businesses, which can transition to the ACA January 1, 2014. It suggests why Massachusetts met with less resistance in their reform and concludes with lessons learned from Maine.

Policy Changes for a Nutrition Education Program in Maine: Issues and Implications

Authors: Majka, Alan; Fairman, Janet; Yerxa, Kathryn

Maine Policy Review 22(2): 55-63

Food insecurity and preventable chronic disease have profound impacts on quality of life and health care costs in Maine. Many government programs have been developed to address these issues; however, effectiveness has often been limited by restrictive policies and less than optimal coordination. In this paper, the authors draw upon their research and experiences in Maine, research conducted by others, and state and national statistics to elucidate some of these programs, including their efficacy, limitations, potential and threats to their sustainability. The authors contend that recent federal rule changes allow for greater impact through implementation of evidence-based strategies at the same time that budget cuts threaten to undermine progress. Short-term savings achieved through budget cuts to anti-hunger and preventive health programs may be outweighed in the long-term by decreased academic performance in children, increased health care costs and disability as a result of chronic diseases such as diabetes.

2012

Home Care Workers in Maine: Increasingly Essential Workers Face Difficult Job Conditions

Author(s):           Butler, Sandra S.

Maine Policy Review 21(2): 82-91

As the population in Maine ages, the need for home care workers is increasing. Turnover is high in this field and the longitudinal Home Care Retention Study (HCWRS) examined predictors of turnover and work experiences of home care aides in Maine. Younger age, lack of health insurance, and poorer mental health were among the predictors of termination for the study participants who left their jobs. In telephone interviews, they spoke of low wages, inconsistent hours, unreimbursed mileage and poor communication with employers in describing why they had left their jobs. A follow-up inquiry with 31 of the HCWRS study participants who were aged 63 to 80 provides information on how the job is experienced by older workers—those most likely to stay in the field. The article concludes with current policy activity affecting home care workers in Maine.

2011

Poor Nutrition amidst Plenty

Author: Mills, Dora Anne

Maine Policy Review 20(1): 107-123

Hunger and food insecurity is on the rise in Maine as are increases in obesity, heart disease, and diabetes, all linked to food choices. Old and young, immigrant and native, rural and urban—Mainers are experiencing a food emergency made graver by the economic recession and rising health costs. Dora Anne Mills writes about “poor nutrition amidst plenty,” its causes, consequences, and the programs and policies that address it.

2010

Economic Assessment of Children’s Health and the Environment in Maine

Author: Davis, Mary E.

Maine Policy Review 19(1): 36-44

Reducing children’s exposure to environmental toxins is important for both moral and economic reasons. Mary Davis discusses the economic impact of envi­ronmentally related childhood illnesses in Maine, focusing on disease categories with fairly strong evidence connecting environmental pollution to childhood diseases: lead poisoning, asthma, neurobehavioral disorders, and cancer. Lead poisoning and neurobehavioral conditions are the most expen­sive because they lead to chronic diseases that are largely incurable and not easily treated. She concludes that state funding for initiatives aimed at reducing childhood exposure to environmental pollutants “would be money well spent.”

2009

Early Childhood Health

Author: Mills, Dora Anne

Maine Policy Review 18(1): 46-59

Dr. Dora Anne Mills presents a panoramic portrait of early childhood health in Maine, describing the ways in which poverty, health insurance, preg­nancy, early growth and development, infectious and chronic diseases, oral health, environmental health, injury, mental health and physical activity and nutrition affect children. She notes policy successes in these areas and describes some of the challenges that remain and the new challenges that are arising.

Maine’s High-Risk Infants and Maternal Health and Wellbeing: The Maine Infant Follow-Up Project

Authors: Logan, Beth A.; Hayes, Marie J.; Brown, Mark S.; Tisher, Paul; Paul, Jonathan A.; Krishnan, Ramesh

Maine Policy Review 18(1): 60-67

The Maine Infant Follow-Up Project is a research-based effort to accelerate early identification of devel­opmental risk for infants whose mothers use drugs or alcohol. These infants are at high risk for neurodevel­opmental disorders, and early identification will enable early-early intervention. Targeted interven­tions will increase the chance for children to catch up developmentally during the period of most rapid brain growth in the first three years of life.

2008

Improving the Health of Maine, One Employee at a Time

Author: Whalen, Jerry

Maine Policy Review 17(1): 108-111

In this commentary, Jerry Whalen, an officer in Eastern Maine Healthcare Systems, discusses employee wellness programs and the importance of focusing on the workplace. He notes that managers and senior executives have a key role to play in ensuring success of  employee wellness programs

2007

Taking a New Look at MaineCare

Author: Saucier, Paul

Maine Policy Review 16(1): 30-38

Maine’s Medicaid program, called MaineCare, provides health care coverage to one in five state residents. Paul Saucier gives an overview of MaineCare’s services, eligibility categories, and financing. He discusses root causes of MaineCare’s continued expansion in breadth and cost, which has prompted reform proposals to rein in what many believe is unsustainable growth. Examining reform efforts in other states, Saucier cautions that we need to learn from these experiments. Finally, he raises important questions for policymakers related to MaineCare’s mission, its complexity, and the stability of its financing.

Building on MaineCare’s Success

Authors: Pohlmann, Lisa; Hastedt, Christine

Maine Policy Review 16(1): 39-43

This commentary provides a particular viewpoint on MaineCare (Maine’s Medicaid program). Lisa Pohlmann and Christine Hastedt critique reform efforts in several states and emphasize the key role of MaineCare in the state’s overall health care system.

MaineCare—A Provider Prospective

Author: Steele, Erik N.

Maine Policy Review 16(1): 44-45

Dr. Erik Steele in this commentary discusses MaineCare (Maine’s Medicaid program) from a provider’s perspective. He suggests that delays and problems in the state’s reimbursement to providers have led to doubts about the state’s credibility both as a payer and as a health care systems change leader.

2005

Using Public Engagement to Inform the Future of Health Care in Maine: Talking About “Tough Choices”

Author(s):           Beard, Ronald E.; Tanski, Tish

Maine Policy Review 14(1): 24-35

The biennial state health plan mandated by Maine’s innovative Dirigo Health Reform Act guides how the state makes decisions about using its health care resources. Public engagement in the development of this plan was made an explicit goal. Ron Beard and Tish Tanski discuss how nearly 400 Maine citizens were involved in a virtual town meeting in May 2005 that provided input on the state’s health plan. The collective voice of citizens involved in this forum has proven to be an important input in the ongoing efforts of policymakers to devise a responsive health care system.

Solving Maine’s Health Care Crisis Requires “Tough Choices”

Author(s):           Wolf, Wendy

Maine Policy Review 14(1): 36-37

Wendy Wolf’s commentary discusses the “tough choices” process, which invited selected Maine citizens to participate in town hall meeting sessions to provide input on the state’s health plan. She notes that it was easier for participants to agree on health promotion and healthcare delivery processes than for them to make choices about how to pay for healthcare.

2004

How Many Regional Medical Centers Can Maine Sustain? How Patient Hospital Utilization Can Help Define Structure

Author(s):           Rydell, Lars

Maine Policy Review 13(2): 58-65

Thoughtful decisions about where various levels of hospital care are to be provided is an important part of controlling overall healthcare costs. Efficient use of healthcare resources requires that high-cost and less frequently used high-tech equipment and specialized personnel should be limited to a few tertiary regional medical centers. Lars Rydell uses patient discharge data from the Maine Health Data Organization to suggest that Maine currently has only two hospitals that function as tertiary regional medical centers—Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor. Policymakers need to think about whether Maine’s population base warrants more than two such centers.

Mental Health Parity and Beyond: Aligning the Public and Private Systems of Care for People with Mental Illness

Authors: Kitty Purington

Maine Policy Review 13(2): 66-75

Maine is one of the first states to mandate comprehensive mental health coverage for its citizens under private insurance plans. Mental health advocates nationwide long have lobbied for such parity. In this article, Kitty Purington first provides an overview of the federal and state legislation leading up to the present law. She then compares current parity provisions under private plans with those of MaineCare (Maine’s Medicaid program, reporting that coverage under MaineCare for individuals with serious mental illness still exceeds that which is mandated under private plans.

2004

Obesity in Maine: A Policy Approach

Author: Mills, Dora Anne

Maine Policy Review 13(1): 28-47

Compared to earlier generations, Americans are eating more, making poorer nutritional choices, and are less physically active. The result is an “obesity epidemic” facing Maine and the nation. Dora Anne Mills, director of Maine’s Bureau of Health, summarizes the extent, impact, and causes of obesity, and presents policy solutions suggested in public health and medical literature. Because the factors behind the obesity epidemic are so interwoven in the fabric of society, policymakers, businesses and individuals must consider a variety of solutions on the personal, local, state and national levels. Mills warns if we do not act soon and systematically, “our youth may be the first generation to not live as long as their parents’ generation.”

Financial Performance of Hospitals in Maine, 1993-2003

Author: Kane, Nancy

Maine Policy Review 13(2): 36-51

Hospitals are the largest single component of healthcare expenditures. Nancy Kane’s study of hospital financial performance fulfills a mandate of Maine’s Dirigo Health Reform Act. By most financial measures, Maine’s hospital industry outperformed hospitals nationwide and in the Northeast during 1993-2003. Still, there is major variability among the state’s hospitals in financial performance. Kane analyzes financial and non-financial characteristics of high-, medium-, and low-performing hospitals, and suggests that not maintaining acute inpatient volume is the biggest problem for low-profitability hospitals. Although no hospital is in imminent danger of failing, Kane suggests a new “blueprint” is needed for Maine’s healthcare system, before financial crisis and loss of access occurs.

2003

Top 10 Health Issues Faced by Maine People

Author(s): Dora Anne Mills

Maine Policy Review 12(1): 30-54

In this article Maine’s Bureau of Health Director, Dr. Dora Anne Mills, outlines the top 10 health issues facing Mainers today. As Mills points out, many chronic health issues would be greatly alleviated if people ate less and better, exercised more, and didn’t smoke. Despite the role of self determination in affecting these behaviors, Mills argues that all can be influenced through more proactive policies at the local, state, and national levels, and changes to our surrounding environments. Only when neighborhoods, schools, workplaces, and communities are structured in ways that promote healthy lifestyles will there be real changes in the health trends of our time.

The Challenge of Preserving and Expanding Affordable Health Care in Maine

Author(s): Wolf, Wendy

Maine Policy Review 12(1): 56-68

Maine’s health care system is in crisis. The state’s health care expenditures represent the third highest percentage of Gross Domestic Product in the nation. State health care spending is projected to top $11 billion per year, or $8,291 per person per year, over the next seven years. Businesses in Maine pay 12 percent to 23 percent more for coverage than the national and New England state averages. And the state’s uninsured and vulnerable populations continue to grow. In this article, Wendy Wolf charts the rising cost of health care in Maine and the implications of these costs for all Mainers. In turn, she looks at each of the drivers of cost and calls for a comprehensive approach to solving the crisis. Only when all of the players agree to work together and, more importantly, to make changes will we be able to change directions.

Rising Prescription Drug Costs: What Is Involved and What Can Be Done?

Author(s): Carroll, James

Maine Policy Review 12(1): 70-83

The rapid rise of prescription drug costs in the United States has triggered heated debate at the federal and state levels about how to control costs and expand access for those in need. In part, the United States finds itself in this situation because, unlike most countries throughout the world, the federal government thus far has refused to exact federal price restrictions on pharmaceutical products. James Carroll argues that this has left each state in the difficult position of trying to leverage lower costs and expanded access for its citizens. In this article, Carroll provides an overview of these attempts, including the Maine Rx program and the more recent legislation passed by Maine’s 121st legislature. He concludes with an analysis of how effective such programs are likely to be in the long run, particularly if the federal government continues to abdicate its responsibility to address the issue in comprehensive fashion.

The Changing Nature of Long-Term Care in Maine

Author(s):           Saucier, Paul; Fralich, Julie

Maine Policy Review 12(2): 24-35

The increase in the proportion of older adults, many with one or more chronic medical conditions, will increase the demand for long-term care. Paul Saucier and Julie Fralich discuss the socio-demographic factors affecting long-term care policy, and describe various state and federal options for providing and financing long-term care. They note that Maine’s long-term care system has so far been able to absorb considerable growth in people by serving increasing numbers in lower-cost settings. Cost sharing has been introduced, and tax policy has been changed to provide incentives for long-term care insurance. Policymakers must now consider whether the current balance of public and private financing of long-term care is sustainable in the long run.

Dirigo Health

Author(s): Treat, Sharon Anglin; Brennan, Michael; Woloson, Ann

Maine Policy Review 12(3): 12-23

Maine’s pioneering Dirigo Health program aims at reducing health care costs, improving quality, and increasing access by providing health insurance coverage to all of Maine’s currently uninsured population. State senators Sharon Treat and Michael Brennan and co-author Ann Woloson provide an overview of the components, structure and financing of the program. They discuss some of the challenges and opportunities posed in Dirigo Health’s implementation, and give an insider’s perspective on the process by which the program was enacted.

Dirigo Health: Its Opportunities and Obstacles

Author(s): Wood, Godfrey

Maine Policy Review 12(3): 24-25

Dirigo Health: A Small Business Perspective

Author(s): Cook, Deborah

Maine Policy Review 12(3): 26-27

In her commentary Deborah Cook, executive director of the Maine Small Business Alliance, discusses Dirigo Health from the viewpoint of small businesses, whose employees and families, along with the self-employed, represent the largest proportion of uninsured in Maine’s population. She notes that rising costs of health care and insurance are a major threat to the viability of small businesses.

2002

Why More Is Required to Address Maine’s Childhood Lead-Poisoning Problem

Author: Littell, David

Maine Policy Review 11(2): 116-129

Although largely hidden from the public eye, childhood lead poisoning has been identified as one of Maine’s leading environmental health problems. Recent data show not only that lead-poisoning levels are unacceptably high among Maine’s children, but also that screening rates are lower than recommended by national health organizations and lower than in other New England states. David Littell discusses why childhood lead poisoning is such a problem in Maine and what can be done to remedy the situation, providing a thorough examination of how children are exposed to lead and the magnitude of the problem. He reviews the state’s existing program, and contrasts Maine’s approach with that of several other states. Littell concludes with a series of thoughtful recommendations and argues that the state must do much more if it intends to achieve its policy goal of ending childhood lead poisoning by 2010.

2000

Chronic Disease: The Epidemic of the Twentieth Century

Author: Mills, Dora Anne

Maine Policy Review 9(1): 50-65

One hundred years ago, the leading causes of death were infectious diseases such as tuberculosis, influenza and pneumonia. Of equal concern were water-borne diseases such as cholera and typhoid. Yet today, as a result of public health measures to clean up drinking water and provide immunizations, and by improvements in medical care, such diseases have been eradicated.  As Dora Anne Mills points out, as we begin a new century, we have much to celebrate but still more to consider. Today, we face an epidemic unlike any found in 1900. One hundred years ago only one-in-six people died of a chronic condition; today, three-quarters of Maine people die from four chronic, and mostly preventable, diseases: cardiovascular disease, cancer, chronic lung disease, and diabetes. Not only does Maine have the fourth highest death rate due to chronic disease, it also leads the nation in the three behavioral risk factors that cause or exacerbate chronic disease: tobacco use, poor nutrition, and physical inactivity. In this article, Mills first chronicles Maine’s chronic disease epidemic, and second, lays out a plan for strengthening the state’s disease prevention and health promotion efforts. She calls for a local as well as a statewide focus, and suggests that efforts to change Maine’s health status will require whole communities to take coordinated action.

1999

A Dose of Public Health through Grassroots Advocacy: The Development of Tobacco-Control Policy on a College Campus

Author: Bryant, G. Lea

Maine Policy Review 8(2): 30-36

Maine has the unfortunate distinction of having the highest rate of tobacco use among 18- to 30-year-olds of any state in the nation. Moreover—as Bryant points out—first-time smoking among traditional college-age populations has risen nearly 30 percent in the past decade. Armed with these statistics, it is not difficult to conclude that college campuses in Maine face a serious public health issue. Carried by the momentum of recent tobacco-control policy developments at the state level, the University of Maine at Farmington (UMF) has passed a stringent new tobacco-control policy that places UMF in the forefront of nationwide efforts to curb tobacco use among college-age students, and also to minimize the harmful effects of secondhand smoke. In this article, Bryant traces the grassroots advocacy efforts that led to the recent passage of a new tobacco-control policy at UMF. She concludes with a set of recommendations for policy advocates in other settings.

1998

New Health Care Help for Maine’s Uninsured Children

Author: Longley, Susan W.

Maine Policy Review 7(1): 70-73

1996

An Interview with Norm Ledwin: Continuous Change in Healthcare Management

Author(s): Ledwin, Norm

Maine Policy Review 5(1): 3-10

Managed care continues to enter Maine—a trend that alarms some and is welcomed by others. Norman Ledwin, president and chief executive officer of Eastern Maine Healthcare and Eastern Maine Medical Center (EMH/EMMC), believes managed care has the potential to improve the state’s ability to provide high quality, economical healthcare for its citizens. In a December 1995 interview with Maine Policy Review, Ledwin discussed managed care as well as related healthcare changes underway in Maine.

Reaction to the MHCRC Draft Report

Author(s):           Wihry, David F.

Maine Policy Review 5(1): 27-32

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Angus King in November 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period. Commission members were “mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations” Reactions to the MHCRC report were invited from individuals who represent constituencies, which often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report: this first is by David Wihry, an economist at the University of Maine.

Playing with a Stacked Deck: Why Was a Single Payer Plan Dealt Such Bad Cards?

Author(s):      Millard, Peter; Rosen, Clifford; Thomas, Susan

Maine Policy Review 5(1): 33-38

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Angus King in November 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period. Commission members were “mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations” Reactions to the MHCRC report were invited from individuals who represent constituencies, which often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. This second commentary provides perspectives from three practicing physicians in Maine.

A Political Process That Worked: Comprehensive Healthcare Reform in Progress

Author(s):      Campbell, Richard H.

Maine Policy Review 5(1): 39-42

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Angus King in November 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period. Commission members were “mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations.” Reactions to the MHCRC report were invited from individuals who represent constituencies that often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. In this third commentary, state Representative Richard Campbell comments on the development, process, and outcomes of the Commission.

Healthcare Reform Proves Difficult at State Level

Author(s):      Shorr, Elizabeth O.

Maine Policy Review 5(1): 43-46

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Angus King in November 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period. Commission members were “mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations” Reactions to the MHCRC report were invited from individuals who represent constituencies that often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. Elizabeth O. Shorr, Blue Cross and Blue Shield, provides a third-party-payer perspective in her commentary.

Response to Draft Recommendations for Health System Reform

Author(s):           Gordon, Dale J.; Boothby-Ballentyne, Kimberly

Maine Policy Review 5(1): 47-49

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Angus King in November 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period. Commission members were “mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations” Reactions to the MHCRC report were invited from individuals who represent constituencies that often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. Dale Gordon and Kim Boothby-Ballantyne offer a nursing perspective in this commentary.

Start Making Sense: A Legislator Looks at Professional Licensure Reform

Author(s):           McCormick, Dale

Maine Policy Review 5(1): 49-55

This past summer, the Maine Health Professions Regulation Project and its task force released a report to Governor King and the Maine legislature. The report, “Toward a More Rational State Licensure System for Maine’s Health Professions,” represents the best thinking and accomplishments of a project directed by Judy Kany of Medical Care Development, Inc. Dale McCormick’s commentary addresses five aspects of this project: the approach of the task force, why licensure reform is necessary, the relationship between this project and the Maine Health Care Reform Commission, the report issued by the task force, and a brief review of the nine “problem areas” and 12 recommendations contained in the report.

Health Care Reform in Maine: Continuing the Dialogue

Author(s):      Keller, Robert; Rolde, Neil; Hayes, Peter

Maine Policy Review 5(2): 71-76

An Interview with David Peterson and David Jones: Envisioning the Future of Rural Healthcare

Author(s):      Peterson, David; Jones, David

Maine Policy Review 5(1): 11-19

Managed care and other healthcare changes may affect Maine differently than more urban states. Managed care companies, striving to create economies of scale in healthcare financing, often prefer to fold rural regions into larger plans that emanate from more populous hubs. In much of Maine, many question whether this will be best for the consumers and providers of rural healthcare. Maine Policy Review interviewed David Peterson, president and chief executive officer of The Aroostook Medical Center (TAMC), and family practitioner David Jones who practices at Aroostook Family Practice and is an active member of TAMC’s medical staff, to obtain their views on rural healthcare and the impact of state and national healthcare trends on rural providers.

Tax-and-Match: Resolving Tension between State Financial Pressure and Federal Public Policy Intentions

Author(s): Woodward, A. Mark

Maine Policy Review 5(1): 57-63

How tax-and-match, a federal program designed to help states subsidize hospital care for low-income patients, came into existence and how it was overexploited is recent history Mainers should consider. Woodward traces Maine’s tax-and-match experience from its inception in 1991 to its repeal in 1995 and in doing so illustrates a set of larger issues related to the integrity of federal-state relations, the difficulties in developing fiscally sound health policies in a resource tight environment, and the political machinations that can lead to quick-fix solutions over long-term policy resolutions. With federal block grants looming in the future, Woodward suggests that if Maine is willing to learn from its recent tax-and-match experience, then perhaps Maine is poised to do the right thing when it comes to developing fiscally sound health policies for the future.

1995

The Importance of Health Insurance Reform

Author(s):      Kassebaum, Nancy Landon

Maine Policy Review 4(2): 67-69

In her commentary, Republican Senator Nancy Kassebaum of Kansas outlines a proposed bipartisan health insurance reform act, which she will introduce in the Senate next year.

1994

Health Care Reform: Where Do We Go From Here?

Author(s):      Dukakis, Michael S.

Maine Policy Review 3(3): 1-6

Will universal health insurance ever become a reality? In this, based on his address in October as the 1994 Margaret Chase Smith Lecturer, former Massachusetts Governor Michael S. Dukakis suggests that efforts to establish universal coverage will continue. He argues, however, that the success of these efforts depends on the public adhering to the principle that all citizens will contribute to a system of universal coverage.

1993

The Clinton Administration’s Vision for Economic Development

Author(s): Tyson, Laura D’Andrea

Maine Policy Review 2(3): 1-6

The twentieth anniversary of the Governor’s Economic Development Conference last October focused on the impact of public policy on the competitiveness of Maine’s business and industry. Among many other important presentations, the University of Maine-sponsored conference featured a keynote address by the Clinton Administration’s top economic adviser, Laura D’Andrea Tyson. Tyson’s remarks, which detailed the policy initiatives meant to enhance the nation’s international competitiveness, are presented in this article.

Assessing the Merits of the Clinton Health Care Reform Proposal

Author(s):      Kessler, Warren C.

Maine Policy Review 2(3): 11-15

The twentieth anniversary of the Governor’s Economic Development Conference last October focused on the impact of public policy on the competitiveness of Maine’s business and industry. Warren C. Kessler, president of Kennebec Health Systems, assesses the Clinton administration’s health care reform proposal.

Maine’s Gubernatorial Candidates Present Their Positions on Health Care Reform

Author(s):      Carter, Jonathan; Collins, Susan; King, Angus

Maine Policy Review 1994 3(2): 1-12

Few issues have dominated the public policy agenda in the last decade as health care reform has in 1994. Although health care reform is stalled in Congress at this writing, it is not an issue that will exit the public stage quickly or quietly. Maine faces many of the problems that have spurred the national health care debate. The state has attempted to address these through public policy. But larger health care issues remain unresolved and the next governor will most certainly play a major role in addressing those issues. Maine Policy Review invited the four major candidates seeking to become the state’s next chief executive to present their views on health care reform for publication in this issue. Three of the four candidates, Jonathan Carter, Susan Collins and Angus King, responded to that invitation. Their statements on health care reform are presented in this article.

1992

A Public Health View of Environmental Regulation

Author: Graham, John

Maine Policy Review 1(2): 34-38

The laws and regulations that govern the use of environmental resources have complicated effects on our society and our economy. Efforts to regulate environmental impacts are frequently controversial precisely because they have such complicated effects. No single perspective can adequately encompass all of the issues that arise in environmental regulation and environmental protection. Even the terms themselves suggest the fundamentally opposed philosophies that approach the assessment of environmental laws: While proponents of greater environmental activism emphasize the need to “protect” the environment, critics of more stringent controls emphasize that these laws “regulate” and limit the actions of individuals. At the PURE ’92 conference, speakers with very different perspectives were invited to share their views of the important issues in environmental protection and environmental regulation. Dr. John Graham provides a perspective from the point of view of public health, looking at the health risks and costs of pollution.