According to polls, health care is one of the top issues voters are concerned about this election. Whoever takes the helm as Maine’s next governor will have plenty of challenges to address, from Medicaid expansion and the overall cost of treatment to the opioid crisis and senior care.
Here’s how each of the four candidates would tackle these challenges.
The radio version of this story aired Monday, Oct. 15.
Independent Alan Caron: I think we should have done it within the first 10 minutes it was offered. I think whenever the federal government is willing to put $9 on the table and $1 from us, we shouldn’t fret about where that dollar comes from. And I found that whole excuse about ‘we don’t have the money’ was nonsense. We’re the richest society in history. We have no excuse for not insuring every single human being. We can afford it, but our priorities are wrong.
Independent Terry Hayes: I do think it’s the best deal for Maine currently. It’s not only the social but the economic thing to do. At the same time, there’s a significant gap between the costs and the reimbursement rates, particularly with Medicaid. So as we expand, we have to fight to bring costs down and reimbursement rates up. Or it’s not going to be sustainable downstream.
Democrat Janet Mills: From a humanitarian point of view, from an economic point of view, from a business point of view, Medicaid expansion poses all the advantages that we need. Businesses are saying they need to reduce health care costs and they want to level the playing field by being able to compete with businesses in 33 other states where insurance rates have gone down. The cost of uncompensated care in hospitals across the state of Maine in one year alone amounted to $570 million. That cost is shifted to insured individuals and employers and the working population of Maine, and that’s one reason that insurance rates are going up. Expanding Medicaid will also reduce the cost of health care and insurance for those not eligible for Medicaid.
Republican Shawn Moody: I think we’ve passed the point of the debate on whether we’re going to support or oppose Medicaid expansion. It’s law and we’re going to have to deal with it. We’ve moved on to the phase of how can we responsibly and sustainably fund it without raising taxes, raiding the Rainy Day Fund, or using one-time budget gimmicks that aren’t sustainable. I would definitely work with the Legislature [to identify a funding source] and bring in the hospitals and providers. There’s a lot of pent up anxiety and frustration from a lot of constituents, so we’re going to have to get this ironed out, I’d say, first thing.
Caron: Transparency would be a big help. As far as I’m concerned, that’s the first priority. People need to know what the cost of procedures are, and they need to know relative to the cost of similar procedures in the area. Transparency by itself wouldn’t get us where we need to go in terms of lowering costs in health care, but it’s an important step. I’m for actually incentivizing people. If you find a lower price in your community for the same procedure and feel quality is good, and you take it, you should get a portion of the savings. We should design a system to make sure you get a check in the mail, thank you for being a good consumer and saving all of us the cost of health care, which overall would lower insurance costs and ancillary costs.
Hayes: Focus on wellness and prevention. Because for me, the less health care you need, the less expensive it is. The state does not currently have a wellness and prevention program for its citizens. We have one for state employees. Employers have figured out that’s the low-hanging fruit when you’re looking to reduce costs. And then the other is working within the provider community. We talk about lean and different efficiencies. Let’s look at that within the health care realm. And I‘m sure there are people who are doing this now so I can learn something from them on how to make that more widely available.
Mills: Small businesses and self-employed individuals are taking it on the chin right now with the high cost of health insurance. It’s very tough if you’re not eligible for Affordable Care Act subsidies or Medicaid. Then you’re stuck in the middle with increasing premiums. I’m looking at a plan to address those needs concurrent with expanding Medicaid. The plan includes providing health insurance to those individuals in the middle and protecting people with any insurance policy against waivers of coverage for pre-existing conditions and other protections we all have come to expect, such as mental health and maternity care.
Moody: We can introduce things that I’ve done in my business into the mainstream. We were able to take our experience-rated health plan and introduce wellness programs, give gym passes and create funding for health savings accounts. But most Maine businesses are too small to afford experience-rated plans, so there’s no incentive for them to create healthy, productive work environments, which their coworkers would take home with them. One of the biggest areas of opportunity to improve the overall health of the Maine workforce is to allow small employers to buy insurance across state lines through associations or co-ops. That would give them access to experience-rated plans at discounted prices, and it would incentivize them to do more productive and innovative things. I think transparency as well is an important component to reduce health costs. I can’t think of another product or service that you don’t know what the price is before you purchase it.
Caron: I would love to use the power of the collective employees of Maine, including teachers across the state, to leverage for lower drug prices. I think we have to take action at the state level, because there’s no leadership at the federal level. I want to look at how can we get Canada prices into Maine. We can do it the way they do it, which is to negotiate with power and strength and demand not only lower prices but reasonable prices that make sense relative to the cost of production.
Hayes: The first thing we have to do is to make sure we need prescriptions. I think there is an ethos that has developed that we need a pill for everything. We use more medications here in the U.S., I believe, than any other country, and don’t have best health outcomes. So it’s not just about how much they cost, it’s how we’re using them. There are also options for negotiating, particularly if the state is paying for prescriptions. I’d have to look at it more specifically. I would start with trying to minimize the need.
Mills: As attorney general, I’ve gone after drug companies for price gouging. We pay way too much for prescription medications. I’ve been working on this for two years now with Democratic state Sen. Eloise Vitelli of Bath, trying to get the Legislature to at least enact a law that allows drug price transparency. That is critical. I also want to address the drug price issue by reinvigorating the Drugs for the Elderly Program and the Medicare Savings program.
Moody: Prescription drug costs are unsustainable. If you’re in the private sector and have an experience-rated health plan or are self-insured, you get all this data to see how many employees are using generic prescriptions. Once employees recognize the savings available, through incentives, they’ll get generic prescriptions. The common thread with health care is transparency and allowing people to have choice and take control over their well-being.
Caron: Certainly expanding Medicaid would be one of the things to address the opioid crisis. I think there’s no question we need more attention on the treatment side. But that doesn’t mean we can’t acknowledge there may be more we can do on the enforcement side in terms of larger dealers. Pay attention to people on the ground. Pay attention to professionals on the leading edge of the work. Listen to them. Don’t let politics get in the way of medical common sense. We’ve engaged people in solutions, then ignored them.
Hayes: We have to put state resources into the treatment network. I would like there to be on-demand support when someone’s ready. I think that’s the fastest way to get at this problem. And we need to continue our efforts in law enforcement and supporting the reduction we’ve already been successful at in terms of prescriptions. We need to talk about substance use disorder differently. We need to see it as a brain disease, without the judgment. Without the stigma. I think the way those of us in the policy realm speak about it is so important because it pushes people away from treatment instead of welcoming them toward it.
Mills: There are three ways to address the problem: prevention and education, treatment and enforcement. Enforcement includes drug court. I want to work with the judicial system to make sure all the drug courts are at full speed, taking as many people as possible and giving them the best wrap-around services. DHHS needs to be at the table with the Department of Labor as well to help people find work, be productive and help them stay out of jail. The correctional costs for a person incarcerated for a year is much higher — like five times higher — than keeping them productive and paying for drug court. I’m a big fan of the hub-and-spoke treatment model. I’m a big fan of getting into schools and helping teach kids decision-making skills that they need to stay away from substances that will harm their futures. Medicaid expansion goes along with [increasing access to treatment].
Moody: We’ve got to have more data-driven outcomes so we can resource our programs adequately and effectively and recognize the ones that aren’t working. I want to work with treatment providers to create a dashboard with 5-10 metrics and then look at outcomes. We can see which recovery centers are producing the best results and share best practices with other centers across the state, scale it up and become much more effective.
Caron: I think it ought to be for a woman to decide. I think government should be out of this decision process.
Hayes: I fully support a woman’s right to choose. It’s between a woman and her health provider.
Mills: I will uphold the right of women to safe and legal abortion no matter what the Supreme Court does to chip away at Roe v. Wade.
Moody: I’m pro-life.
Caron: I’ve spent years running referendums, so I’m a big fan of the people’s voice. I do not like this referendum. I did not like the last couple referendums that employed the same device, which is, ‘Hey, how would you like an apple pie with some ice cream on it and somebody else will pay?’ I think that’s a terrible way to make policy. Yes we need more home health care. Yes it will be better for people and communities and will save money over time. It’s just a better approach. But having the rich people in Maine pay for it absolves us of any responsibility, and it makes us less competitive as we’re trying to build an entrepreneurial economy in Maine.
Hayes: I won’t support ballot Question 1. I don’t agree with writing tax policy at the ballot box for starters. I find it very difficult to say, ‘Do you want ‘X’ as long as somebody else pays for it?’ To improve senior care I think it’s a matter of listening to seniors about what they want. We’re going to need to put some additional resources to work, such as what voters have already approved around housing options (a $15 million senior housing bond) for older retirees in Maine.
Mills: I cannot support ballot Question 1 as worded. I’d like to see alternatives. I’m troubled by the amount of money raised and how it would be spent. I’m troubled by the fact that this bill would set up an autonomous board not controlled by the taxpayers or their elected representatives. I’m troubled that the bill requires that board to fund home health care for the very rich as well as the poor. To support seniors, I’m very excited about age-friendly communities. Part of my economic action plan is an age-friendly community grant program. I would also issue the $15 million senior housing bond that’s been sitting on Gov. LePage’s desk for I think three years now.
Moody: That’s a big no on ballot Question 1. This ballot initiative would have a tremendously negative impact on our businesses. It would put us in a position to be the highest-taxed state in the nation. One thing I want to do that’s vital for the state’s economy as well as taking care of our elderly is to come up with a strategic marketing plan to go across the country and the globe, and relocate former Mainers that left and bring them back and rejoin their families in rural Maine. When you think about the best situation for elder care, it’s to reunite families so our families can take care of themselves, which they will.
Caron: Mental illness is a symptom of a deeper underlying social and economic set of problems. A strong economy with opportunity and hope lifts people up. It doesn’t remove mental health issues, but it diminishes them. My general approach to improve mental health care will always be to assemble people who are on the front lines to get the best information and experience we can. To listen carefully and respect those folks.
Hayes: My sense of the mental health network is it’s more crisis-focused, and even then, there’s a waitlist for it. We just don’t have a good system. There are gaps in it. And we don’t pay for the services. We don’t reimburse fully. We need to look at the system holistically — I’m sure the folks working within the system have some good suggestions for improvements. That’s a priority. We have to work at recognizing that mental health is part of physical health.
Mills: There are a lot of agencies that contract with the state to provide mental health services. I want to support them and make sure they’re accountable to state tax dollars. Expanding Medicaid will help support the mental health care system in Maine. There’s a backlog in institutional and community care, and we need to address that. I certainly am a fan of the ACT (Assertive Community Treatment) program for those who might otherwise be institutionalized. I think we can expand that.
Moody: My mom struggled with mental health issues. I became her legal medical guardian and that changed her life and our family’s life. I made sure she went to doctor’s appointments and was on the proper treatment regimen. I think we could utilize legal medical guardians more.
These interviews have been edited for clarity.