We have recently completed the first session of the 126th legislature and I am taking time to reflect on what I have experienced and what we in the legislature have and have not accomplished.
I ran for the position of state representative when I learned that our state was not supporting full implementation of the Affordable Care Act so that all Mainers could have health insurance coverage. I had spent a large portion of my career trying to provide medical care to sick people who were working without insurance. I saw the poor outcomes and the cost shifting and know that covering everyone lowers costs and keeps people healthier and better able to work. It also seemed that our government had become so polarized that we were not able to get anything done. Having learned as a physician to care for anyone regardless of their opinions, I hoped I could help find compromise and practical solutions. I came to this job with two guiding principles. The first is to tell the truth and the second is to treat others as I want to be treated.
When I began in Augusta I learned that there were over 50 new representatives, first term legislators like me, who were frustrated with the direction of government. We range in age from 21 to our seventies and have diverse education, work and life experience including recent military service, teachers, business owners, marine biologists, lawyers, organizational developers, farmers. We represent diverse areas of the state from Kittery to Lubec. We all shared a desire to get things done, to fix problems we see with how we invest in each other, our education system, healthcare, business environment, roads, bridges and social service systems.
We were sworn in last December, elected our leaders in the house and senate and began our committee work in January. We had to submit all bills (proposed laws) by mid-January. I submitted the bill related to my main reason for running, to have Maine participate in the Medicaid expansion to increase eligibility for MaineCare health insurance for people making between 100 percent and 138 percent of federal poverty level (about $15,000/year for a single person). I became lead co-sponsor with Representative Linda Sanborn of Gorham, who is also a physician.
Committees have 13 or 14 members from both house and senate and both parties and independents. We consider all bills related to our area. They are presented by the sponsor with a public hearing and testimony “for”, “against” or “neither for nor against”. The majority of bills are voted out of committee with a unanimous vote on whether or not to pass. The number of unanimous votes range from two-thirds to 90 percent agreement depending on the committee.
Legislators are often asked to submit legislation by constituents or by organizations that see a problem to fix. I submitted three other bills at the request of organizations. Maine Medical Association recommended that we update the language of existing laws relating to healthcare providers with substance abuse problems.
Maine Health proposed reducing the restrictions on the ability of healthcare providers to discuss a patient’s mental healthcare when trying to coordinate care for the patient. Planned Parenthood asked that we expand coverage under the Medicaid program to cover family planning services for more people. The first two bills passed to be enacted and the third will be carried over to the second session next January.
The Medicaid expansion was paired with the bill to complete paying the hospitals for past debt. It passed both house and senate, but was vetoed by the Governor and fell short of enough votes to override the veto.
We heard from some legislators that they would consider voting for the expansion if it was separated from the hospital payment bill. Both issues were brought back separately. The hospital payment bill passed and was signed by the Governor, but the Medicaid expansion was vetoed again by the Governor and fell two votes short of the number needed to override the veto. Those of us who support the bill will bring it back again in January. Unfortunately, this means some of us with the lowest incomes will not be able to sign up for health insurance in October to start coverage in January.
Why has it been so hard to get this passed? It seems to me that we are battling over our views of welfare and welfare recipients as well as the role of government. Some of us believe that if people would just get a job and stop depending on a “hand out” from the State they could access all of the things they need. State-funded health insurance and welfare are seen as the same thing. “Lazy” people do not deserve it and “we” can’t afford it. Others of us ask “what are the barriers to people getting off of welfare?” How can we change the system to encourage and help people get healthcare, find and keep work and get paid a living wage so they can be independent of government support?
These competing philosophies, “survival of the fittest” vs. “we are all in this together” have affected many of the issues that divide the legislature. Being a pragmatist, I believe in “enlightened self-interest” as well as “we are all in this together “. I hope that going forward my fellow legislators will be willing to leave ideology behind and focus on what I believe are our shared desired outcomes, which include opportunities for good health, good work at fair pay and good government at the lowest cost and the least interference in our lives.