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"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including . . . medical care . . ."
Article 25, Universal Declaration of Human Rights adopted by the UN on December 10, 1948

Maine needs universal health care

Editor's note: This recent Bangor Daily News story provides yet another example why we need a simple, effective and affordable health care system that covers everyone in Maine. Sandy Butler and Luisa S. Deprez, two University of Maine professors, document the plight of a Richmond woman with a kidney transplant. No one should live in fear because they cannot pay for their needed medications.

If this story strikes chord with you, please join us and support our work of education and advocacy.

A lot of fears: A Richmond woman’s health problems and 3 months without coverage

‘A lot of fears’: A Richmond woman’s health problems and 3 months without coverage

By Sandy Butler and Luisa Deprez
Special to the BDN
Oct. 24, 2014

Sheila Scott has lived in fear of kidney failure for 20 years. Then, for the past three months, she lived with the fear that goes along with not having health insurance. She’s still afraid her health coverage won’t last.

Scott, 52, of Richmond was diagnosed with kidney disease at age 32 and had a kidney transplant eight years later. Ever since, she has depended on medications she’ll have to take for the rest of her life to ensure her body doesn’t reject the transplanted kidney.

“One of my biggest fears in having a transplant was not being able to pay for the meds,” Scott said. “And everyone was like, ‘Oh, don’t worry.’ You know, ‘You don’t have to worry.’ And here I am worrying.”

That’s because in August, Scott joined the ranks of thousands of Maine residents who have lost their health coverage through MaineCare over the past year as a result of state budget cuts. MaineCare is Maine’s version of the federal Medicaid program, which offers health coverage for people with low incomes and disabilities.

Scott recently received notice that her coverage would be reinstated, though the notice didn’t explain why. But for three months, she joined nearly 35,000 Maine people, the majority of whom work, who lost coverage as a result of the budget cuts and Gov. Paul LePage’s vetoes of legislation that would have allowed Maine to accept federal funds set aside through the Affordable Care Act to close the “coverage gap” for people with low income. Those people are not eligible for subsidies to help them afford private insurance. Not accepting the federal funds meant many low-income adults — working people like Sheila — were cut from MaineCare and lost their health care coverage.

The people who lost coverage at the start of the year fit into two categories: parents who earned between 100 and 133 percent of the federal poverty level and adults without dependent children. None of them earned more than $11,670 annually for a household of one. Scott likely qualified for Medicaid as part of this latter category.

It’s unknown to Scott and those who advocated for her continued MaineCare coverage why the Department of Health and Human Services cut off her coverage in August, rather than in January when other childless adults lost their coverage. It’s similarly unclear why she received notice that her coverage would be reinstated.

A DHHS spokeswoman said the department can’t comment publicly on specific cases. It’s possible, however, that the department has determined Scott qualifies for coverage due to disability.

“There are a variety of reasons why an individual could lose coverage and then regain it,” DHHS spokeswoman Sarah Grant wrote in an email. “For example, if the department requests information and the client does not provide the information, their case would close. If the client subsequently provides the information, the case could then be reopened.”

Scott first qualified for MaineCare more than 20 years ago as a low-income parent with dependent children. She kept her coverage after she became disabled due to her kidney disease diagnosis. After the transplant 12 years ago, Scott returned to work and stopped collecting the Supplemental Security Income she had been receiving as a result of her disability.

Though she stopped collecting her disability-related income, she continued to qualify for MaineCare until she lost it in August. The loss of health insurance coverage presented life-threatening consequences for Scott. How would she afford the medications she needs for her kidney?

Without MaineCare, she couldn’t afford them. She was able to receive some assistance from the Kidney Foundation, but the foundation paid for a substitute medication. “I just had to swap medications because I couldn’t find anyone to cover [my previous prescription].”

She is not certain yet whether the new medication is working properly because she has not been able to have the needed blood test to check that out.

That would involve seeing a doctor, and Scott had to stop going to the kidney specialist she has seen for years because she couldn’t afford those services without MaineCare. “I have a lot of fears, because I don’t want to go back on a kidney machine,” she said. “I don’t know how I did it as long as I did. My kids were young, and I just needed to.”

Scott’s two sons are grown now and have children of their own. She helps take care of her grandchildren and works 20 hours a week as a cook at a market in Richmond. She makes $8.75 per hour. She lives alone in a small, one-bedroom, rental house and struggles to make ends meet.

Maintaining her health is the priority in Sheila’s life, and losing MaineCare scared her — “especially after years of taking care of myself,” she said. “I don’t drink. I don’t smoke. I don’t do drugs. I’ve taken care of myself to keep this kidney.”

Without coverage, Scott found herself neglecting other health care needs. “My knees have been swollen for two weeks now,” she said recently before she found out her coverage would be reinstated. “I see my primary care doctor on Thursday, but I couldn’t afford to go to two [other] doctors and I don’t even know if I can get x-rays or anything. You know, it is just the wrong timing. My condition is never going to get better, because of what I have.”

Some days, Scott had to miss work as her health has deteriorated. She knows this means a decrease in much-needed income but says, “Since my leg’s been bothering me, I had to call out because it hurt too much to be on it. I had worked Friday and Saturday, so I called out Sunday.” When her boss asked her if she needed to stay home the following week, she said no, despite her ongoing pain. “I can’t afford to because I have meds to pay for next week, and there is no way to pay for them.”

Scott also suffers from degenerative disc disease, type II diabetes, severe arthritis and cataracts. She has begun to look into getting disability benefits again, but for now she works at her physically demanding job.

Without MaineCare, Scott lived in fear of what would happen if she couldn’t afford the medications and doctors’ appointments she needs to maintain her health. “Before you do a transplant, make sure you have good insurance, because it is not easy,” she warns others with kidney disease. “Make sure you are going to be able to keep it, because you have to be on these meds for the rest of your life. You can’t just stop them.”

Scott still worries her MaineCare, while reinstated, won’t last.

If Maine had accepted the federal funds to expand MaineCare this past year, Scott would not have gone without coverage. Maine can still accept the federal funds to close the “coverage gap” so Scott and nearly 70,000 Maine people can gain coverage.

Scott said she hopes a new Legislature and governor will agree to accepting the federal funds following the Nov. 4 elections so she and many others in Maine can rest a little easier knowing they can access the health care they need to remain healthy, continue working and taking care of the children and grandchildren they love.

 

Sandy Butler is professor of social work and graduate program coordinator in the School of Social Work at the University of Maine. Luisa S. Deprez is professor and department chair of sociology and women and gender studies at the University of Southern Maine. They are members of the Maine Regional Network, part of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications.

SIDEBAR

The intent of the 2010 Affordable Care Act (ACA) was to extend health care coverage to those earning less than 138 percent of the federal poverty level ($27,310 for a family of three).

  • Nearly 70,000 low-income Mainers would be eligible for health care coverage if Maine accepted federal funds set aside to expand Medicaid. Many of these 70,000 are not eligible for federal subsidies as they are below the federal poverty level. They fall in the so-called “coverage gap.”
  • The Legislature passed bipartisan legislation to accept federal funding to close Maine’s “coverage gap” and expand Medicaid for people who can’t afford health care coverage in the new marketplace. Gov. Paul LePage vetoed various versions of this legislation five times.
  • New Census data show the number of uninsured Mainers increased by 12,000 in 2013 and that Maine’s uninsured rate rose to 11.2 percent from 10.2 percent in 2012. This is in sharp contrast with national trends where the uninsured rate fell by 0.2 percent during that same time.

A July 2014 Urban Institute report found that overall, the ACA has helped states to experience a significant drop in uninsured rates.

Studies also show that uninsured people generally receive much less care for acute and chronic health conditions and fewer preventive services and screenings, such as mammograms, pap smears, or prostate screening and that people without coverage often wait to seek health care until they are in need of more costly care.

The Maine Center for Economic Policy estimates that Maine’s failure to accept federal money for Medicaid expansion is costing Maine’s economy half a billion dollars each year, which could support over 4,000 jobs, ensure Mainers get the care they need from their family doctor, and save hospitals millions of dollars for care provided to the uninsured.

Accepting federal funds to close the coverage gap in Maine makes good sense. Adults with insurance coverage are healthier and at lower risk for premature death than the uninsured. Recent studies of states that have accepted the federal funds show the amount of charity care provided by hospitals has substantially decreased in states that have expanded Medicaid while revenues have increased.

 

What Can Maine Doctors Do?

Return medicine to its healing roots — help educate and advocate for universal, single-payer health care that covers every Maine resident

  • Join Maine AllCare mailing list, and volunteer to help, including supporting financially
  • Join PNHP — www.pnhp.org
  • Visit our websites regularly — www.maineallcare.org & www.philcaper.net for more information
  • Organize and make your voices heard through the Maine Medical Association
    • Doctors have lost influence during the past 30 years or so, but we are far from powerless – they don’t have much of a business without us!
    • Doctors are still influential – make your views known
  • Write op-eds and letters to the Editor of your local paper
  • Testify in person and in writing before the relevant legislative committees when legislation affecting health care is being considered. MAC can help organize these efforts
  • Organize speaking events directed at professions and lay audiences for Maine AllCare speakers
    • Grand rounds
    • Local and specialty medical societies
    • Community forums, church groups, Rotary Clubs, Lions Clubs, Chambers of Commerce

If you have ideas about how else we might advance the cause of universal health care here in Maine, please write to us at info@maineallcare.org and and put "Idea" in the Subject line. Thank you.

Senior docs in Maine strongly support single-payer

Senior docs in Maine strongly support single-payer

Maine AllCare vice president Phil Caper, MD gestures to make a point at meeting of senior docs as Rep. Charlie Priest looks on.

MANCHESTER – A discussion of the desirability of switching to a single-payer health care system for the people of Maine was conducted by MAC Board members Philip Caper, M.D., Senator Geoff Gratwick, M.D. and Representative Charlies Priest under the auspices of the Senior Section of the Maine Medical Association on August 20, 2014 at the Association's headquarters in Manchester Maine.

About 50 physicians attended, the largest turnout in the history of the Senior Section programs. The participants spent over 90 minutes discussing the pros and cons of converting the people of Maine from our present private-insurance dominated system to one more closely resembling a single-payer system, and was held as a follow-up to the recent 2014 poll of MMA members showing 64% of Maine physicians answering the poll favored a single-payer system, up from 52% in 2008.

A straw poll at the end of the session showed that, although there were some strong opponents in the room, almost 90% of those attending the session favored a single-payer system at the end of the discussion.

Maine Allcare Universal Dollar Fundraising Campaign

Small ¢ontribution$ toward a big idea — Universal Health Care in Maine

We at Maine AllCare invite you to join our Universal Dollar Fundraising Campaign. We are asking for small, recurring donations. Monthly contributions of two, five or ten dollars from many people will create a modest, but stable and reliable funding source to help pay for printing the brochures, handouts and newsletters we use at community meetings around the state. Other costs add up fast, such as theaters rentals for showing the award-winning documentary, The HEALTHCARE Movie.

Please consider making a recurring donation of any amount to support our education and advocacy for universal health care in Maine. Anyone who makes a recurring donation will receive the above “button” as a “Thank You” until our supply runs out. (We have hundreds). We are a nonprofit, nonpartisan organization. Your contributions are tax deductible. It’s easy. Simply click on the blue Donate button on the left and fill in the brief form; and don’t forget to select the “Donation frequency.” One more thing: The more donor/supporters we have, not in dollars but in numbers, the more our combined voices are heard and the closer we get toward a majority who believe that every Mainer should have affordable, quality health care! Thank you.

Good news for Healthcare for Everyone in Maine! Our support is growing.

The results are in: Single-payer 64 – Current system 36

On Monday, March 10th the Maine Medical Association (MMA) released the results of their recent survey on their members’ “attitudes and opinions about the directions which reform of our current healthcare system should take...” The crux of the 462 responders’ message was a resoundingYES in support for universal, single-payer coverage of all Mainers.

12-point Increase in Physician Support of Single-payer Health Care in Maine between 2008 and 2014

The survey, a repeat of one completed in 2008, was the product of a resolve introduced by Drs. Petzel, Dillihunt, Maier and Maine AllCare president Pease during the MMA’s annual meeting in October 2013. You can read more about the complete results here, as it appeared in the MMA “Spotlight” feature, online.

Support for single payer heathcare growing in Maine

Maine Health care FACT

Maine’s uninsured population rose from 135,000 individuals in 2012 to 147,000 in 2013, an increase of 12,000 people, according to the U.S. Census Bureau’s American Community Survey. (story)

HEALTHCARE INFORMATION FOR MAINE VOTERS

5 Questions and 5 Facts

Editor's note: The following voter information was developed by Maine AllCare members William D. Clark, MD and Gail Eaton, MBA.

All candidates for Maine House and Maine Senate should be able to tell voters how they would assure that every Mainer has access to comprehensive healthcare, and how their position would affect both the Maine economy and Mainers’ expenses.

Questions You Could Ask Your Candidates

  1. How would you get all Mainers access to comprehensive medical care?
  2. Would you vote for Medicaid expansion in Maine? Why?
  3. Would you vote to fund healthcare for all Mainers with a simple, universal and fair tax program (like, for example, Social Security)? Why?
  4. Would you vote to change Maine’s current profit-oriented healthcare system to a patient-oriented one, such as improved Medicare for all? Why?
  5. What methods to contain and minimize Mainers’ healthcare expenses would you vote for?

Top Maine Healthcare Facts

Maine Economy and a Patient-Oriented System: Transition to a Medicare-for-All type system would cover every Mainer AND, save a billion dollars the first year. (Dr. William Hsiao, healthcare policy expert, speaking to Maine Legislature, October, 2010.)

Maine Economy and Medicaid: If Maine accepted federal Medicaid funds . . .

  • almost 70,000 Mainers (about half of whom are working) would gain health care access, AND
  • Maine would gain about 4,400 jobs and over $500,000,000 in annual economic activity by 2016. (Maine Center for Economic Policy)

Maine Medical Association: 64% of MMA physicians favored a patient care-oriented, single-payer approach, rather than trying to improve our current profit-oriented system (Maine Medical Association, March, 2014)

Uninsured: between 100,000 and 130,000 Mainers lack insurance - even after full ACA coverage kicks in. (Health Affairs Blog, 2014)

Maine bankruptcy: More than 2000 personal bankruptcies were filed in Maine in 2013; and from validated national data, we estimate that 1400 were due to medical bills, and that ¾ of the 1400 had health insurance. (www.healthcareforallcolorado.org)

 

microphoneMaine AllCare vice president Dr. Phil Caper was guest on Mind Over Matters on July 19, 2014 on KEXP 90.3 FM, a Seattle, Washington, radio station that focuses on today's most important social, political and economic issues. Host Mike McCormick did a great job in asking, "So, who is making the money? Who is left out and not getting health care? What's the solution?" You may listen to this informative and wide ranging interview here.

Dr. Philip Caper

Think about your health when you vote in November

By Dr. Philip Caper
Special to the BDN
October 16, 2014

Elections matter. And when it comes to health care, the upcoming election on Nov. 4 will matter a lot. This seems an appropriate time to take stock of where we stand.

I strongly believe in health care with dignity for everybody. When I took the Hippocratic Oath, I swore to put the patient first. That means treating people according to their medical needs, not their employment status, net worth, place of employment, age, gender, lifestyle or where they happen to live.

The United States spends more on health care — about 50 percent more — than any other wealthy country. Despite continuing to pour more and more money into health care, we still rank behind those countries on infant mortality, life expectancy, health care quality and access to needed care. The fact that we continue to do so every year tells us we need new thinking.

Where is all that money going? According to the Institute of Medicine, we in the U.S. waste $750 billion a year on our broken health care system.

The Affordable Care Act is a first step in trying to repair it. Offering federal subsidies for private insurance, expanding Medicaid and neighborhood health centers and regulating insurance industry abuses are important advances. We shouldn’t toss them aside. Repealing the ACA, as many conservatives propose, would be a disaster for Maine and for the country — unless we replace it with something better.

The ACA is in some ways a step forward, but it is not enough. Even with greatly expanded coverage, too many Americans will not see the benefits they would with a universal health care system.

Maine is the only state in New England that has failed to expand Medicaid and is one of just two states in the country where the number of people without health insurance increased in 2013. Expanding MaineCare would cover an additional 70,000 Mainers at almost no cost to the state and would inject nearly $1 million a day of federal revenue into our economy. Failure to do that — because of Gov. Paul LePage’s vetoes, sustained by Republicans in the Legislature — has cost the people of Maine more than $300 million so far.

We can do much better than that. We need a simpler, less expensive system that includes everybody. We already have such system for seniors — it’s called “Medicare.” When Medicare was implemented by the federal government in 1965, 19 million people were enrolled within nine months, using index cards. There were no software glitches, no crashing websites and little confusion. There was no need to re-enroll every year. Once people are enrolled in Medicare, they stay in it for life.

We need to extend the benefits of Medicare to every Mainer and to every American. There are two ways we can accomplish this.

Congress could pass a new law expanding Medicare. There are bills in the House and the Senate that would do that. But we don’t need to wait for new national legislation. There is another way.

Starting in 2017, existing federal law allows individual states to design their own health care reform if it provides at least as many benefits at no greater cost. No more exchanges, mandates on businesses and individuals to buy private insurance, or hard-to-enforce tax penalties.

That opportunity shouldn’t be missed. Our neighbors in Vermont already have passed a law setting the goal of a single publicly financed health care system to include every Vermonter. They are now moving forward to implement that law. Rather than cutting more people from the rolls, Maine should retake its position as a national leader in health care.

The popular and successful Canadian health care system, which was once almost identical to ours, got started in one province: Saskatchewan. It was so successful that within 10 years it spread across the country.

According to William Hsiao, an internationally respected Harvard health care economist, we could save $1 billion a year in unnecessary administrative costs in Maine alone by making fundamental changes in the ways we finance health care. The money we save could then be invested in roads and bridges, improved public safety and educating our children. It would result in higher wages for our workers and would stimulate the creation of new businesses. It would free our people up to pursue their dreams, instead of being stuck in dead end jobs just to get health care benefits.

But those changes can’t and won’t be made without the full and energetic support of our people, our governor, our legislature and our entire congressional delegation.

That’s worth thinking about when you go to the polls Nov. 4.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.