Healthcare Access

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This issue is important to me personally because moving back to Maine from California I was shocked at how much my costs rose across the board.  Maine has about the 14th highest healthcare premiums in the country, and only average outcomes for most of the State.  Meanwhile NH next door has some of the lowest premiums in the country and better health outcomes.  I know that this is a real burden on households in current finances, and on families as lives are shorter, and harder.and I aim to make it better for us all.   Currently our Legislature as a whole is too busy blaming each other for the State of healthcare in Maine, and catering to their side's interests,.

To do that, I am going to present to you new ideas, that I am going to ask you to think about before dismissing.  These are not all ideas of my own creation, and I am not trying to change things alone.  That Legislature has a lot of people willing, and hoping to make change, who are stifled by being outnumbered by a party faithful.  I am going to have to speak truth to power, and that is frankly going to be uncomfortable for some of you who have developed this team mentality around the parties.  

I would ask you to consider what I am saying, and join me in becoming a force to make change.

Healthcare has been one of the hardest issues to  tackle, not only because it is such a large industry, but there seems to be some market forces or party influences that are bending the truth.  

Greater access to PCPs is a First term Priority for me.  In our system denying access to a PCP, is in most instances denying them access to healthcare.  This is why it is a big consumer fairness issue.  15% of the Maine health insurance market is entering a new plan each year.  A Market, where you can buy a health plan in December, and come January find out  you cannot see your doctor for months.

Here are my two proposals:

Every Insurance plan sold in the State of Maine provides two things:

1.  The time a new patient has to wait for an in person PCP appointment to be available in there system, listed as a metric, which consumers can judge plans on before buying.  

2.  Virtual Primary Care MUST be included in every  plan.  Not as a replacement for in person physicians, but to allow patients to not struggle to continue prescriptions or ongoing treatments.  

Let me preempt a couple common arguments:

It is too hard.  You are reading this online, but I am not sure how tech-savvy you might be.  Let me assure you, the Agentic-ai, with access to a Large Language model, that answers the phone and speaks to you like a human, when you call,  is also a whiz at spreadsheets.  There is not a technical hurdle to this.

There is no need because the law says you have to get a PCP appointment in 30 days, so no need for a virtual option.  And the only correct part of that, is that the people who passed the law say, that is what the law does.  But, here in reality the lobbyists got a hold of it and now the law basically says that a customer cannot start complaining before 30 days, which then leads to a grievance process that takes minimum three months, which is the same as saying you will probably get a PCP within 90 days.  Enough games.  Include the virtual option.  Denying access to patients first year is just a money grab.  It also adds anxiety, and burden to the consumer who now must set up an urgent care appointment for every prescription, or ongoing treatment.

These are clean and simple proposals with bipartisan appeal that can bring access in 2027 or 2028.

Have you ever watched one of those time-lapse videos of a flower blooming or a day passing by?  That is how I think of the Maine Healthcare market.  Over the years, I have seen Maine Health come into an area, buy a hospital, close the hospital, wonder earnestly, and publicly about the dangers of rising health costs.

Just like that flower we can think back to when Sanford had a hospital in the past.  Maine Health bought it, and now it is closed.  How Lincoln had a hospital, and Maine Health bought it.  And now it is closing it in the present, and now York has a hospital that is being bought by Maine Health ...  And yet.

Did you know that almost every Democratic Legislature from York County got together to congratulate themselves on expanding healthcare in the County, by letting the only two providers in the County consolidate?  That doesn't make any sense right, because the words 'consolidate', and 'expand' are nearly antonyms (words that mean the opposite of each other).   So what is happening here?  How  are these people some of whom I know and respect all getting together to do this, and cheering it on?

Here is how it is presented.  York hospital is not making enough money for its owners, and it will close.  That will leave no services in the area, and the health and safety of your constituents will be at risk.  But if you let this near my organization, Maine Health move in to the area, and get a larger cut of the healthcare business, then Maine Health might be inclined to keep some of those services open.  Especially the money making ones. So if you think of it that way and compare no services to what Maine Health will keep open, and consider no other options, then it may sound like 'expansion'.

But if you take out Maine Health and imagine Joe Peschi telling you 'his organization is going to move into to the area, take a larger percentage of the business, and if it does not happen people will not be safe', it sounds like the plot from Good Fellas, where the mob is running a protection racket.  And I am not saying Maine Health is running a protection racket, though a clearer distinction would be welcome.  What I am saying is that the power dynamic is the same.

If you look at Maine Health revenue.  Nearly half comes from Mainecare, and Medicare.  A third of the commercial side is from Municipalities, Fire, and Police departments etc.  The only way for these services to remain available is for Maine to pick up the costs through either direct pay or higher insurance premiums.  Without any competition Maine will never get out from under that nut.  

Here is my proposal"

Levy a fee on employers with over 50 employees.  That fee will be imposed for every employee that works for them, but is on Mainecare.  Use that money to buy and build healthcare facilities in Maine.  

Let me again preempt some arguments from entrenched stakeholders:

"No one does this":  New Jersey is doing something similar, but without the specific target.  

This forces employers to provide healthcare.  It does not.  The employer has a choice of 

a.  Paying for the employees healthcare which is a 100% tax-deductible expense.  OR

b.  Pay the fee on the earnings saved by not providing healthcare.

The hope is that this will incentivize employers to provide health care.  For those who make the business choice not to, their fees will create a pool of revenue that should be targeted to providing healthcare.