MAINE MEDICAL ASSOCIATION

2018 ANNUAL REPORT OF THE COMMITTEE ON LEGISLATION

by

Stephen Meister, MD, Chair

The 186 legislators comprising the 128^th Maine Legislature began their Second Regular Session at the State House in Augusta on January 3, 2018 and adjourned it sine die on April 18, 2018 during a period of bitter partisan disagreement within the legislature and between the legislature and Republican Governor Paul LePage.  They departed the State House leaving much unfinished business, including most bills on the Appropriations Table.  Among the tabled items are several important initiatives to address the opioid drug abuse crisis. 

Following a needed break, legislators returned to Augusta to begin their First Special Session on June 19^th and were in session through June 21^st, followed by a “veto day” on July 9^th.  Anticipating legislation on the state’s child protective services system from Governor LePage in the aftermath of two high profile child abuse deaths, the legislative leaders did not adjourn the special session sine die.  The Governor’s package of 5 bills, L.D.s 1919-1923, became available to the public during the week of August 20^th and the Health & Human Services Committee held both a hearing and work session on those bills on Monday, August 27^th.  The full legislature reconvened the special session on Thursday, August 30^th to consider these bills. 

Most witnesses at the public hearing on the child protective services bills agreed with the Governor that improvements are needed and supported additional resources for the system found in L.D. 1923, but sharp differences in opinion emerged about the allocation of any new spending.  The MMA and the Maine Chapter of the American Academy of Pediatrics were concerned by the Governor’s proposal to criminalize “failure to report” indicators of child abuse or neglect, and the organizations testified against the bill.  A majority of the HHS Committee voted “ought not to pass” on L.D. 1919 on August 27^th and following a roll call vote on August 30^th, the House defeated the bill 72-53.  The Senate followed with an unrecorded vote accepting the majority “ought not to pass” report.  The legislature enacted the other four bills in the Governor’s package, L.D.s 1920-1923.  L.D. 1923 is a multi-part funding bill providing more resources for the child protective services system.  The legislature is expected to return for another “veto day” at a date yet to be chosen in September.

The clinical and public policy response to the state’s continuing opioid drug abuse crisis has remained a focus of legislators during the 2018 sessions.  The recommendations of an Opioid Task Force created by Joint Order during the 2017 session have informed legislators’ discussions about the crisis.  You can find the Task Force’s Final Report on the web here: http://legislature.maine.gov/uploads/originals/opioidtffinalrpt-3.pdf.  Two important bills addressing the opioid crisis that became law despite the Governor’s objections during this session are L.D. 1871, An Act To Implement the Recommendations of the Task Force To Address the Opioid Crisis in the State Regarding Respectful Language (P.L. 2017, Chapter 407) [replacing dated terminology with the term “substance use disorder”] and L.D. 925, An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government (P.L. 2017, Chapter 460), a budget bill that includes several provisions addressing the opioid abuse crisis.  Part E of the bill provides a 15% increase in reimbursement rates for medication management under MaineCare Benefits Manual, Chapter III, Section 65, Behavioral Health Services.  Part G of the bill requires DHHS to support a “hub-and-spoke” system for the treatment and recovery of individuals with substance use disorder.  Part J of the bill provides additional funding to support the State’s drug court system.

Along with allied advocacy groups, the MMA continues its work with the legislature and the public in pursuit of ACA Medicaid expansion.  During the recent special session, Governor LePage vetoed a Medicaid expansion bill for the seventh time and his veto was sustained in the House by an 85-58 vote.  The Medicaid expansion issue also remains in litigation now before the Maine Supreme Judicial Court.  In mid-August, the Law Court ordered the LePage Administration to proceed with implementation of the voter-approved law.

Since January, the MMA has been at the State House presenting physicians’ views on a variety of bills dealing with aspects of health insurance, public health, mental health and substance abuse, children’s issues, medical and recreational marijuana, professional regulation, and other health policy before the legislature. 

The 128^th Maine Legislature includes three physicians, all returning incumbents.  The senior member of the “physician caucus” is Senator Geoffrey Gratwick, M.D. (D–Senate District 9, Bangor & Hermon) and he is a retired rheumatologist serving his third term in the Senate who sits on the Environment & Natural Resources Committee.  The two physician members of the Maine House are Representative Patricia Hymanson, M.D. (D–House District 4, Ogunquit and parts of Wells, York, & Sanford) and Representative Heidi Brooks, M.D. (D–House District 61, part of Lewiston).  Representative Hymanson is a retired neurologist who serves as the House Chair of the Health & Human Services Committee and Representative Brooks is trained as a family physician and she sits on the Insurance & Financial Services Committee.  Both representatives are serving their second terms. 

The 128^th Legislature has a very close partisan division.  The Senate is composed of 18 Republicans and 17 Democrats.  The House of Representatives includes 73 Democrats, 70 Republicans, 1 Green Independent, 5 Independents, and 1 Common Sense Independent.  Candidates for the 129^th Maine Legislature include 8 physicians, 3 incumbents and 5 newcomers.  If you have not done so already, now is a great time to get to know the candidates for the General Election to be held on November 6, 2018.  You can find the General Election information on the web here:  http://www.maine.gov/sos/cec/elec/upcoming/index.html. 

In addition to the candidates for the 129^th Legislature, the MMA is also concerned about the impact that November’s ballot initiative Question 1 may have on physician recruitment and retention. The “Universal Home Care Program” will create a program to provide home based assistance to the elderly and people with disabilities funded by a new 3.8% tax on adjusted gross income of individuals and families earning more than $128,400. Details of this ballot initiative can be found here:

https://www.maine.gov/sos/cec/elec/citizens/uhcleg.pdf.

The MMA offers several tools to assist you and your staff with your efforts to comply with the new laws enacted by the 128^th Legislature.  The first tool is a PowerPoint presentation of the highlights of the previous legislature’s work with an emphasis on day-to-day practice management issues.  The next tool is an Excel spreadsheet legislative summary of every bill tracked by the MMA advocacy team during the previous legislature.  You can find the tracking list document on the web at:  https://www.mainemed.com/sites/default/files/content/testimony/128th_LD_Tracker_032018.pdf.

Once the 128^th Legislature completes its work, the MMA also will prepare a summary of highlights of the 2017-2018 sessions.

Most bills become effective 90 days after adjournment of the legislature and for the Second Regular Session, that date is August 1, 2018.  Emergency legislation becomes effective immediately upon the Governor’s signature and some bills include a specific effective date.  Because the First Special Session has not yet adjourned, the general effective date for its legislation has not yet been determined.  

I believe that the 2018 session was a successful one for the MMA and Maine physicians in a very difficult political environment, and I would like to thank all the MMA members who contributed to our advocacy activities this year - - Legislative Committee members, participants in our weekly conference calls (participation was excellent, with wide representation from a number of specialties), those who served as "Doctor of the Day" at the State House, witnesses at legislative public hearings, and contributors to the Maine Physicians Action Fund, the MMA's affiliated political action committee.  All of you made substantial contributions to a successful year of advocacy for physicians and patients in the Maine legislature and executive branch agencies.  I would also like to thank the MMA staff for their competent guidance of our advocacy efforts. 

The 129^th Maine Legislature will be seated in December and will begin work in early January 2019.  The MMA staff welcomes input from individual members, practices, or specialty societies on the MMA’s legislative agenda for the next legislature.

For more information about the MMA's advocacy work, please contact me or Gordon, Andy, or Peter.  If you are interested in participating in the MMA’s advocacy work in 2019, look in the Maine Medicine Weekly Update for a notice of the next organizational meeting of the Legislative Committee to be scheduled in late November or early December.