June 9, 2003

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Joint Select Committee on Health Care Reform Passes Dirigo Health Plan
On Friday, June 6th, the Legislature's Joint Select Committee on Health Care Reform gave the Governor's amended Dirigo Health Plan proposal a favorable "ought to pass as amended" report. The full legislature is expected to vote on the Plan this coming week.
Last week, the Governor's Office of Health Policy & Finance and various stakeholder groups, including MMA, redrafted L.D. l611 to incorporate the amendments agreed to in the compromise achieved by the various parties the previous week.  Upon viewing the final language on the health insurance premium assesment, (now called a "savings offset payment") the Committee voted 9-5 "ought to pass as amended."   The vote was largely upon party lines, with all Democrats present voting for the proposal and all the Republicans except Sen. Arthur Mayo (R, Bath) voting against the bill.

Republicans on Friday argued that the Committee members were being rushed to a vote and that the weekend should be used to review the new and complex language in the amendment.  The majority responded that the Committee would follow common practice and vote pending review of the final language this comming wek.

The major issue creating controversy last week was the potential impact of a "pass-through" of the4% premium assessment to health insurance premium payors. Consumer groups, the Maine State Chamber of Commerce and the Maine State Employees Association all objected strongly to the "pass through" and were not satisfied with the GOHP&F  staff explanation that the assessment would be re-captured through a reduction or avoidance of bad debt and charity care, because of the new enrollees in Dirigo Health.  So in addition to working on other amendments to the bill, much of the past week was dedicated to trying to find a compromise on the assessment language.

On Thursday afternoon, GOHPF Director Trish Riley announced to the Joint Select Committee that she was close to finding an alternative funding source and promised to brief members at the work session on Friday.  On Friday, it was revealed that the Governor's Office had agreed to have the state fund the first year of the assessment from the new federal monies recently made available.  These funds will amount to $53 million to cover the first year of the plan from 7/1/04 to 6/30/05.  The assessment is now being called a "savings offset payment" and is being linked even moreclosely  to "reflect aggregate measurable cost savings, including any reduction or avoidance of bad debt and charity care costs to health care providers in the state, as a result of the operation of Dirigo Health and any increased enrollment due to an expansion in MaineCare eligibility occuring on June 30, 2004.

The Joint Select Committee will meet again on Monday afternoon (6/9) to continue to review the final language in the amended bill.  The amendments of most interest to the Association were prepared by MMA staff last week and, for the most part, were accepted by Committee staff for inclusion in the final bill.  While the proposal is by no means perfect,  Association staff and leadership believe it represents a legitimate compromise and that it is acceptable.  For more details on any of the amendments, please feel free to contact Andrew MacLean or Gordon Smith at amaclean@mainemed.com and gsmith@mainemed.com respectively.  Or just give them a call at 622-3374.

Constitutional Amendment to Protect the Fund for a Healthy Maine to be Considered this Week
The Joint Select Committee on Health Care Reform discussed but did not vote this past week on L.D. l612 which proposes a constitutional amendment to ensure that the Fund for a Healthy Maine is invested in the future of our health care system rather than used for unrelated purposes.  Because passage of the proposal requires a two-thirds vote just to get the question on the ballot, prospects are unfortunately not as good as we may have hoped.  Certainly there is still a chance that the political circumstances will change and that the necessary votes can be found, but in the meantime, please help by talking with your legislator about the need to pass L.D. 1612.  Talking points are available on the MMA website at www.mainemed.com. [return to top]

Smoking in Maine Bars Soon to be History
Based upon very strong votes in both the House and Senate this past week, it now appears that L.D. 1346, An Act to Protect Workers from Second Hand Smoke and to Promote Worker Safety will pass and be sent to the Appropriations table on its way to the Governor's office.  If signed into law, as expected, the effective date of the prohibition will be January 1, 2004.

Congratulations to the Maine Coalition on Smoking OR Health and other grassrotts support for the anticipated passage of this landmark legislation.  Jo Linder, M.D., of the Associaton's Committee on Public Health chairs the Coalition. [return to top]

MMA Executive Committee to Meet Wednesday
MMA's 26-member Executive Committee meets on Wednesday (6/11) to cosider a number of internal and external items.  Chaired by Lawrence Mutty, M.D. of Castine, the Committee will focus its attention on the Governor's Dirigo Health Plan and will also review an amended budget for the current year.  The Committee will also hear reports from the Payor Liaison Committee, the Committee on Physician Health and the AMA delegation.  Reports will also be presented on the proposed settlement of the class action suit against Aetna, the expanded MaineCare drug program and the legislative review of the effort by acupuncturists to pull a dozen or more eastern medicine modalities under their licensing umbrella, a proposal the Association strongly opposes.

Plans will be advanced regarding the Annual Session being held Sept. 5-7 at the Balsams Gand Resort Hotel and the Sesquicentennail Gala planned for Nov. 8th in Portland. [return to top]

Work on Merger of DHHS and Department of Behavioral and Developmental Services Begins
The new Council charged with creating the legislation to combine the Departments of Human Services and Behavioral and Developmental Services met for the first time this past week.  Chairing the Council is former Labor Commissioner Valarie Landry.  The Council is comprised of representatives of interested parties in the restructuring, including HHS Committee House Chair Thomas Kane (D, Saco), former CMP Executive David Flanagan and several others.

The Council must report back to the Legislature with suggested legislation in January, 2004. [return to top]

MMA Legislative Committee to Meet Tuesday Night on Dirigo Health Plan
MMA's Legislative Committee will meet at the MMA office in Manchester on Tuesday, June 10th at 6:00pm.  Dinner will be served.  The major purpose of the meeting is to review the amendments to the Governor's Dirigo Health Proposal.

Any member of the Association is invited to attend the meeting.  If you are attending, please give Charyl Smith at MMA a call at 622-3374 or via e-mail at csmith@mainemed.com. [return to top]

Maine RX Re-worked; Legislature Expected to Act
Governor Baldacci announced on May 30th his intention to submit a redesigned and relabeled Maine RX program to the Legislature now that the U.S. Supreme Court has ruled that the State may continue the program.

In late May, the U.S. Supreme Court, in a widely watched and reported decision, ruled that the State could continue to implement the law that permitted the state to provide discounted prescription drugs to residents through additional rebates collected from pharmaceutical companies that provide prescription drugs to the medicaid population.  The program, previously called Maine RX, was challenged in court by the Pharmaceutical Research and Manufacturers of America.  (PhARMA).  Under the program, if a company did not enter into a supplemental rebate agreement, that company's prescription drugs would be subject to a "prior authorization" requirement before they could be prescribed to medicaid patients.

The Supreme Court rejected the argument raised by PhARMA that this program was violative of the Interstate Commerce Clause, but the court did note that it "offered no view as to whether it would be appropriate for the Secretary of Health and Human Services to disapprove the program"',  thus giving PhARMA another avenue to challenge the program.

The new program announced by the Governor will be called Maine RX Plus and will provide discounts to fewer people than originally intended.  However, it is likely that the discounts available to the fewer patients will be more substantial than intended or expected in the original program.  And more significantly, state officials believe that the new discounts can be offered without having to negotiate rebates with drug manufacturers.  It is hoped that the new program will offer lower drug prices to about 275,000 persons.  The original plan was to have covered as many as 325,000 persons. Eligibility in Maine RX Plus will be limited to persons earning below 350% of the federal poverty level.

The Supreme Court ruling issued on May 19th lifted a 3-year injunction that had prevented the program from being implemented. [return to top]

Medicare Geographic Equity Coalition Establishes Website
The Geographic Equity in Medicare (GEM) Coalition, to which MMA belongs,  has established a website.  The site contains an explanation of the issue, talking points for discussions with legislators and a list of the states and specialty societies participating.  The goal of the coalition is to establish a national fee schedule for Medicare that does not vary rates by geographic region.  Under the current system, Maine physicians receive up to 40%  less than physicians providing the same service  in an urban area.

To see the site, click on www.iowamedical.org.  Once in the site, click on the GEM logo on the far righthand side of the site.  The Medical Society in Iowa has led the coaltion very ably and is making the site available through its own website. [return to top]

American Medical Association to Convene Annual Meeting Saturday
The American Medical Association begins its Annual Meeting on Saturday, June 14th, in Chicago.  Attending the meeting from Maine will be the two AMA delegates, David Simmons, M.D. and RIchard Evans, M.D. and the two alternate delegates John Makin, M.D. and John Garofalo, M.D. 

Policy issues focused on at the meeting will include professional liability reform and Medicare physician payment rates.  Internal issues include resolution of the much discussed proposal to transform the AMA into an Organization of Organizations, rather than basing membership strictly on individual physicians.

MMA members wishing to share ideas with the delegation may communicate via e-mail to any of the delegation members at the e-mail addresses noted below.

                      David Simmons, M.D.  topdoc@nbnet.nb.ca

                      Richard Evans, M.D.    raevans95@earthlink.net

                      John Makin, M.D.           john2@gwi.net

                       John Garofalo, M.D.      garofalo@gwi.net [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association