May 9, 2011

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Maine House Passes Health Insurance Reform Bill on First Reading, 76-72.

In a straight party-line vote, Republicans in the Maine House on Thursday gave initial approval to a package of changes to Maine's health insurance laws that are intended to make Maine's health insurance market more competitive.  Republicans say that the changes will bring younger, healthier Mainers into the market.  Democrats countered that the provisions would raise premiums for those older citizens, those with chronic conditions, and those who live in rural areas.  While there are some provisions in in the bill deserving of support, MMA opposes the bill at this time primarily because of its repeal of provisions in the insurance code that provide protections to physicians and other health care providers.

While the process the Joint Standing Committee on Insurance & Financial Services (IFS) followed in getting the bill out of committee (also on a strict party-line vote) also left a lot to be desired, it is the unintended consequences of some of the provisions that are of most concern to MMA.  In addition, the lack of a consensus process to look for common ground between the parties is also very disappointing.

Much of the work during this session has been very collaborative, with the work of the Appropriations Committee on the budget perhaps the best example.  But the IFS Committee has not followed the lead of other committees and the bill, L.D. 1333, was expanded at the last minute to encompass a number of provisions in other bills.  A 45-page amendment that replaced the original bill and a prior 29-page amendment was presented only 24 hours before the House vote, making it difficult if not impossible, to consider the implications of many of the bill's provisions.  And some of these are very complex such as expanding community rating bands, the geographical access standards in rule Chapter 850, authorization for captive insurance organizations to provide health insurance, and the proposal to allow the sale of products over state lines.  The bill also would establish a high risk pool that would insure those individuals with chronic conditions or who are otherwise at high risk.  The pool would be partially paid for by an assessment of $4.00 per month on all private policies.  Finally, and perhaps the most incomprehensible, is a provision repealing the State Health Plan and abolishing the Health System Development Advisory Council.

A second vote in the House is expected tomorrow, May 10th, at which time several amendments will be considered.  A Senate vote could happen as early as Thursday.  MMA advocates are encouraging Senators to re-commit the bill back to the IFS committee for more work, including an attempt to look for common ground.

"As we saw in the case of the federal ACA, bills that make significant changes in policy are treated by the public as dead on arrival when citizens believe that one party over-reached and that the implications of the legislation have not been well understood and thought out," noted Gordon Smith, MMA EVP.  "Both parties are capable of this kind of behavior, and the result is public cynicism and hyper-partisanship rather than collaborative leadership."

In addition to MMA, the Maine Hospital Association has also expressed opposition to several provisions in the bill that would adversely impact rural areas.  The Maine Primary Care Association opposes the bill, as does the AARP and several consumer groups.  Even the State Chamber of Commerce has not endorsed the bill, preferring to be "neither for nor against" at this point.  Last month, the Chamber spoke against the bills that authorized the purchase of insurance over state lines.

MMA members are invited to participate in the weekly conference call with the legislative committee where the bill will be discussed in more detail.  The calls are held each week at 8:00 pm on Tuesday evening.  Details can be found in the related article below.

The original version of L.D. 1333 was sponsored by Representative Wes Richardson (R-Warren) who is the House Chair of the IFS Committee.  The majority report will do the following:

  • It changes the maximum rate differential for individual health plans on the basis of age from 1.5:1 to 5:1.  The changes in rating for individual health plans are phased in over a period of 4 years.
  • It changes the maximum rate differential for small group health plans on the basis of age and occupation or industry from 1.5:1 to 5:1.  The changes in rating for small group health plans are phased in over a period of 4 years.
  • It authorizes a maximum rate differential on the basis of smoking status from 1.5 to 1.
  • It allows rating on the basis of geographic area outside of the rating bands for age.
  • It repeals guaranteed issue and renewal requirements for individual health insurance.
  • It creates a high-risk pool called the Maine Guaranteed Access Plan Association funded through an assessment on insurers.
  • It permits insurers authorized to transact individual health insurance in any state to offer their individual health plans for sale in this state if certain requirements of Maine law are met, including minimum capital and surplus and reserve requirements, disclosure and reporting requirements and grievance procedures.  
  • It adopts the federal definition of medical loss ratio and the minimum medical loss ratio requirements of federal law.  It allows individual health insurance rates to be filed for informational purposes without prior approval by the Bureau of Insurance if the insurer maintains a minimum 80% medical loss ratio.
  • It repeals the requirement for a State Health Plan and the Advisory Council on Health Systems Development.  It also deletes all statutory references to the Governor's Office of Health Policy & Finance.
  • It repeals the geographic access standards.  It repeals the authorization for the Superintendent of Insurance to establish standardized individual health plans by rule.  
  • It authorizes the issuance of short-term health insurance policies for a term not to exceed 24 months.
  • It provides a tax credit to employers of 20 or fewer employees for the expense of developing, instituting and maintaining wellness programs for their employees in the amount of $100 per employee, up to a maximum of $2000.
  • Finally, the bill would establish new standards for captive insurers to provide health insurance coverage.


Medical Organizations Join in Opposition to Mandatory Provisions of L.D. 1501

L.D. 1501, An Act to Reduce Opioid Overprescription, Overuse and Abuse was the subject of a lengthy public hearing this morning, May 9th, before the Health & Human Services Committee.  Introduced by Representative Jon Hinck (D-Portland), the bill attempts to address the state's serious problem of prescription drug abuse and diversion.  

While well-intended, the proposal as drafted would have a significant adverse impact on treatment of chronic pain.  In addition to requiring use of the Prescription Monitoring Program (PMP), the bill also would mandate referrals to pain specialists, CME on this issue, and virtually puts into statute the guidelines currently in Joint Rule 21 on treating patients with chronic pain.  

While acknowledging the serious problem, representatives from MMA and the following organizations asked that the bill be "carried over" to the second session and that a stakeholders' group be formed to work collaboratively  on these issues.  MMA suggested that the group be convened by the Maine Substance Abuse Services Commission, an advisory group to the Office of Substance Abuse.

The opponents to the bill included:

  • The Maine Medical Association

  • The Maine Osteopathic Association

  • The Maine Hospice Council

  • The Maine Chapter of the National Association of Social Workers

  • Joseph Py, D.O.

  • The Maine Civil Liberties Union

  • Hannaford Brothers (opposing the requirement that pharmacies see a photo id on all such prescriptions)

Those speaking "neither for, nor against" the bill included:

  • Stephen Hull, M.D.

  • Mark Publicker, M.D.

  • Maine Office of Substance Abuse

  • Maine Primary Care Association

While testifying in the category of "neither for, nor against," Dr. Hull's testimony on behalf of himself and Dr. Publicker noted several problems with the bill as drafted and expressed concern that passage of the bill would adversely affect access to appropriately prescribed opioid analgesics.

The bill will be worked by the Committee later this week, perhaps as early as tomorrow afternoon.  The MMA joined a group of stakeholders in negotiating the bill for about an hour immediately following the public hearing.

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MICIS Now Offers Atrial Fibrillation Module

Atrial Fibrillation Module NOW Available!!!

Slow(er), even if not steady, wins the race

The Maine Independent Clinical Information Service is launching a new academic detailing module on the management of atrial fibrillation.  Atrial fibrillation (AF) is the most common arrhythmia, affecting nearly 2.5 million Americans.  Because its prevalence rises rapidly over 60 years of age, this number is likely to increase significantly as the population ages.  Regardless of underlying causes, or if no cause be found, the patient should be evaluated for rate or rhythm control.  Rate control appears to cause fewer adverse drug effects and hospitalizations than rhythm control.

AF is a major cause of stroke, but treatment can reduce that risk by two-thirds. Most AF patients will require long-term anticoagulant or anti-platelet medication to reduce their risk of stroke however, there is ample evidence that anticoagulation is vastly under-utilized in patients with AF, particularly the elderly. This appears to result from an incorrect assumption that the risks of bleeding from these regimens are greater than the risk of stroke, which is generally not the case.

This module covers the following important information for the care of patients with AF:

Treatment targets: Control the rate, or control the rhythm?

Beta blockers, calcium channel blockers, digoxin and antiarrhythmics

Using the CHADS2 scoring system and the HAS-BLED risk index to guide thromboprophylactic therapy

Aspirin, clopidogrel, warfarin and dabigatran

For more information, or to request an educational session at no cost to your practice, contact the Maine Medical Association: 207.622.3374 or

For more information on MICIS and academic detailing, visit:

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New CDC Director Sheila Pinette, D.O. to Present at 20th Annual Practice Education Seminar, May 18

MMA's 20th Annual Practice Education Seminar, being held again this year at the Augusta Civic Center, will feature presentations on a number of topics that members say are difficult for them to get their hands around.  The program will be held on Wednesday, May 18, 2011 from 8:30 a.m. to 4:30 p.m.  Registrations materials were mailed to all MMA members and practice managers two weeks ago.

This past week, new Maine CDC Director Sheila Pinette, D.O. confirmed that she will attend the Seminar in the morning and provide some brief remarks shortly before the 10:30 a.m. break.  Dr. Pinette began her work at the Center this past Monday. 

Among the topics are the following: 

  • Measuring Quality in a physician practice;
  • What's New at Medicare;
  • Achieving Meaningful Use in a Meaningful Way;
  • Preparing for Accountable Care Organizations;
  • Addressing Issues with Elderly Drivers;
  • Social Media in Your Practice:  Friend or Foe; and
  • Preventing Prescription Drug Abuse

 In addition to Dr. Pinette, other presenters include Insurance Superintendent Mila Koffman, J.D., John Freedman, M.D. of Freedman HealthCare, Thomas Arnold, Deputy Secretary of State and Elizabeth Mitchell, President of the Maine Health Management Coalition, and William Kassler, M.D., Medical Director of Region I, Centers for Medicaid and Medicare Services (CMS).

Interested individuals may also register now on the MMA website at  For one information on the Annual Seminar, contact Gail Begin at MMA via e-mail to




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McAfee vs. Gamache: Legislature's LCRED Committee Hears Bill to Bring Prize-Fighting Back to Maine

On this past Tuesday, the legislature's Labor, Commerce, Research & Economic Development Committee (LCRED) held a public hearing on L.D. 889, An Act to Regulate Boxing and Prizefighting in Maine.  Professional boxing in the state has been illegal since 2005 when the Maine Athletic Commission was abolished, because of both a perceived lack of interest in and a growing recognition that repeated blows to the unprotected head of an opponent can result in permanent brain damage. 

While the bill was supported by former boxing sensation Joey Gamache, his father/coach/manager Joe Gamache, Sr., and many other former boxers and current trainers, former MMA and AMA President Robert E. McAfee, M.D. more than held his own as the only opponent to the bill.  Dr. McAfee noted that he was a former boxer himself and a former ringside physician at many fight cards in Portland, his hometown and the city where he practiced vascular and general surgery for more than forty years.  In his opposition testimony, he cited the increased awareness of post-concussion syndrome in all sports as a reason for upholding the current ban on professional boxing in the state.  While amateur boxing is allowed, amateur boxers wear protective headgear.  Professional boxers, most emphatically, do not.

Dr. McAfee noted Muhammad Ali's long battle with dementia and Sugar Ray Leonard's bilateral retinal detachment.  When challenged by committee members about the dangers inherent in all sports, Dr. McAfee pointed out that in no other sport was the object to injure your opponent - even to knock your opponent unconscious.  The American Medical Association called for the abolition of boxing more than twenty-five years ago, based upon the evidence shown by new imaging technology that significant anatomic changes to the brain of boxers occurred after as little as one fight, one knockdown or one concussion.

MMA also opposes L.D. 889 but passage is likely, as the current popularity of Mixed Martial Arts competition is noted by legislators and this Legislature has shown a propensity to value economic activity over public health (i.e., removing the current ban on fireworks).  The bill would rename the current Mixed Martial Arts Authority with the new name being the Combat Sports Authority.  The bill's sponsor is Representative Matt Peterson (D-Rumford).  Representative Peterson was also instrumental in the establishment of the Mixed Martial Arts Authority.

A work session on the bill will take place this coming week.  Despite Dr. McAfee's TKO, an "ought to pass" report is expected. [return to top]

CMS Releases 2009 Quality Measurement & E-Prescribing Data Report

On April 19th, the Centers for Medicare & Medicaid Services (CMS) released its 2009 Physician Quality Reporting System (PQRS) and e-prescribing incentive program experience report.  According to the report, 119,804 physicians and other eligible professionals in 12,647 practices satisfactorily reported on quality measures to Medicare and received an incentive payment.  The average 2009 PQRS incentive payment was $1956 per eligible professional and $18,525 per practice.  For the 2009 e-prescribing program, the average incentive payment was just over $3000 per eligible professional and $14,501 per practice.  While participation in both programs increased, successful participation in the 2009 PQRS program was around 56%, and 57% for the 2009 e-prescribing program.  In an effort to improve successful participation in both CMS programs, the AMA continues to advocate for more timely and meaningful participation feedback and outreach.  The full 2009 PQRS and e-Prescribing Experience Report is available on the CMS web site at: [return to top]

BNN Learning Center & MMA Offer Upcoming Coding Certification Course at USM

The Learning Center at Baker Newman Noyes in conjunction with the Maine Medical Association is offering a AAPC Approved Coding Certification course.

´  Thursdays, June 9, 2011 to September 22, 2011

´  4:00pm – 8:00pm

´  University of Southern Maine in Portland (#1 Payson Smith Room)

Click Here for the link to the Learning Center’s website for additional details and a Registration form.

Should you have any questions, please don’t hesitate to contact either the Learning Center or Hayat Freeman-Lutes, CPC, CEMC at 207-791-7126 begin_of_the_skype_highlighting            207-791-7126      end_of_the_skype_highlighting. [return to top]

AMA Discusses New Opioid Strategy with White House

The AMA met recently with senior officials in Vice President Biden's office and the White House Office of National Drug Control Policy to discuss the Administration's recently released plan to combat prescription drug abuse. The plan responds to several past AMA recommendations for addressing the diversion and abuse of opioids, such as:

  1. Providing a coordinated multiagency approach with a public health focus;

  2. Encouraging more states to adopt prescription monitoring programs; and

  3. Placing a priority on physician and patient education to improve prescribing and prevent abuse and diversion.

The AMA pointed out that state prescription drug monitoring programs need to provide real-time access for physicians at the point of care, with a continued focus on patient safety rather than punitive measures.  While offering to work with the Administration on further developing its educational strategies, the AMA expressed strong concern about the Food & Drug Administration's Risk Evaluation and Mitigation Strategy (REMS) for long-acting and extended release opioids because, as currently outlined, it assigns an inappropriate role to manufacturers.  The AMA also pointed out that any plan to link continuing medical education programs in pain management to the Drug Enforcement Administration (DEA) registration process must carefully balance the need to prevent drug diversion against patient access to opioids when medically appropriate.  White House officials stated they have no plans to raise DEA fees to fund the national strategy's enhanced educational programs.

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SAVE THE DATE: Pierce Atwood Labor & Employment Seminars, Co-sponsored by MMA, June 10th & 17th

Save the Date! Pierce Atwood Program in your area June 10 & 17:

Labor & Employment Issues for the Maine Healthcare Industry

 Brewer & Portland, Maine

Date: June 10 and 17, 2011
Time: 8:30 AM - 3:00 PM

The Pierce Atwood Employment Group, with our co-sponsor Maine Medical Association, is pleased to invite you to a program on Labor & Employment Issues in the Healthcare Industry.  We will be offering this program twice.

  • June 10, also sponsored and hosted by Eastern Maine Healthcare Systems, at the EMHS Brewer office 
  • June 17, also sponsored by Martin's Point HealthCare, at The Woodlands Club in Falmouth

Our tentative agenda includes the following topics:

  • Managing the impaired worker
  • Wage-hour challenges for healthcare employers
  • The latest on union activities around the state including, Maine State Nurses Association/California Nurses Association, Teamsters and others
  • Significant developments in Augusta and Washington
  • Immigration issues in the healthcare industry
  • HIPAA, privacy and technology, including duties of employers and employees
  • Special guest Short Fuse Theater: "Coping with the high performing, high risk healthcare employee". (Portland only) 
  • Rapid-fire round - questions and answers on topics across the labor & employment spectrum

Our agenda is tentative because we want your help in shaping it.  When you register, please use the box on the registration screen to suggest questions or topics you'd like to see us address.  We'll synthesize your responses and incorporate as many as we can into our presentation.

Also, when registering, please indicate which program you wish to attend.

This program will be of interest to senior management, human resources management and staff, in-house counsel, risk managers and upper level supervisors.  Please forward to any interested persons in your organization.

The program will run from 8:30 am to approximately 3:00 pm.  There is no charge to register, and lunch will be served.  Our sincere thanks to our co-sponsors for helping to make these events possible.

Please check your email box for a reminder in the next couple of weeks.

If you have any questions, please contact Amber Elliott at or 207-791-1143.

Copyright � 2011. Pierce Atwood LLP. All rights reserved.

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Attend the EHR Educational Events For Critical Access Hospitals and Primary Care Providers

MEREC, in partnership with Quality Counts, will be hosting the second in a series of free regional forums about electronic health records, meaningful use, and related federal and state incentive programs.  The forums are specifically targeted for primary care providers and staff of small independent practices as well as clinical and administrative staff in Maine’s rural and critical access hospitals.  The events will include a panel of health information technology experts, both local and national, a specific discussion on the integration of HIT in the patient centered medical home, and as group breakout sessions focused on using EHRs (inpatient and outpatient) to improve health care quality and outcomes, reduce costs and ultimately achieve federal meaningful use requirements.  Hope to see you at one of the following events:

•       Franklin Memorial Hospital:  Tues, May 10, 1:30 - 5:30 p.m.
•       Mt. Desert Island Hospital:  Wed, May 11, 2 - 6 p.m.
•       Mayo Hospital:  Wed, May 25, 2 - 6 p.m.
•       Goodall Hospital:  Wed, Jun 1, 2 - 6 p.m.

Register online at or by calling Maria Stevenson at 207-541-9250 begin_of_the_skype_highlighting            207-541-9250      end_of_the_skype_highlighting, ext 201.

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AMA Recommends Medicare Payment Reforms to House Committee

On April 26th, the AMA sent a letter in response to a bipartisan request from the House Energy & Commerce Committee dated March 28th, asking for suggestions on reforming the Medicare physician payment system.  In the letter, the AMA laid out a 3-pronged approach to reform:

  1. repeal the sustainable growth rate (SGR) formula;

  2. provide five years of stable payments with positive updates; and

  3. transition to an array of new payment structures.

The proposal envisions using the 5-year transition period to develop and test various new payment structures designed to enhance care coordination, quality and appropriateness, and to reduce costs.  The letter also provides background on some of these options, such as accountable care organizations and episode of care bundles, as well as some transitional models.  Dr. Cecil B. Wilson, President of the AMA, also testified before the House Energy & Commerce Subcommittee on Health regarding the AMA's proposal at a hearing on May 5th, entitled, "The Need to Move Beyond the SGR."  In his testimony, Dr. Wilson highlighted the AMA's support for creating a new Medicare payment option that will allow patients to contract freely with physicians without penalty.

You can see a press release regarding Dr. Wilson appearance along with a link to his testimony on the web at:

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Legislative Committee Conference Call This Tuesday; New Bills for Review

The MMA's Legislative Committee will hold its next weekly conference call this Tuesday, May 10th at 8:00 p.m.  Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239 begin_of_the_skype_highlighting            1-877-669-3239      end_of_the_skype_highlighting

Passcode:  23045263

The purpose of the weekly conference calls is to review and finalize the MMA's position on bills printed that week, to hear the views of specialty societies on the new bills or their concerns about any health policy issues, and to discuss the highlights of legislative action that week.  The calls rarely last longer than an hour and usually we can accomplish our business in much less time.

If you have any questions about the conference calls, please contact Andrew MacLean, Deputy EVP at or 622-3374, ext. 214.

 The following bills of interest to the physician community have been printed since last week's call and will be discussed on Tuesday.  For each bill, MMA Deputy EVP Andrew MacLean has proposed a staff recommendation for the MMA's position (support, oppose, monitor) and any specialty society or MMA committee that may be particularly interested in the bill.  Clicking on the "L.D. XX" will take you to the summary page on the legislature's web site showing you the procedural status of the bill.  To find the bill text for review, click on the "Bill Text and Other Docs" tab on the left side of the page.

Priority bills for discussion:

 L.D. 1551, An Act to Clarify and Update the Laws Related to Health Insurance, Insurance Producer Licensing and Surplus Lines Insurance (monitor; check balance billing provision for consistency with HMO Act)

L.D. 1554, An Act to Implement the Requirements of the Federal Patient Protection and Affordable Care Act (monitor)

Consent bills for discussion only if requested by a call participant:

L.D. 1537, An Act to Amend Licensing and Certification Laws Administered by the Department of Health & Human Services (monitor)

L.D. 1548, An Act to Update and Improve Maine's Laws Pertaining to the Rights of Persons with Intellectual Disabilities (monitor; psychiatrists)


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POLITICAL PULSE: Legislative Highlights of the Week


Late last week, the Appropriations & Financial Affairs Committee received the Governor's proposed "change package" to his FY 2012-2013 biennial budget (L.D. 1043).  Some key aspects of the health care provisions in the change package include:

  • $16.8 M in savings in the second year of the biennium from certification of the MIHMS and receipt of enhanced match for the certified system;
  • $5.4 M in savings in the second year of the biennium through implementation of a MaineCare managed care strategy effective January 1, 2013; and
  • almost $35 M in savings over the biennium from first freezing of enrollment and then elimination of so-called "non-categorical" MaineCare eligibility.

The Appropriations Committee will hold a public hearing on the budget change package on Wednesday, May 11th at 1 p.m.

You can find the Appropriations Committee materials, including the change package summary, on the web at:


On Tuesday, May 3rd, the Insurance & Financial Services Committee heard L.D. 882, An Act to Limit Health Care Mandates, a bill that would ask the Bureau of Insurance to compare Maine's current insurance mandates with the minimum essential benefits established under the ACA.  The bill also would prohibit insurance carriers from offering mandated benefits beyond the federal essential benefits package after January 1, 2014.

The Committee also saw its insurance reform bill (L.D. 1333) reported out favorably on a partisan split debated in the House on Thursday (see lead article).

Tomorrow afternoon (Tuesday, May 10th), the Committee will hear two bills representing the Republican (L.D. 1497) and Democratic (L.D. 1498) approaches to the implementation of a health insurance exchange in Maine as envisioned in the ACA.


Concluding several years of work and reconciling two bills (L.D. 1331 & L.D. 1337) this session on health information privacy issues regarding a statewide health information exchange, the Health & Human Services Committee unanimously reported out amended versions of both bills.  Of particular interest to health care providers, the bills will require them to provide a form to patients that would enable them to "opt out" of the statewide health information exchange.  HealthInfoNet would develop the form under the oversight of the Office of the State Coordinator for HIT.

During a work session on Thursday, May 5th, the Committee also unanimously recommended passage of L.D. 1023, An Act to Authorize the Board of Licensure of Podiatric Medicine and the State Board of Veterinary Medicine to Establish a Podiatrist Health Program and a Veterinarian Health Program.  This bill was submitted on behalf of the MMA to permit podiatrists and veterinarians to enter the MMA Medical Professionals Health Program.

During a work session on Wednesday, May 4th, the Committee voted to request "carry over" on one bill (L.D. 806) and "ought not to pass" on two bills (L.D. 1131 & L.D. 1393) that would establish new requirements for health care provider price disclosure.


On Tuesday, May 3rd, the Judiciary Committee held a public hearing on three bills seeking to amend current law relating to abortion that will affect the physician-patient relationship.  The bills are:

  • L.D. 116, An Act to Require a 24-Hour Waiting Period Prior to an Abortion (Rep. Clark, R-Easton)

  • L.D. 924, An Act to Educate Women on the Medical Risks Associated with Abortion (Rep. Espling, R-New Gloucester); and

  • L.D. 1457, An Act to Strengthen the Consent Laws for Abortions Performed on Minors and Incapacitated Persons (Rep. Crafts, R-Lisbon)

Witnesses spoke passionately on both sides of these bills.  Several physicians testified on the bills with the majority of them speaking in opposition.  The MMA's testimony in opposition to all three bills is available on the MMA web site:

The Judiciary Committee has a work session scheduled for these three bills along with two bills on minors' rights to confidential health care treatment (L.D.s 31 & 746) for 1 p.m. on Thursday, May 12th.

You will find the members of the Judiciary Committee and their contact information on the web at:

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