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Coffee CAHC policy round-up: January 24th, 2018

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!

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Coffee CAHC

115th Congress, 2nd session

128th Maine Legislature, 2nd regular session


Wednesday, January 24th, 2018


Hello from D.C.! I managed to get off the ground yesterday, despite the unexpectedly robust ice storm. I was born and raised in Maine and have lived here most of my life, and yet somehow I keep being surprised by the bad weather this year every time it hits. “What?! Were we supposed to get a storm today?!” But now I’m in Washington, which is a positively balmy 44 degrees as I write this. Tropical!


I apologize for the late hour of today’s update, but I wanted to wait for two reasons. First, because I was eager to pass along any tidbits or updates from the conference today. And second, because I wanted to be able to make a…



Special CAHC announcement

You may have already seen the public announcement earlier today, but in case you missed it, I am thrilled to be able to share with you all that our friend Ann Woloson will be assuming the role of executive director here at CAHC!

Many of you probably know Ann from her many years of dedicated service to people across Maine. In fact, she used to be the senior health policy analyst at…CAHC!

She’s also served as Chief of Staff to the Maine Senate Majority Office, Health Care Project Director at Maine Children’s Alliance (where she helped launch the Maine Oral Health Coalition), worked within Maine’s Medicaid and WIC programs, and was executive director of a nonprofit organization called Prescription Policy Choices. Most recently, as many of you no doubt know, she was a policy analyst with our partners at Maine Equal Justice Partners.

All of us here at CAHC are excited to welcome Ann back to the team. She officially joins us on February 12th. If you see Ann, please pass along your congratulations!


National level

Well, that was weird.

In case you blinked and missed it, the federal government did in fact shut down at midnight this past Friday, and reopened this past Monday, with the passage of yet another short-term continuing resolution (CR). This time, the government has funded itself for three weeks (until February 8th), at which point we’ll be back at the brink of a potential shutdown depending on what the mood is in Congress at that time.

The Washington Post wrote some decent takeaways in this piece. I’m not going to spend a lot of time here recapping the shutdown itself or trying to game out who won or lost. Because the reality is, for months now, American families have been held hostage by a ridiculous game of brinksmanship in D.C. In that context, it’s hard to say anybody was winning anything.

Now, for health policy advocates, the one piece of decent news to emerge from the shutdown is that the 3 week CR extended CHIP funding for six years. Now, it’s positively ludicrous that Congress let CHIP funding lapse at all, and indefensibly shameful that it took them 114 days to reauthorize it. That said, the hundreds of thousands of kids and families who were being held hostage by this unnecessary game of brinksmanship can rest a little easier now knowing that the program is safe for a few years.

What was notably not included in the CR was any funding for our federally qualified health centers (FQHCs), which also lapsed last year. Extending federal funding for the health centers is another no-brainer. Here in Maine alone, 200,000 people rely on our FQHCs to provide their primary care. These health centers are lifelines in rural communities across Maine and the country.

The fact that their funding still hasn’t materialized is particularly unbelievable when you realize that, for the most part, nobody in Washington opposes it. This is a program whose funding has doubled under both Republican and Democratic presidents. The two standalone bills in Congress to extend the funding (the Community Health Investment, Modernization, and Excellence – or “CHIME” – Acts), both of which are sponsored by Republicans, have 217 bipartisan cosponsors in the House and 19 tripartisan cosponsors in the Senate: 9 Republicans (including Senator Susan Collins), 9 Democrats, and an Independent in our own Angus King.

In other words, one step forward, but still several steps short of a success. We’ll be following the debate very closely to see what happens between now and February 8th, and will see if the chances of another shutdown change as we get closer.


State level

The Task Force on Health Care Coverage for All of Maine held its second meeting this past Monday, and CAHC was invited to present to the Task Force on topics related to the economics of health care. We used the opportunity to speak about the ways in which health care costs impact how and when consumers seek health care services.

While Congress holds lots of exploratory and investigative hearings that are more open-ended and topical in nature (rather than focused on a single specific piece of legislation), it’s exceedingly rare in the legislature here in Maine. CAHC is very thankful to the Task Force for giving us the opportunity to weigh in this way, because – as I’ve covered in previous Coffee CAHCs – the fact is that consumers are often blamed for rising health care costs, which they are not causing and cannot control.

I don’t typically put links in Coffee CAHC to the testimony we have delivered (in fact, I’m not sure I’ve ever done it), but I’m going to make an exception for this one. If you have a few minutes, take a look at the remarks I delivered. We included 17 citations in our presentation, almost all of which were for high-quality, independent, sound studies analyzing why American health care costs so much.

I’m sure you’ve heard some variation on the theme that American consumers “go to the doctor too much”. There’s this pernicious idea that never seems to go away that Americans are constantly running to the hospital and demanding expensive services willy-nilly. That is simply, absolutely, completely untrue. Not only do we not go to the doctor “too much” (compared to our peers in other, comparable countries), we probably don’t go to the doctor enough. Americans have a remarkable tendency to avoid seeking needed health care, and that’s almost always because of the cost of receiving that care. It is not utilization that is driving our health care spending up: it’s the prices we pay for that health care.

In a case of remarkable timing, the day after I spoke to the Task Force about this very topic, the Health Care Cost Institute released their 2016 Health Care Cost and Utilization Report. And, sure enough, their research backed up this exact point. They found that while utilization (how much health care people use) has stayed steady or actually decreased over the past five years, overall health care spending went up – because of how much the prices spiked.

In other words, Americans are damned if we do (seek care and get gouged), and damned if we don’t (avoid care altogether). Something has to give, but it is unreasonable, unfair, and in fact counterproductive to demand that consumers change their behavior in response. I, for one, am sick and tired of consumers being blamed for something we didn’t do and being expected to fix a problem we didn’t create and can’t change.


Would you like to know more?

I highly recommend that you take the time to sift through the entirety of HCCI’s utilization and cost report. They have made all of the materials publicly available. There’s a lot to absorb.


Until next time, friends, I remain,


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