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Coffee CAHC policy round-up: June 16, 2017

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, 1st session

128th Maine Legislature, 1st session


Friday, June 16, 2017


I’m a little mopey today because the new gardenia plant I adopted a few weeks back seems to be in a bad way. Leaves were turning yellow, which I thought maybe was overwatering; I held water back for a few days, and then all the yellow leaves turned brown and crunchy. HELP. Any gardenia experts out there!? Poor Bart (that’s what I named it) and I need you!

Oh, well. Could be worse, Bart – you could live at home, where you would face death-by-kitty-nibbles.

Speaking of animal nibbles, I have to say something about the latest viral (HA HA GET IT) story from the BDN. By now I’m sure you heard about Rachel Borch, the young jogger attacked by a rabid raccoon who drowned it in a puddle. I can, in a way, sympathize with one tiny part of her experience.

I once woke up at around 2am with a bat flapping frantically around in my bedroom, and since I didn’t know if I’d been bitten or not (and bat teeth are like little needles, so you might not know), I went through the entire rabies vaccination series myself as per CDC recommendations.

Lemme tell ya something. It’s quite the experience to have a nurse nervously edge his way into your ER room with a look of sad, frightened regret on his face, clutching what can only be described as a “fistful” of syringes, to inform you that the number of immunoglobulin booster shots you get is based on your weight (and, well, let’s just say that my weight meant I probably cleaned out all the immunoglobulin they had). The phrase “human pincushion” comes to mind.

And, before any of you wonder or ask, no, rabies shots are not given in the stomach anymore, and apparently haven’t been for decades. Just normal arm jabs.

Anyway, I had a hearty chuckle this morning over Rachel’s quote: “I really do also hope that I can accomplish something more with my life, more than just my 15 minutes of fame as a raccoon killer.” Based on how you handled this experience and your interviews, Rachel, I think you’ll do just fine. We here at CAHC wish you all the best!


National level

Oh, Past Steve. I remember those heady days when the House was debating AHCA, when we knew what was in the bill and what was being discussed. You were so young! So innocent! (lo, those many weeks ago). How I yearn to go back.

I can only really talk about process here, because I’m not kidding when I say we have no idea what’s in the bill.

That’s if there even IS “a bill” at the moment: there may not be.

No senators seem to have seen it, or can even seem to agree on what exactly it is that they’re trying to do.

HHS Secretary Tom Price hasn’t seen it.

The only thing President Trump knows about the Senate bill is that he’d like it to be less “mean” than the House bill (but he still seems extraordinarily confused about what exactly it is that he and the GOP are even proposing, since he insists that more people will have coverage with lower deductibles, when in fact AHCA would accomplish the exact total opposite of that in every single possible way).

Despite the unprecedented secrecy and confusion, even if that means tens of millions of Americans pay the price in loss of coverage, loss of care, loss of vital protections for pre-existing conditions, paying more for less, and a radical overhaul of Medicaid that will leave state budgets on the hook for tens of billions of dollars in health care spending (are you sick of this refrain from me yet?!), Senate Majority Leader Mitch McConnell continues his headlong rush toward taking a vote sometime in the next week or two. It’s absolutely astonishing.

And it gets worse. I’ll tell you the fun little nugget I learned earlier this week. Remember how I’ve been saying all along that the Senate needs a CBO score before they can vote on the package? Get this. Turns out that, as I now understand it, it is actually possible for Senator McConnell to open debate on the floor on the House version of the bill – which, remember, does have a CBO score already – and then introduce an amendment to wipe the entire thing out and replace it with the Senate version of the bill. He could do this to avoid having to wait for the CBO to score the Senate package before forcing his caucus to vote on it. That means that a bill that has already been completely shielded from any kind of public input (or even input from other senators) would be introduced within hours, maybe even minutes, of being adopted. How crazy is that?

It is, in fact, even more crazy that any senator would be considering voting for this since new research shows that voters in every single state absolutely hate AHCA.* The most supportive state is estimated to be Oklahoma, with…wait for it…a robust, um, 38% approval rating. That’s quite a bit better than Maine, which is near the national average with a dismal 30% approval. Womp womp.


*Thanks to a Coffee CAHC reader for the heads-up on this article!


State level

No news is, in this case, terrible news. Budget negotiations seem to have completely broken down as of last night. Democrats in the House, and Democrats and Republicans in the Senate, seem to be willing to negotiate in good faith; it is, by most accounts, House Republicans who have refused to bring any kind of compromise to the table. The Legislature has blown through a couple of self-imposed deadlines over the past 36 or so hours, despite the best efforts on most of their parts. If a budget doesn’t land on the Governor’s desk by this Monday, then – assuming that the Governor, as he has in the past, takes all the time he’s allowed before vetoing – the 10-day veto window guarantees a shutdown.

I don’t really know what else to say about any of this. It’s so weird and sad and frustrating. A government shutdown should not be a bargaining tactic. People, real people, get hurt by a shutdown. It’s easy to think “oh, state parks will be closed, big whoop.” But state government is enormous and vital. Will hospitals, health centers, and doctors get reimbursed for MaineCare patients they see during a shutdown? Will nursing homes and home health agencies get paid? What about families who are waiting to be approved for MaineCare so that they and their families can get the health care they need? What about health and safety inspections of bridges, or milk production facilities, or restaurants? What if you’re a business waiting for a license approval? Will Maine CDC be able to monitor and respond to public health emergencies during a shutdown? What about Maine Emergency Management?

And remember, Maine has a budget surplus this year. We have more money than we expected! So this is not about “painful decisions as to where to cut” – this is about spending priorities when we have the resources we need. Governor LePage’s final budget as governor may very well end with Maine people getting harmed by this brinksmanship. It’s beyond belief that we’ve gotten to this point.


What’s at stake

This week’s featured story is from Dr. Mark Lupinetti. Dr. Lupinetti is a cardiothoracic surgeon in Bangor who writes about how critical MaineCare and the ACA have been for his patients, and how he has operated on people who ignored their own wellbeing for years because they couldn’t afford to see a doctor without coverage.


Would you like to know more?

A brutal report from Center on Budget and Policy Priorities about how bad AHCA will be for children with disabilities and special health care needs (in a nutshell: horrifying).

And here’s a report from the Center for Consumer Engagement in Health Innovation on how equally destructive a radical overhaul of Medicaid will be for long term services and supports and home care jobs.


Until next time, friends, I remain,


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