Mainers are paying some of the nation’s highest prices for health care.

Our monthly insurance premiums are rising faster than those paid by most other Americans.

Hospitals and physicians are losing money on patients covered by government insurance plans, forcing everyone else to pay even more.

The broken business of health care will demand much attention from Maine’s next governor.

He or she will lead the state through a historic overhaul of the American health care system, the result of federal reforms passed in March. And there will be plenty of tough decisions to make in the meantime, such as how to contain costs and attract physicians, and what to do with DirigoChoice, the controversial state-subsidized insurance program.

Growing health concerns, from childhood obesity to mental illness, also will continue to strain limited state resources.

“Whoever gets that job has my sympathy and understanding,” said Erik Steele, a Bangor physician and chief medical officer of Eastern Maine Healthcare Systems. “Maine has one of the oldest, poorest populations in the country and among the highest health care costs per person in the country … All of those things mean really a staggering burden for a state that really doesn’t have that big, well-insured industrial base to support all that.”

Maine’s next governor will need to grapple with the cost-of-care issue from day one, agreed Wendy Wolff, a physician and president of the Maine Health Access Foundation.

But he or she also will inherit some tactical advantages, Wolff said.

Mainers share a lifestyle and a clean natural environment that can help improve the state’s health. We enjoy vast outdoor recreation opportunities and one of the nation’s largest numbers of organic farms per capita, Wolff said.

Maine also has a head start compared with other states when it comes to implementing the new national reform law. It already requires insurers to cover pre-existing conditions and bans lifetime caps on claims, for example.

“I think the next governor is fairly well positioned to make sure Maine can capitalize on all the benefits of health reform,” she said.

The 11 candidates seeking their parties’ nominations in the June 8 Republican and Democratic primaries shared their views on health care in e-mails and telephone interviews. Here is a snapshot. 

Medicare reimbursement rate ‘unfairly low,’ Abbott says

Abbott said the state’s “unfairly low” Medicare reimbursement rate may be the most important health care issue facing Maine. “It is critical for the next governor to work with our congressional delegation to address this issue,” he said.

To control health insurance costs, Abbott favors allowing Mainers to purchase insurance across state lines and making it easier for small businesses to pool together to purchase insurance.

Abbott said government-subsidized insurance programs should control costs like self-insured companies that have wellness programs and managed care. Strengthening the economy and creating jobs is the best way to expand access to health insurance, he said.

“I’m concerned that the federal reforms do very little to control the costs of health care and ultimately will make health insurance more expensive for many citizens and employers,” he said.

Abbott calls DirigoChoice “a well-intentioned program that needs to be eliminated.”

The people now covered through Dirigo and MaineCare should be moved to “a managed care system administered by the caregivers. The state shouldn’t administer it nor should the insurance companies.”

Abbott said the state is not meeting the needs of the mentally ill and needs to prioritize resources better.

“One way to find more efficiency in the system is to use performance-based contracting, where we measure outcomes and tie payment to achievement,” he said.

Abbott supports efforts by hospitals and universities to train and encourage doctors, nurses and other health professionals to stay in Maine. 

Beardsley blames overcoverage for Maine’s high premium costs

Beardsley said health care has become unaffordable mostly because of legislative mandates that require insurers to cover therapies and procedures “that far exceed national averages.”

He would bring those coverage benefits into line with other states to reduce premium costs, he said.

Beardsley said the state also should allow government employees and teachers to choose different providers to restore competition.

“Begin with these simple things and Maine’s insurance cost disparities with other states will begin to fade and the ability to expand access improves,” he said.

“Dirigo Health is a financial and social disaster and should go,” he said. “The state would have made far more progress if it had honored its reimbursement obligations to hospitals and clinics that actually serve the uninsured.”

Maine has not been efficient or coordinated with the money it spends on mental health services, he said. The state spends too much of its limited education and mental health funds on the high number of children identified as needing special education, he said.

Forgiving education loans for health care providers in certain areas, something that is already budgeted for, would help with shortages of medical care professionals, he said. He also said Maine’s failure to reimburse health care providers is a major reason independent health providers are forced to close their practices or join larger groups. “I also believe Maine’s certificate of need is driving rural and small- town health care providers away from where need is greatest,” he said.

Improve business climate, and physicians will come, stay

Jacobson said federal reforms and the Dirigo program will not control high health care costs that kill jobs and hold back the economy.

“Let’s address the real cost-drivers instead,” he said.

State mandates that require insurers to cover “just about every possible medical condition you can name” have made Maine’s insurance costs among the highest in the nation, according to Jacobson. Those costs have forced more Mainers into MaineCare, the state’s Medicaid program. And low Medicaid reimbursements to doctors and hospitals are, in turn, making health care costs rise even faster, he said.

The problem is a national issue, but Maine has to take steps on its own to lower costs, Jacobson said.

Jacobson said he wants to reduce mandates to the absolute minimum and give Mainers more choices about what their health insurance covers and what it costs. He wants to open up competition across state lines, create a “high-risk pool” to provide coverage to the sickest patients and allow insurance rates to vary based on wellness incentives.

Jacobson said he will end the DirigoChoice program immediately. It should have been ended five years ago, he said, when it was clear it would require “continual infusions of taxpayer dollars.”

Jacobson said lowering health care costs will allow the state to provide mental health services and other support for the people who need it.

And, he said, his top priority of improving the state’s business climate will attract physicians and other health care workers to the state. 

LePage would draw on other states’ cost control successes

LePage said he would draw on solutions that have helped control health insurance costs in other states.

“We must encourage competition in the marketplace to lower costs,” he said. He supports allowing individuals and businesses to purchase insurance across state lines.

LePage said he would rein in frivolous medical lawsuits by supporting state and federal tort reform legislation.

He said he supports tax credits as a way to help individuals and businesses purchase health insurance.

Maine cannot afford a health care system “saddled with Cadillac mandates,” so he would reduce minimum coverage guidelines to federally established levels, he said. That would allow Maine people to buy coverage that makes sense for them.

LePage said he would end DirigoChoice and that lowering premiums is the way to expand access to health insurance.

He said he would model mental health programs on the High Hopes Clubhouse in Waterville, an independent program that works to provide education, guidance and job opportunities to adults with mental illness.

“Maine has abandoned our citizens with mental health issues, placing many in jail rather than giving them the help and guidance that they require,” LePage said.

He said he would support medical training programs and the use of tax incentives to encourage medical professionals to relocate to Maine. 

McGowan envisions universal health care coverage by 2020

McGowan said he will use new federal funding to expand health insurance coverage to all Mainers and keep costs under control.

“My plan will move Maine to universal health care coverage within 10 years,” he said. “We can do this with the help of enhanced subsidies that are part of the federal health care reform plan.”

He said he would overhaul the Dirigo Health program into a platform for a new private health insurance exchange to provide low-cost insurance options to individuals and small businesses.

“One of my first priorities in office will be to make Maine the first state in the nation to open such an exchange,” McGowan said. He said he will propose legislation to use the exchange to provide the uninsured with state and federal subsidies, based on need.

McGowan said he would make Maine a pilot site to create a system in which “health care providers will make more money when they make Maine people healthier.” He said he will propose a new payment system based on state quality criteria.

He said he also will promote healthy lifestyles and continue the “Take It Outside” initiative launched while he was commissioner of the Department of Conservation.

McGowan said Maine spends more money per capita on mental health services than any other state in the country, and that he would evaluate existing programs to make sure the money is spent efficiently.

McGowan said he would invest in professional education across the board, including for health care professionals. 

Mills: Replace DirigoChoice, revive insurance market rivalry

Mills said the cost of health care “is the biggest single threat to our economic security and our ability to compete.” 

It’s up to Maine to control costs because the federal government failed to, he said.

Mills said he has sponsored or supported reforms already in the works, including electronic record systems, shared decision-making initiatives and Medicaid payment changes.

He said the state needs to revive competition in the insurance market and replace DirigoChoice.

“We must recognize the failure of (Dirigo) and focus on providing care for those in need … through school-based clinics, rural health centers, and charity hospitals.”

The state needs to shift doctors and hospitals to a new model in which they are paid for outcomes and results rather than the volume of services they provide, he said.

The state government should combine its health care purchasing power with other major employers to demand a more rational, more effective and less costly system for managing care, he said.

Mills said he would create a high-risk pool to guarantee health care access to the sickest patients and reduce costs for others.

Mental health services need to be better coordinated among numerous agencies to improve efficiency, he said.

Mills said the state will have enough doctors if it can “reduce the over-utilization of medical services and adopt accountable care organizations.” 

Mitchell: State needs to push for more wellness incentives

Mitchell said she would promote preventive and community-based health care to help bring down unaffordable insurance rates.

“We have to focus more on preventive care … and treating people when they’re well and not just when they are sick,” she said. “Part of that is we don’t have enough primary-care physicians so that everyone can have a medical home.”

Mitchell said she would work to retain physicians who can manage patients’ care and keep them well so they don’t need expensive treatments.

She wants to expand the use of wellness incentives that have helped keep costs down for large self-insured companies. For example, she said, “you get a reduction in your premium costs if you follow a health program.”

She would push for similar reforms in MaineCare, she said. “We need to really revamp Medicaid and have a global look at that in terms of how to reward people” for preventive care.

Mitchell would open the small employer insurance pool to more companies and combine them with individual policy holders to increase bargaining power and bring down costs.

She said DirigoChoice should be used as a basis to create an insurance exchange that brings such groups together to provide more low-cost insurance options.

She said the state should conduct a “wholesale audit” of mental health services. “I honestly think that is an area that has to have a lot of reform,” she said. 

Otten sees potential in Mainers turning to healthier lifestyles

Otten said a big part of the solution to rising health care costs is for Mainers to improve their health by getting better preventive care, eating healthier and exercising.

Sixty percent of  our high health care costs are avoidable, Otten said.

“These are solutions that don’t cost money but do save in health care costs.”

Otten said he would reduce insurance costs, in part by opening Maine to more competition. He would create a high-risk pool, such as New Hampshire has, to provide coverage to the sickest patients. He also said Maine needs comprehensive tort reform.

Otten said he would work with the congressional delegation to change the new federal health care reform law, which he said will do more harm than good.

Otten said he would eliminate the DirigoChoice program.

Mental health services could be provided more efficiently and effectively by focusing more on community-based care, he said. The fact that mentally ill people sometimes end up in jails and prisons “is a problem that needs immediate attention. It does not require more financial resources, but it does require better management of resources and using the experts closest to the problem to find the answers.”

Otten said the state must fix inequities in the reimbursement programs and get to the point that our health care providers are being paid for their services.

That, along with collaboration with schools, hospitals and businesses, will entice more medical professionals to live and work here, he said. 

Narrowing MaineCare can be ‘major force’ to reduce costs

Poliquin said driving down health care costs is key to restoring economic growth in Maine.

“We need to open up competition in our health insurance market,” he said. “You have to make it attractive for insurance companies to come here and want to do business.”

Poliquin also said the state needs to reform MaineCare, a state Medicaid insurance program financed by state and federal funds. The program is too large and expensive, he said, partly because of coverage benefits that are more generous than those in other states. Poliquin would limit benefits to be more in line with those in other states.

“Once we can reform our MaineCare program, that can be a major force driving down health care costs in the state,” he said. “We’ll be able to have more money to spend on those who really need it.”

Poliquin said he is concerned new federal reforms will force the state to expand the MaineCare program. “We already can’t afford the MaineCare program we have.”

Poliquin called DirigoChoice “a classic example of mismanagement” and said it needs to be reformed or shut down.

“We of course can’t put the folks in the program on the street. We need to provide an option,” he said.

He said he would increase support for mental illness service, as well as other state programs, by creating a more business-friendly environment that attracts investment, expands the economy and increases state revenues.

“We clearly need to provide the services that we can to take care of those who truly need them.” But, he said, “the state is broke. We have no new money.” 

Rowe urges higher pay for doctors, more preventive care

Rowe said he wants to improve access to community-based preventive care, which will reduce costly hospital visits and lower the overall health care costs.

“The result will be healthier people and lower costs,” he said.

He would create more health insurance options in Maine. That, along with lower costs, will open access to health care for more Mainers, he said.

Rowe would retain the Dirigo- Choice insurance program as part of the competitive health insurance exchanges that the state will establish under the new federal reform law. “Maine is well positioned because Dirigo is essentially an exchange and it already operates a health care tax credit,” he said.

Rowe praised the national reform law as “the first time in the history of our nation that we have a federal law that says everyone is entitled to health care.”

Rowe said he also would retain the Maine Quality Forum, an independent part of Dirigo that collects and publishes health data and helps control costs.

Maine should do a better job providing community-based mental health services, he said. Additional services would be paid for with federal and state funds, which could be generated by growth in the economy, reduced spending in other areas, and possibly additional revenues, he said. 

Maine should increase educational opportunities for health professions and, along with the federal government, reform the payment system so that primary-care professionals are paid at higher rates. The reimbursement system now pays higher rates for hospital treatment, he said. 

Scarcelli would eliminate or cut co-pays for preventive care

Scarcelli said she knows first-hand as a business owner how the high cost of health insurance is putting Maine at a competitive disadvantage and holding back wages and job growth.

“It is our most critical concern now, as it is for most Maine businesses,” she said.

Scarcelli said she would move as soon as possible to establish health care exchanges that will provide more insurance options and low-income subsidies. States are required to set exchanges up by 2014, “but there is nothing to prevent states from establishing such exchanges beginning in 2011,” she said.

She also would move to create a network of community-based health centers called for in the federal reform bill to expand access to care that is “patient-centered,” not “profit-centered,” she said.

Scarcelli said she would reduce or eliminate patient co-pays for preventive care and increase them, based on ability to pay, for less critical services.

Reforms would allow the state to replace DirigoChoice with new, less expensive coverage, she said.

Individuals also need to take some responsibility for illness prevention, early detection and treatment, she said. Her policies would reward healthy habits, “promote fitness, anti-obesity and diabetes awareness” in schools and encourage consumption of more locally grown, nutritious foods.

She would look for ways to make mental health services more efficient and available.

She said she supports and would look to expand efforts to train and retain doctors and other health care professionals in Maine. 

Staff Writer John Richardson can be contacted at 791-6324 or at:

jrichardson@pressherald.com