1. Is Maine spending too much on its social safety net?

Libby Mitchell

No. While I believe we must always look to see if we are spending our funds efficiently, in Maine we take care of each other. We are in a difficult budget situation and we all have to make sacrifices, but in a recession people need services more than ever.

Paul LePage

We spend too much on safety net bureaucracy and that keeps us from getting enough resources to Maine’s most vulnerable. ‘Envision Maine’ pointed out that Maine’s welfare payroll increased by 46 percent since 2002 while the national average went down 13 percent.

Shawn Moody

I think we are a bit too generous with our welfare programs, and the facts seem to bear this out. The goal of our social service agencies should be to get folks off welfare and end their dependency, but there are many factors to consider. If we just change the mindset in Augusta so people understand that services should provide a lifeline, not a lifestyle, we’ll reduce the costs of our social services.

Eliot Cutler

Yes. We need to help the distressed and the truly disadvantaged with a focus on the very young, the disabled and the elderly, but for most Mainers the best welfare program is a good- paying job. Employing more people for more hours at higher-paying jobs will lift more people over the poverty line in Maine and reduce our spending on the social safety net. We also appear to be lagging well behind other New England states in transitioning people from welfare to work.

Kevin Scott

Yes, anytime we have high unemployment and people dependent on the state we need to reduce these numbers.

 

2. What, if any, state health care mandates do you think Maine should eliminate? Why or why not?

Libby Mitchell

When people talk about mandates they are actually talking about the consumer protections that require coverage for things like mammograms, autism treatment, and prostate screenings. These are vital to prevention and keeping people healthy. Maine has been a leader in the health care reform movement and I will continue that progress by shifting us toward a more preventative based system that will save money in the long run.

Paul LePage

Consumers should have individual choices when it comes to health insurance. Everyone is different, but our one-size-fits-all approach forces people to pay for coverage they may not need. The net result is fewer private insurance customers, driving up the costs for those who cannot go without insurance and more cost shifting to MaineCare.

Shawn Moody

The most important one to eliminate is the bar on buying health insurance across state lines. There has to be a way to put in place a system that allows consumers to buy health insurance in the competitive marketplace. If you own a flower shop, for instance, you can be a part of a large association of florists nationwide that provides low-cost health insurance for its members. But that’s not permitted under Maine law. Breaking down this barrier will allow more competition and help bring down the cost of health insurance.

Eliot Cutler

I think all health care mandates should be carefully considered before they are adopted, they should be reviewed for compliance with the new federal health care reform law and for comparison with other states. All mandates should be reviewed periodically. Sixty percent of our health care costs are for chronic preventable illnesses. Our focus should not necessarily be on mandates, but keeping people healthy and paying for performance outcomes.

Kevin Scott

Until I do a full examination of the issue I will hold judgment. We do need to address the incredible inflation in the actual cost of health care, that is the issue.

 

3. Do you plan on working with the federal government to help implement the new health care reform law? Why or why not?

Libby Mitchell

Yes. The new health care law offers Maine the chance to establish an insurance exchange which will allow families and small businesses to pool their resources and buy insurance at lower costs. Maine is particularly well situated to capitalize on this opportunity and numerous other benefits of the new law. I will work diligently with our federal delegation to make sure that every opportunity for funds or programs that will help lower Mainer’s health care costs are pursued.

Paul LePage

I have concerns about the constitutionality of forcing Mainers to buy insurance. The better approach is to ensure the market has the freedom to provide consumers with affordable options and to let individuals make the right choice for their needs. 

Shawn Moody

Absolutely. No plan is perfect, and there are still many unanswered questions in the federal health care reform law that need to be addressed, but I believe there is enough flexibility in the law to make it work for Maine.

Eliot Cutler

Yes. As governor I intend to take full advantage of the opportunities for innovation afforded by the Affordable Care Act (ACA) so that it works for Maine – through the creation of new programs and financial vehicles to deliver care to all patients. This will permit doctors and hospitals to work directly with patients and Maine businesses to provide best practice health services, improve accountability of care, facilitate continuing care that is not tied to a particular employer, and reduce administrative costs.

Kevin Scott

McDonald’s and 3M, along with many other huge corporations, are seeking a waiver on this plan now from the U.S. Attorney General and will most likely have it granted. Our U.S. Congress does not have to participate. We can do better in Maine.

4. How can Maine more make the Department of Health and Human Services more efficient?

Libby Mitchell

First, I will eliminate duplication and inefficiency by implementing LEAN management practices in every department. I will reform MaineCare so we save money by focusing on prevention and keep people out of the emergency room. I will order the review of all DHHS contracts and make sure they have clawback provisions so that taxpayers can recoup money when a contractor fails to deliver the service they were hired for.
 

Paul LePage

The first job of the DHHS should be to help people return to work or to move from part-time to full-time employment. Our system fails too many by creating a culture of dependency that does not serve the taxpayer or the recipient well.

Shawn Moody

First, we need to listen more closely to our front-line workers. They are the ones who know where the inefficiencies are. Second, we need to take their advice and consolidate many of the contracted agencies in order to eliminate duplication. Third, I am a strong believer in open-book management. That means opening all the books to all stakeholders. In the state’s case, that would mean that the taxpayers can go on a website and see exactly where every dollar of spending is going, in every department.

Eliot Cutler

We need to be certain that we are delivering public assistance services in ways that best serve the interests of both taxpayers and service recipients. For example, when the DHHS delivers services through about 4,800 different organizations in a state with a population of 1.3 million, it is clear that the delivery system needs to be reexamined and excessive overhead and administration costs need to be squeezed out of it.

Kevin Scott

By utilizing business processes such as the Department of Labor “Bend the Curve” initiative and by having a governor who wants to work on these issues with state employees, not blame them.

5. Will people currently receiving MaineCare be purged from the rolls if you are elected? Why or why not?

Libby Mitchell

No. I will make MaineCare more cost effective by utilizing managed care and by putting the focus on prevention rather than just treating sickness. I will ask my DHHS commissioner to review eligibility standards and benefits to make sure we have an efficient system that provides the sufficient coverage. What I will not do is purge poor children, the elderly and disabled from health care rolls.

Paul LePage

We need to make insurance more affordable in Maine so working families do not have to turn to MaineCare as the insurer of last resort.�

Shawn Moody

No one who is in need of affordable health care coverage will be purged from the rolls. We’ll work with the new federal health care reform legislation to revamp MaineCare and move people to other, more affordable health care programs. People signed up for MaineCare with the expectation that they would receive coverage, and we simply can’t break that contract without first putting in place a new system of coverage to take its place.

Eliot Cutler

I hope to be able to include MaineCare recipients, state employees and retirees in large new purchasing group, that will also be open to small businesses, families and individuals while ensuring that recipients of MaineCare are better off when they work by eliminating a drop in benefits once certain income levels are reached and adopting a tiered reduction.

Kevin Scott

That would be irresponsible and people know that. We need to initiate a co-pay for MaineCare immediately, even if it is $5.

 

6. Besides eliminating certain mandates, how can Maine lower its health care costs?

 

Libby Mitchell

Our current health care spending is unsustainable. I will bring all of the stakeholders to the table to create a global spending budget we all must follow to lower costs. I will change the health care payment system so we are paying for prevention rather than more costly treatments after people are sick. I will also look to partner with other states in our region to maximize the effectiveness of our health exchange even further.

Paul LePage

We need to bring an end to cost shifting and increase new competition in the marketplace. I support paying the hospitals what is owed. I support reducing mandates and allowing Mainers to purchase health insurance across state lines to increase competition.  As insurance becomes more affordable for businesses and families, we will see more people move into the system and less reliance on MaineCare.  Wellness plans that focus on prevention must also be part of the mix.

Shawn Moody

We need to introduce transparency and create financial incentives that promote healthy behaviors and positive healthcare provider outcomes. We need to rework the entire health care system so we don’t just treat illness and disease, but reward doctors and health care providers for preventing illness and keeping people healthy.

Eliot Cutler

My Maine Wellness plan will bring public and private payers together for the benefit of all Mainers to develop a common health services payment system that uses prospective payments; rewards quality; realigns incentives away from medical interventions and toward prevention; strengthens the public health infrastructure; and, encourages individual responsibility for maintaining a healthy lifestyle.

Kevin Scott

Starting up a private, nonprofit health care service industry that competes with our current providers but without insurance required. Low cost, community-based doctors who want to treat patients – not process federal and state paperwork.