February 3, 2013

Politicians strive to stay in hospitals' good graces

But the partisan tension over who gets credit for paying the state’s debt to medical institutions reveals that industry’s outsized clout.

By Steve Mistler smistler@pressherald.com
State House Bureau

(Continued from page 2)

click image to enlarge

Paul LePage, then the Republican nominee for governor, talks to supporters in front of Central Maine Medical Center on Oct. 14, 2010, at a rally to decry the state’s debt to Maine’s hospitals. As governor, he has delivered on the debt payment that he promoted at the rally, named an industry lobbyist to a Cabinet post and called for another debt payment.

2010 file photo by Scott Monroe/Kennebec Journal

Related headlines

Maine's Top 50 Employers
2nd Q 2012 - by average. monthly employment
Hospitals are listed in red

1  Hannaford Bros Co.
2  Wal Mart / Sam'S Club
3  Maine Medical Center
4  Bath Iron Works Corporation
5  LL Bean Inc.
6  Eastern Maine Medical Center
7  T D Banknorth N A
8  Unum Provident
9  Central Maine Healthcare Corp
10 Mainegeneral Medical Ctr.

11 Shaws Supermarkets Inc.
12 Mercy Hospital
13 Verso Paper Corp.
14 Home Depot Usa Inc.
15 Lowes Home Centers Inc.
16 Pratt & Whitney Aircraft Group
17 S D Warren
18 St Mary's Regional Medical Ctr.
19 Southern Maine Medical Center

20 Rite Aid Of Maine Inc.
21 Jackson Laboratory
22 Goodwill Industries Of Northern N E
23 Bowdoin College
24 Circle K
25 York Hospital
26 University Of New England
27 Mid Coast Hospital
28 Penobscot Bay Medical Center
29 Aroostook Medical Center

30 FIA Card Services NA
31 Idexx Laboratories Inc.
32 Spurwink Services Incorporated
33 Cianbro
34 Central Maine Power Co.
35 Rumford Paper Company
36 Henrietta D Goodall Hospital Inc.
37 New Balance Athletic Shoe Inc.
38 Attendant Services Inc.
39 North Country Assoc Inc.
40 Bates College
41 United Parcel Service Inc.
42 Mardens Inc.
43 Dead River Company
44 Anthem Health Systems Inc.
45 Colby College
46 Franklin Memorial Hospital
47 C N Brown Co.
48 St Joseph Hospital Inc.
49 Martins Point Health Care Inc.

50 Nestlé Waters North America NA
Source: Maine Department of Labor

The hospital association's reaction to Haggett's proposal, which was leaked early, was swift. Mayhew, the association's lead lobbyist -- now LePage's health commissioner -- claimed that Haggett had hijacked the bipartisan commission and inserted his own agenda. The report was eventually watered down before it was adopted by the Democratic-controlled Legislature.

Smith, with the Maine Medical Association, said Haggett took it on the chin.

"Closing hospitals? That's a non-starter here," Smith said.


Despite a weak economy and the Medicaid debt that is still unpaid, hospitals are adding jobs and expanding. State labor statistics show a steady increase in hospital employment since 2002, from 24,272 jobs to 32,354. The figures are higher than those reported by the hospital association because the state includes related health care facilities.

The Labor Department also projects an 18.6 percent increase in hospital jobs, or 7,726 total, from 2010 to 2020. No other employment sector in the state is projected to match that growth.

With jobs at a premium, the employment potential at hospitals will weigh heavily with lawmakers in both parties, as they consider LePage's budget and his plan for paying hospital debt.

As those deliberations unfold, there are warning signs from inside and outside the state about a downside to hospital growth and the ensuing competition for a limited number of patients.

Most Maine hospitals are below the national occupancy rate, according to a Portland Press Herald report published in December.

The same month, Steward Health Care Systems, a for-profit chain of hospitals, abruptly pulled out of a deal to purchase Mercy Hospital in Portland, citing, among other things, lower-than-expected patient volumes and the cost of paying down Mercy's $162 million expansion on the Fore River.

Mercy has since entered into an agreement to merge with Eastern Maine Healthcare Systems, which operates a hospital in Bangor and several other facilities.

Miller, with The Bingham Program, said hospital expansions can drive up costs.

"It feels like an arms race sometimes," she said. "That's our money through insurance premiums, money through bonds, our money through taxes deferred because they're nonprofit systems, it's our money in Medicaid programs."


Katherine Baicker, a professor of health policy at the Harvard School of Public Health, sounded a similar note in a July article in the New England Journal of Medicine. Baicker said the increased number of health care jobs is a positive only if it leads to improved health outcomes.

"Salaries for health care jobs are not manufactured out of thin air -- they are produced by someone paying higher taxes, a patient paying more for health care, or an employee taking home lower wages because higher health insurance premiums are deducted from his or her paycheck," Baicker wrote.

Michaud, at the hospital association, acknowledged that hospitals will have to strike the right balance.

"We cut both ways," he said. "Business and government would be cooked without us because we're such a big part of the economy, but it's incumbent upon us to make sure we're efficient."

Striking the balance is likely to be a challenging task, with policymakers from both the Democratic and Republican parties clamoring to obtain credit for job creation. Right now, as always, that means the focus is on Maine's hospitals, said Smith, with the Maine Medical Association.  

"Of course they're influential," he said. "They should be. That's been the case for 30 years."

Demeritt, the former LePage spokesman, said hospitals don't have to pick a side. The political parties either side with the hospitals or suffer the consequences.

"They exert the pressure on an issue basis, not a partisan basis," Demeritt said. "You get to the point where you can speak solely on your issues and you don't have to get into Republican vs. Democrat. That's a good spot to be in."

State House Bureau Reporter Steve Mistler can be contacted at 791-6345 or at:




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