When the book closes on the 129th Maine Legislature, it may well be remembered as the health care session.

Consider what already has passed or is headed for passage:

• A bill that tightens up childhood vaccination requirements by ending most exemptions.

• An act to require abortion coverage for Medicaid recipients and another to allow nurse practitioners to perform abortions.

• A bill to ensure various patient protections under the federal Affordable Care Act that have been at risk of disappearing during the Trump administration.

• Measures to increase access to lower-cost prescription drugs and to make pricing of prescriptions more transparent.

On top of that, budget priorities by Gov. Janet Mills and majority Democrats in the Legislature are heavily weighted toward health care. These include more money for treatment options to combat the opioid crisis; full implementation of Medicaid expansion, which stalled under Mills’ predecessor, Gov. Paul LePage; and additional funding for more caseworkers in child protective services.

Collectively, the measures – many of which would have been dead on arrival two years ago – have shifted Maine in a decidedly progressive direction. They also reflect a national effort by Democrats to deliver on an issue that resonates with their base of support.

“We anticipated a lot of interest in health care issues with the new administration and the new Legislature,” said Andrew MacLean, interim CEO of the Maine Medical Association. “I think we all know that, around the country in this cycle, Democrats felt like they ran on health care and won on health care, so this isn’t a surprise.”

The session has not been without partisan fights. Republicans have objected to mandatory vaccines and to expanding access to women’s reproductive rights. They also have expressed repeated concerns about increased spending, even as Mills has resisted calls from some in her party to consider new taxes.

“The narrative that Republicans don’t care about health care is false,” said Rep. Kathleen Dillingham of Oxford, the House Republican leader. “But we’re interested in making sure things are done in a fiscally responsible manner.”

Rep. Beth O’Connor of Berwick, the lead Republican on the Legislature’s Health and Human Services Committee, said she believes Democrats have been pushing extreme policies on health care that are out of step with Maine people.

But because Democrats hold such big advantages in both the House and Senate, and because the governor is a Democrat, they have been able to accomplish most of what they want.

“Anytime you’re out knocking on doors, this is what people are talking about,” said Sen. Geoff Gratwick, D-Bangor, who co-chairs the Health and Human Services Committee. “They want to know: How can I access whatever health care services I need and how can we make them more affordable?”

Some thorny debates – including over proposals to create a single-payer health care system – have been carried over to the next session. Others, such as whether to allow physician-assisted suicide, may fail to gain enough support. But Gratwick said his party should be pleased with its accomplishments.

“There has been a distinct shift,” he said. “And we have more to do.”

‘DRAMATIC SHIFT’ IN MEDICAID STANCE

On her first day in office, before any bills went up for debate, Mills signed an executive order to begin expanding Medicaid immediately.

Maine voters, after seeing numerous legislative attempts to expand government health care for low-income Mainers fail, passed a referendum in 2017, but LePage refused to implement expansion, even when told by the federal government to do so.

Robyn Merrill, executive director of Maine Equal Justice Partners, which advocates for low-income Mainers, said that decision set a clear tone.

“We keep having conversations with people who are accessing health care for the first time, and there is a relief in their voices,” she said. “There is no question it’s been a dramatic shift.”

Similarly, Democratic leaders made their first bill a health care-related measure: An Act to Protect Health Care Coverage for Maine Families.

That bill ensured that patients with pre-existing conditions cannot be denied coverage. It also allows children to remain on a parent’s health insurance plan to the age of 26 and prohibits any lifetime limits on coverage, provisions that also are part of the federal law.

Other moves by the Mills administration have made clear that health care is her top priority.

Her first cabinet appointee was Department of Health and Human Services Commissioner Jeanne Lambrew, who worked at the U.S. Department of Health and Human Services and also for many years was a policy director in the Obama White House.

Mills also created a new position – director of opioid response – and appointed longtime Maine Medical Association vice president Gordon Smith to coordinate efforts across all state agencies to fight the deadly epidemic that has threatened an entire generation.

In a statement last week, the Democratic governor said she’ll continue pushing efforts to improve the lives of Mainers.

“From more affordable, accessible health care to cheaper prescription drugs to tackling the opioid epidemic, the people of Maine sent a clear message last November that they wanted change. Now we are working to deliver it,” she said. “My administration has prioritized health care and working closely and collaboratively with the Legislature as we have been, we will continue to look for ways to improve lives by improving health care.”

Republicans, though, have cast Democratic priorities in fiscal terms. Many feel Medicaid expansion will stretch the budget for years to come, undoing progress made by LePage to reduce health care spending. They also have questioned other spending increases.

But Mills has resisted proposing any tax increases, at least during the first two years of her term. The increased spending is possible because of a strong economy that is producing more revenue.

O’Connor said it’s not just the spending, but also who is benefiting. She accused Democrats of prioritizing “able-bodied adults and non-citizens” over the “truly vulnerable.” She said there is still a waiting list for services for adults with developmental disabilities, a problem that dates back to the LePage administration.

Dillingham said Republicans have by and large supported additional spending on the opioid crisis and on child protection but wish they had a stronger voice at the table.

“I’ve tried to approach it by being respectful and focusing on policy, but we’re clearly not on the same page with some of these things,” she said.

REPUBLICANS FEEL SHUT OUT

The legislative session started slowly, as most sessions do, but as debate has intensified, health care has taken center stage.

On the vaccination bill, hundreds of people turned out for the public hearing and the committee received more than 1,000 pieces of testimony. The abortion bills drew large crowds as well.

At a time when several other states have passed laws to restrict abortions, the fact that Maine has improved access is noteworthy.

Again, that would not have been possible at any point since 2010, when LePage was elected and Republicans controlled the Legislature.

Similarly, the narrowly-passed bill to ensure children who attend public schools have up-to-date vaccinations is likely not something that would have passed in previous Legislatures, much less survived an almost-certain veto by LePage.

O’Connor and Dillingham said both are examples of “extreme left” policies that Democrats will come to regret.

Dillingham, who has a less combative approach than previous Republican leaders, said she has tried to engage with majority Democrats but hasn’t seen much willingness to compromise.

There have been some exceptions. Just last week, the insurance committee unanimously passed a bill that would require insurers to cover mental health and substance use disorder treatment in the same manner as other medical conditions. The bill also bans practices that restrict prescription drug coverage for substance use disorder.

MacLean, speaking for the Maine Medical Association, said his members have been supportive of most of the measures that have passed.

“We always have a fair amount of health care legislation every session given the portion of the economy it occupies,” he said. “What’s interesting right now is, from a budget standpoint, we’re not talking about cuts to services.”

LePage, with help from legislative Republicans, prioritized reducing spending in health care, especially social services.

Supporters praised his fiscal stewardship. Critics argued the cuts were draconian and had led to bigger problems.

Gratwick, the Bangor Democratic lawmaker, said he sees this legislative session and the next as opportunities to consider long-term investments.

He acknowledged that spending in health care has increased to an unsustainable level but said figuring out a way to lower the actual cost of health care should be the goal, not cutting services.

But Gratwick said serving as co-chair of the Health and Human Services Committee has given him a window into how the state has failed vulnerable populations.

“We have under-funded, and I think there is bipartisan guilt because it started during the Baldacci administration and worsened under the LePage administration,” he said.

One proposal that is still being debated is a bill that would add a comprehensive dental benefit – including preventive, diagnostic and restorative care – for more than 100,000 adult Mainers who have Medicaid. Maine would join 33 states that have such a benefit.

The dental bill could be doomed by its cost, which is estimated at $7 million to $19 million a year. But it provides a good example of how prioritizing prevention can require high spending up front while saving money in the long term.

Maine now offers routine dental care for children on Medicaid, but adults are only covered for emergency care, such as tooth extractions. Merrill, at Maine Equal Justice Partners, says it makes more sense to offer adults preventive care rather that emergency tooth extractions.

“I think there is more energy around being more thoughtful and looking out further when it comes to health care,” Merrill said of the current Legislature’s approach to health care issues.

Many of those discussions will spill over into the next session, where Democrats will still get to set the agenda.

O’Connor said Republicans will continue pushing for their own values.

“We’re not trying to be obstructionist,” she said. “I’ll always vote for good policy.”