MEDICAL ASSOCIATION 2012 ANNUAL REPORT OF THE COMMITTEE ON LEGISLATION by Lisa D. Ryan, D.O., Chair

Maine’s 125th Legislature, composed of 35 Senators (19 R, 15 D, 1 U) and 151 Representatives (77 R, 70 D, 2 U, 2 vacancies), conducted its Second Regular Session at the State House in Augusta from January 4 through May 31, 2012. Governor LePage and Republican leaders of the legislature chose a “wait and see” approach to health care reform and implementation of the Affordable Care Act (ACA), preferring to wait until the U.S. Supreme Court ruled on its constitutionality in late June. Accordingly, legislative action stalled on the insurance exchange concept (report of the Advisory Committee on Maine’s Health Insurance Exchange, L.D. 1497, and L.D. 1498) and establishment of “essential benefits” to be covered in health plans offered through the exchange (L.D. 882). Rather than pursue a health care reform agenda, Governor LePage renewed his call for “welfare reform” and advocated substantial amendments in Maine’s Medicaid policy – the elimination of numerous optional services and significant reductions in MaineCare eligibility – through his FY 2012-2013 supplemental budget proposal unveiled in December 2011. The legislature’s Appropriations Committee broke the Governor’s supplemental budget proposal into three separate bills (L.D.s 1816, 1903, and 1746). These three budget bills became the focus of the health policy debate in the second session and negotiations to resolve them extended to the closing hours of the session. Pressure from Democrats and even moderate Republicans in the legislature abated the Governor’s MaineCare and other social service cuts. As a result of these negotiations, the first two budget bills passed by a bipartisan, two-thirds majority, but the last bill could garner only a Republican majority for passage. Please see the Powerpoint presentation, Maine Legislative & Regulatory Update: 125th , for more details on these budget bills and other highlights of the 2012 session. Also, please see the Top Ten Legislative Successes of the 125th Maine Legislature and Jessa’s comprehensive Summary of Health Care Legislation from the 125th Maine Legislature for more specific coverage of the health policy debate in the 125th Legislature. You will find each of these three documents in your meeting materials. Governor LePage and Republican leaders of the legislature seem content to continue their “wait and see” approach to health care reform through the election in November following the U.S. Supreme Court’s June 28th decision upholding the constitutionality of the ACA. Major elements of the budgets enacted last session arguably are contrary to the ACA’s “ maintenance of effort” requirements regarding Medicaid eligibility and depend upon CMS granting waivers of aspects of Medicaid law. It is unlikely that CMS will respond to Maine’s waiver requests before Election Day because there seems to be little political incentive to do so. An Obama re-election and CMS denial of these waiver requests would present some difficult budget choices to Governor LePage and the 126th Maine Legislature in January 2013. During this summer and fall, the MMA has been and will continue to monitor implementation of the ACA and other health care reform developments in Washington, D.C. and in state capitals around the country. The MMA also continues to monitor or

2012 Annual Report of the Committee on Legislation 8/29/12, Page 2 participate in the Maine Prescription Drug Abuse Task Force, the MaineCare Redesign Task Force, a mammography work group, a community paramedicine work group, and several work groups on the implementation of changes in MaineCare coverage of suboxone, methadone, and opiates for pain enacted in the budget bills. I believe that it was a successful session for the MMA and Maine physicians and I would like to thank all the MMA members who contributed to our advocacy activities this year - - Legislative Committee members, participants in our weekly conference calls (participation was the best ever!), those who served as "Doctor of the Day" at the State House, witnesses at legislative public hearings, and contributors to the Maine Physicians Action Fund, the MMA's affiliated political action committee. All of you made substantial contributions to a successful year of advocacy for physicians and patients in the Maine legislature and executive branch agencies. I would also like to thank the MMA staff for their outstanding guidance of our advocacy efforts. The 2012 election campaigns are in full swing as the General Election Day approaches. At the top of the ticket of Maine races is the race for the U.S. Senate seat being vacated by Senator Olympia J. Snowe among former Governor (I), Secretary of State (R), State Senator Cynthia Dill (D), and two lesser known independent candidates. You can find a list of candidates for the general election on the web at: http://www.maine.gov/sos/cec/elec/upcoming.html. The Maine Physicians Action Fund (MPAF), MMA’s affiliated political action committee (PAC), encourages you to get to know the candidates, particularly your state legislative candidates. MPAF Trustees draw your attention in particular to the following physician candidates for the 126th Maine Legislature:

 Geoffrey M. Gratwick, M.D., a Democratic challenger to Senator Nichi S. Farnum in Senate District 32, Penobscot County;  Jane P. Pringle, M.D., a Democrat in House District 111, a part of Windham, running against Republican Stuart A. Pennels in an open race;  Ann E. Dorney, M.D., a Democrat in House District 86, Madison, Norridgework, and Solon running against Edward R. Goff, IV in an open race; and  Linda F. Sanborn, M.D., a Democrat incumbent in House District 130, part of Gorham, running against Republican Matthew L. Mattingly.

If you have not yet done so, your MPAF Trustees urge you to join them in helping to elect state legislative candidates who are sensitive to issues of concern to Maine physicians: https://www.mainemed.com/mpaf/application.php. In addition to these candidates, the November general election ballot will include one citizen-initiated referendum on same sex marriage and four bond questions.

For more information about the MMA's advocacy work, please contact me or Gordon, Andy, or Jessa. If you are interested in participating in the MMA’s advocacy work in 2013, look in the Maine Medicine Weekly Update for a notice of the next organizational meeting of the Legislative Committee for the 126th Legislature to be scheduled in late November or early December.