Poor health makes it harder for children to learn and develop and for adults to work and be fully engaged in their families and communities.

When we think about Maines economy and how to make it grow, the conversation must start with our people. People are the engines of the economy, whether theyre small business owners, innovators and entrepreneurs, or precision manufacturers.

My goal is to keep Mainers healthy and to make sure, when illness or disability strikes, we have the best, most affordable health care system available a system that ensures access not just to medical care but one which is committed to access to mental health and substance abuse services, oral health, housing, supportive services and, when needed, long-term care and other needed services. Most of these services exist; they need to be more affordable, better coordinated and targeted.

Maine, like the nation, remains locked in the grips of a complex and costly system of payment and delivery of care.

WE PAY FOR EACH UNIT OF SERVICE, EVERY SEPARATE TEST AND PROCEDURE -- AN APPROACH THAT REWARDS MORE CARE, NOT BETTER CARE AND THAT REWARDS PAYING FOR ILLNESS

AND NOT PREVENTING IT.

As a result, the US spends twice what other developed nations spend on health care yet we are less healthy than the people of those countries.1

And in Maine we are losing ground; last year we ranked 16th in overall health, while still spending more per person on health care than most every other state.2

But health care reform isnt enough.

Weve long known that poverty, food, housing, education and a job matter more to good health than medical care. New research shows that while the US is No. 1 in health care spending among developed nations, we rank 25th in spending on income supports, employment programs, family supports, survivors benefits, pensions, disability, supportive housing and other social services. That study suggests that, if we improve those supports, we could reduce health care costs.3

Our current practices are not focused on the health of the whole person. Our system is a model of sick care, not health care. The cornerstone of a successful delivery model must be on prevention and social support, an area where we are currently falling short.

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GETTING IT RIGHT FOR HEALTHFOCUSING ON HEALTH CARE NOT SICK CARE

INTRODUCTION

MY HEALTH PLAN FOR MAINE RECOGNIZES THAT ENDING POVERTY AND MAKING SURE EVERYBODY HAS FOOD ON THE TABLE, OPPORTUNITIES FOR EDUCATION AND WORK, AND A

WARM, SAFE ENVIRONMENT ARE A BIG PART OF MEANINGFUL HEALTH REFORM.

We must do more to reduce costs for small businesses so that they can afford to partner with their employees on health insurance coverage, and we must look for ways to partner with other states in our region to improve health, which includes fighting drug abuse and addiction. Such partnerships have the potential to go much further.

We can and must do better. We can and must work together to improve our health while lowering our health care costs. A system that treats people when they are sick instead of keeping them from reaching that point is inefficient and costly on so many levels.

Heres my 10-point plan to improve our health and control health care costs.

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The Affordable Care Act is a landmark achievement. It reforms Americas health care system. It allows more people to afford health insurance, rewards prevention, invests in public health and offers new new ways to deliver and pay for health care and improve its quality. The ACA is an important first step and we need to take advantage of its strengths. It provides Maine and other states new opportunities and the responsibility to keep working to improve it.

The ACA makes full federal financing available in MaineCare through 2016 for all those below 138 percent of the federal poverty level (about $15,500 for an individual) and requires the state to pay no more than 10 percent of their costs in later years. Without this expansion, nearly 70,000 people living below poverty are uninsured. They are our neighbors, friends and family members, including more than 3,000 veterans.4

WHEN PEOPLE WHO ARE POOR AND UNINSURED GET SICK, THEIR COSTS ARE SHIFTED TO ALL OF THOSE WHO PAY HEALTH INSURANCE PREMIUMS. ACCEPTING FEDERAL FUNDS TO EXPAND MAINECARE WILL COVER THESE MAINERS, REDUCE THE HIDDEN TAX ON PRIVATE

PREMIUMS THAT PAYS FOR THEIR CARE TODAY, AND GENERATE ABOUT $3 BILLION OVER 10 YEARS5 IN NEW FEDERAL FUNDS FOR MAINES DOCTORS, HOSPITALS AND OTHER PROVIDERS.

EXPANSION HELPS EVERYONE, NOT JUST THOSE WITHOUT INSURANCE.

These dollars will help support jobs and increase economic activity in Maine. In addition, Medicaid expansion will create savings. Today the state pays for many services, such as mental health and substance abuse for those ineligible for MaineCare. When MaineCare is expanded, newly eligible people will have most of those costs paid by the federal government. The Legislatures Office of Fiscal and Program Review estimated those savings to be $11.8 million in 2015-2016 alone.

The ACA establishes marketplaces, also called exchanges, which help individuals and families access affordable health insurance. States can decide whether to create a state insurance exchange, partner with the federal government or allow the federal government to administer that exchange.

Maine relied on the federal exchange and outreach assistance available through federal grants and Maine Health Access Foundation funding to enroll over 44,000 Mainers.6 That is a start but we can do even better. We need state government to fully support these efforts to get the word out and help people enroll. A new open enrollment period will begin in November 2014.

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1. TAKING FULL ADVANTAGE OF THE AFFORDABLE CARE ACT

Recent court action called into question whether people buying health insurance in the federal exchange could still receive subsidies to purchase that insurance. Additional court action is expected and there are both legislative fixes and court action that can make sure those subsides are protected.

It is premature to contemplate the demise of subsidies available through the federal exchange but, if that were to occur, the state of Maine could establish its own exchange to guarantee that subsidies continue. States that chose to start their own exchanges initially were provided significant federal funding to support start-up. However, those funds are no longer available after 2014. Start-up after that time would require considerable time, staff and technology resources.

The ACA also creates a Small Business Health Options Plan (SHOP) for businesses with fewer than 50 employees.7

BY POOLING MANY SMALL BUSINESSES TOGETHER, THE SHOP WILL HAVE BARGAINING POWER TO NEGOTIATE BETTER DEALS FOR SMALL BUSINESSES.

Two-year tax credits are available for certain small businesses, generally those with 25 or fewer employees with average salaries of under $50,000. Seasonal workers can buy coverage but are not included when employers are counting whether or not they meet the employee limits for participation or tax credits.

In 2016, the SHOP will expand its offerings to cover employers with up to 100 employees. The SHOP is part of the federal exchange but has not been fully implemented. Today small businesses in Maine access new coverage through brokers, insurance companies and agents who help facilitate the process of applying for tax credits which are only available through the SHOP.

A. Immediately accept $3 billion in federal funds to cover 70,000 Mainers.B. Work in partnership with the federally facilitated exchange to increase insurance oversight and

competition, especially for small business, and expand outreach to assist those eligible for premium tax credits to access them.

C. Explore a state-run exchange, if needed and if funds are available.D. Participate in federal grant programs that fund innovation and reforms in how care is delivered and

paid for.E. Support Maines municipalities, hospitals and community health centers as they address the needs

of those who remain uninsured.F. Expand efforts to educate new enrollees in how to use their health care benefit effectively and

efficiently.

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ACTIONS:

The Department of Health and Human Services is one of the largest and most complicated agencies in state government. Under the direction of Gov. Paul LePage, it has been mired in scandal and mismanagement. Costly and ineffective transportation provider contracts, federal decertification of Riverview, cost overruns, a costly, plagiarized consultants report and CDCs document shredding are just some examples. This mismanagement is costing Maine taxpayers millions of dollars while hurting countless working families and businesses.

WHILE THE DEPARTMENT HAS STRUGGLED UNDER GOV. LEPAGE, THE GOVERNORS EFFORTS TO COMBAT WASTE, FRAUD AND ABUSE HAVE BEEN INEFFECTIVE, HIGHLY POLITICIZED AND

LARGELY FOR SHOW.

Even as his policies have failed, and children and families have fallen into deeper poverty, the governor has focused on turning waste, fraud and abuse into a campaign issue instead of ensuring that his own administration works properly.

DHHS programs are the states front line as guardians for public health, addressing the needs of vulnerable populations, ensuring emergency preparedness when disease outbreaks or disasters strike and managing MaineCare, a program whose budget makes up nearly a quarter of the states budget. There are many highly competent and hard working DHHS employees.

The solution is not to reorganize the department that takes enormous time and resources and would not move the department in the right direction. The solution is to give DHHS the governors full attention, appoint competent managers and engage the many constituencies of the department in plans to improve its effectiveness and efficiency.

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2. REVITALIZE DHHS AND HOLD IT ACCOUNTABLE FOR GETTING RESULTS

A. Hire and support competent managers with knowledge and experience in Medicaid and health services.

B. Complete a thorough, well-planned management and performance audit to identify key problem areas and wasted resources within the department.

C. Develop a work plan with measureable goals and outcomes of performance to ensure state and federal funds are well managed, and that programs are run efficiently, effectively and transparently and meet the needs of Mainers.

D. Work with providers and consumers to appropriately and effectively manage care for all MaineCare members and, in collaboration with the CDC, institute policies and programs that measurably improve the health of those members.

E. Establish an Office of the Inspector General to focus on fighting waste, fraud, abuse and mismanagement at all levels, and work to ensure that vital programs achieve successful outcomes for Maine people.

F. Streamline operations and end administrative redundancies that create unnecessary and costly administrative burdens on providers and consumers.

G.Re-dedicate DHHS to its mission of improving health and preventing disease and ensure the Fund for Healthy Maine is spent on programs that support that mission.

H. Encourage rather than discourage efforts to obtain federal funding to supplement state and private investment in public health.

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ACTIONS:

Health care costs are driven in part by high rates of chronic illness and our aging population. Treating preventable illnesses may account for as much as three-quarters of total health care spending each year.8 Even when the data is adjusted to take into account Maines aging population, we have higher rates of cancer, asthma and other lung diseases, and we have more disability than national averages. More Maine adults are overweight and more smoke than our peers across the nation.

But health care reform isnt enough. We need comprehensive policies to address poverty, food, the environment, housing, education and a job things that matter as much to good health as medical care.

A. Launch the Supportive Housing Team, representing DHHS, Maine State Housing, staff from our congressional delegation and federal housing agencies, housing providers, consumers and experts in financing, homelessness, aging and mental health and disability to find ways to design and finance innovative approaches to safe, affordable and, where needed, supported housing and new models for long-term services and supports for elders and persons with disabilities.

B. Initiate a DHHS pilot program that will contract with a local provider, community care team or community health center to deliver primary care and a wide range of social and health services to a group of MaineCare members. The pilot will test whether combining social and health services and payments will result in better care and lower costs.

C. Ensure collaboration among cabinet agencies as we address food security, poverty, a healthy environment, early childhood development, student hunger, educational attainment and economic development.

D. Support programs that focus on preventive services for Mainers, including but not limited to, smoking cessation, diabetes counseling, weight loss programs, nutrition education and exercise programs.

E. Set statewide, regional and local goals to improve public health and work collaboratively with Maines public health community on strategies to improve health and to develop consensus on metrics to measure and report on how those strategies yield health improvements.

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ACTIONS:

3. MAKE MAINE A HEALTHIER STATE BY ADDRESSING THE UNDERLYING CAUSE OF POOR HEALTH

With a median age of 42.7, Maine is the nations oldest state9 and can expect an increase in retirees as the Baby Boom ages. Further, 15.7 percent of Mainers of all ages report that they have a disability, much higher than the US average of 12.1 percent.10

Older Mainers and persons with disabilities have important contributions to make to the state but also may require additional supports and services. Compared to most states, Maines population of persons over age 65 are less likely to be poor -- a predictor of needs. Maine ranks 37th among the states in poverty among those 65 and older. Nevertheless, the MaineCare program is an important source of support for elders and persons with disabilities.

Importantly, Maines Alzheimers population is expected to double between 2010 and 2030. People with dementia are more likely to receive care in residential care and in nursing facilities. Sixty-seven percent of people in residential care facilities and 78 percent of people in nursing facilities have a form or dementia or impaired decision making.11

A. Create incubators of innovation within local communities that support affordable housing, multi-generational support systems, and private and public payment service options. (Examples include multi-generational shared living arrangements; sliding scale Village services; volunteer transportation, home care.)

B. Challenge the private and public sector to develop employment policies that support the employed family caregiver.

C. Work collaboratively with the Legislature on policies such as Speaker Mark Eves KeepME Home initiative to help seniors age in place and in their communities.

D. Foster cross community collaboratives that accelerate the transfer of innovation and information; that promotes aging and its effect on the economy, education, workforce, tourism, retail services, etc.

E. Focus Maines innovation, technology and research enterprises, including the health care sector and Maines higher education institutions, on the states aging population to make Maine a hub for innovation, aging research and technology.

F. Seek federal funds available to implement new models of care that strengthen primary care, help people navigate the complex Medicaid and Medicare systems; better coordinate medical and long term-care services; and support patients and families during times of care transition (e.g. after discharge from the hospital; during a nursing home admission or discharge).

G.Make Maine a leader in dementia care, dementia-accessible environments and dementia-friendly communities. Improve training across all sectors for health care and non-health care workers on principles of dementia; include dementia considerations in environmental and community planning; promote new models of care and technology to care for people with dementia.

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ACTION:

4. ENSURE THAT PERSONS WITH DISABILITIES AND MAINES AGING POPULATION AND THEIR CAREGIVERS HAVE ACCESS TO HOUSING, HEALTH CARE AND LONG-TERM SERVICES THAT ARE PERSON-CENTERED, AFFORDABLE AND COMMUNITY BASED.

Good oral health is a key component of good overall health and can be a factor in employability. Although dental caries, or cavities, are preventable, 22 percent of kindergarteners and 33 percent of 3rd graders had treated or untreated dental caries in 2011; 51 percent of adults had lost at least one tooth and Maine had higher rates of oral cancer than the nation.12

In 2013, when asked to identify unmet health care needs due to cost, Mainers listed dental health as their top concern. Twenty-six percent of insured people and 41 percent of uninsured reported that they could not afford needed dental care.13

DENTAL PAIN IS A LEADING CAUSE OF EMERGENCY DEPARTMENT VISITS, VISITS THAT ARE EXTREMELY COSTLY AND ARE PREVENTABLE WITH BETTER ACCESS TO DENTAL CARE.

MaineCare currently provides dental care for children but not for adults. The ACA requires health plans to provide a dental benefit for children but allows that requirement to be met if a separate, stand-alone dental plan is available.

Established in 2008 with private philanthropic support, From the First Tooth aims to reduce the incidence of dental disease among Maines children by increasing the number of children from birth through 3.5 years who receive preventative oral health. Children on MaineCare are more likely to have a medical visit than a dental visit so this initiative works with medical practices that are seeing those children.

All or part of most Maine counties are federally designated Health Professions Shortage Areas. Maines 19 Federally Qualified Health Centers provide access particularly in rural areas and are actively integrating oral health and medical care.

A. Increase outreach and education about pediatric dental benefits in the federal marketplace. B. Strengthen the Division of Oral Health in DHHS. C. Encourage the co-location of services to include primary care and oral health.D. Examine medical claims for adults on MaineCare to determine the cost of care and emergency

department use that would be prevented with better dental care.E. Develop a plan to offer adult dental benefits, perhaps to a limited group, such as the most

vulnerable populations, paid for by offsets from avoided medical cost.F. Encourage the education and recruitment of future oral health providers.

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ACTION:

5. IMPROVE ORAL HEALTH FOR MAINERS

Telehealth allows increased rural access to specialists, including psychiatrists and helps prevent avoidable admissions and re-admissions to hospitals, particularly from nursing homes. It works to manage chronic illness, provide home care supports and to help to address workforce shortages as more Mainers are covered under the ACA. Visits to doctors offices and emergency rooms could sometimes be avoided if a physician could check a patient through telecommunication a Skype-like program for simple diagnoses. Physicians and patients alike are ready to end the tyranny of the 15-minute visit. Use of telehealth may ensure better use of that office time.

To fully realize telehealths potential requires an appropriate balance of consumer protection, quality and cost oversight and innovation. The goal of telehealth should be to optimize health and make delivery of care more efficient. But payers have not yet fully embraced telehealths capacity to help support and extend the capacity of Maines health care workforce.

Technology also enables better transparency about health care costs and quality and supports electronic medical records and health information exchange that protects consumer information and improves care by reducing redundant testing and ensuring up-to-date information for clinicians.

A. Enact legislation to facilitate cross-state licensing and reimbursement like the model proposed by the Federation of State Medical Boards.

B. Expedite statewide broadband development to ensure the ability to access telehealth and health information exchange.

C. Work with providers and payers to fully integrate telehealth and health information exchange into clinical practices, home care and other settings and to develop payment policies that support these activities and prevent unneeded visits, tests and services.

D. Identify and train existing staff in DHHS licensing to serve as liaison for telehealth, working with the industry and consumer groups to ensure initiatives are evidence based, cost effective, are integrated into clinical practice and appropriately protect consumers.

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6. IMPLEMENT PAYMENT AND REGULATORY REFORMS TO TAKE FULL ADVANTAGE OF TELEHEALTH, AND IMPROVE HEALTH INFORMATION EXCHANGE

ACTIONS:

We pay providers for every test or procedure, not for outcomes of care. The Institute of Medicine and the Congressional Budget Office both report that we could reduce health care costs by 30 percent to 40 percent if we stopped doing things that are unnecessary or wasteful.14 The Maine Health Management Coalition identified increased outpatient utilization and higher unit prices as major cost drivers.15

HIGH HEALTH CARE COSTS PUT COVERAGE AT RISK FOR TOO MANY AND PUT A DAMPER ON MAINES ECONOMIC COMPETITIVENESS.

Certainly Maines health care sector is an economic engine here, providing good jobs statewide. But those jobs are paid for through tax dollars and insurance premiums.

RAND16 reports that new health care jobs result in fewer jobs in the private sector. Its a balancing act as we try to get incentives right, ensure the stability of our health care providers and get the health care we need at the right time, in the right place, in the right way and at a price we can afford. That means we need to find new ways of running the business of health as efficiently and effectively as possible.

DHHS has launched some important initiatives to improve value but the departments management problems have caused delays and diverted staff from full implementation of these programs

A. Accelerate current innovations like the patient centered medical homes, primary care community care teams, Accountable Care Organizations and the work of the State Innovation Model grant to document what works and implement those comprehensive payment reforms and system redesign.

B. Support service delivery and payment that coordinates behavioral, oral, clinical and public health. C. Hold providers accountable for improved outcomes and lower costs.D. Ensure the availability of transparent, comprehensive data and information about quality, cost and

clinical care to accurately measure provider progress.E. Accelerate efforts to engage consumers by providing them with reliable, timely and transparent

information about health care costs and quality.

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7. CONTROL COSTS BY PAYING FOR VALUE NOT VOLUME

ACTIONS:

The State Employees Health Commission (SEHC) operated without any additional funding for four years, despite high health care cost inflation. The commission took action and is now a model in improving quality and restraining cost.

The health plan allows members to reduce out of pocket costs if they have access to and use a provider listed as high quality by nationally accepted, transparent criteria. In addition to encouraging more providers to qualify for those high quality rankings, the initiative resulted in average annual premium increases of 4.5 percent, considerably lower than the commercial state average.17

This model has been adopted by the University of Maine System and the Maine Municipal Employees Trust and marks a critically important re-direction in how care is provided and paid for.

More recently, the SEHC has engaged Maines largest health systems, MaineGeneral, MaineHealth and Beacon Health in Eastern Maine in the establishment of Accountable Care Organization contracts.

These contracts benchmark quality performance, provide that the plan sponsor and the provider system share savings based on actual performance and establish growth caps that help keep premium rates predictable and controlled.

In addition to the innovations underway in the State Employees Health plan, there may be ways to maintain the plans integrity, minimize the plans exposure to taxes and strengthen its innovative purchasing initiatives.

ONE APPROACH WORTHY OF CONSIDERING IS TO EXAMINE HOW TO BROADEN THE POOL OF COVERED LIVES TO ENHANCE THE PLANS NEGOTIATING POWER AND BRING IN

YOUNGER AND HEALTHIER ENROLLEES TO HELP SPREAD AND LOWER COSTS.

The ACA expands the definition of small business to include those with up to 100 workers and there may be opportunities for collaboration between the state plan and small business.

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8. USE THE STATES PURCHASING POWER, IN COLLABORATION WITH THE PRIVATE SECTOR, TO SPUR INNOVATION AND CONTROL COSTS

A. Support the continued development of the ACO and other payment reform strategies by public purchasers and monitor success in achieving quality and cost growth caps.

B. Ensure that the State Employees Health plan receives the level of funding needed to support the integrity of the plan and continue collaboration, innovation and quality improvement efforts.

C. Convene a study group, with necessary actuarial and other support, to examine strategies through which public purchasers may continue and expand their collaboration and whether it would be feasible to offer the opportunity for Maines small businesses to buy into the private health insurance offered to state employees. The study would determine if allowing small business, and their potentially younger employees, to buy into the state employee plan could reduce costs for both while maintaining the state employee plans high quality.

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ACTION:

Mental illness is common and incurs great cost to individuals, families and the community. About one in four adults experiences mental illness in a given year18 and Maines seniors have one of the highest rates in the nation.19

MAINES ADOLESCENTS ARE MORE LIKELY TO DIE FROM SUICIDE THAN ANY OTHER CAUSE EXCEPT ACCIDENTAL INJURY.20

Mental illness remains the top cause of disability.21 Persons who are mentally ill have higher rates of chronic medical diseases with more costly treatment and poorer outcomes. Despite the high cost of untreated mental illness, state money for treatment has been cut in recent years and Mainers who are mentally ill have become more likely to end up homeless22 or in prison.23

Mental illness and substance abuse often co-occur.

THE NATIONAL EPIDEMIC OF PRESCRIPTION DRUG ABUSE HAS HIT MAINE HARD. MAINE RANKS AMONG THE HIGHEST IN THE NATION FOR RATES OF PRESCRIBING BOTH LONG-ACTING AND HIGH DOSE OPOIOD PAINKILLERS.24 MAINES HOSPITALS AND PRISONS ARE

STRUGGLING WITH THE MOUNTING FALLOUT OF OPIOID ABUSE.

Emergency Departments swell with visits related to drug misuse.25 Drug related crimes are escalating at a time when the cost of caring for inmates in Maine is the fifth highest in the nation due to the lack of Medicaid expansion, high incidence of mental illness and an aging population.26 Many of the current administrations positions make the problem worse.

Proposing to withhold life-saving medications like naloxone, curtailing methadone treatment as a matter of policy rather than individual clinical assessment, scaling back mental health budgets and denying health care coverage for the most vulnerable costs the community money and individuals their lives. There were 176 drug-induced deaths in Maine in 2013.27

Medical science shows that mental illness and substance abuse can be treated effectively and recovery is possible. Objective, large-scale investigations have proven which prevention and treatment strategies work. Clinically proven, cost effective strategies not fear or politics must define policy.

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9. REDUCE THE IMPACT OF MENTAL ILLNESS AND SUBSTANCE ABUSE ON MAINE COMMUNITIES WITH EVIDENCE-BASED PREVENTION AND TREATMENT

STRATEGIES PROVEN TO WORK

A. Expand Medicaid under the Affordable Care Act, thereby expanding access to mental health and substance abuse treatment.

B. Seek federal and foundation grants to fund the Maine Substance Abuse and Mental Health Evidence-Based Policy Center, which will assess and make recommendations for aligning state policy with evidence-based prevention and treatment, disseminate best practices and strengthen provider networks.

C. Support availability of substance abuse treatment services with demonstrated efficacy, including outpatient and residential programs as well as alternatives such as opiate replacement.

D. Review the adequacy of current inpatient mental health beds in the state of Maine and the number of persons with mental illness who are boarded in emergency departments awaiting placement in an inpatient psychiatric facility to develop more efficient and patient-centered strategies to meet this need.

E. Support efforts to systematically integrate mental health, substance abuse and primary care services through primary care offices and medical home models. Encourage the co-location of services to include primary care and behavioral health.

F. Sustain a statewide Prescription Drug Monitoring Program and require its use among providers to ensure responsible prescribing practices. Continue to educate providers about best prescribing practices and multimodal pain management to reduce over-prescribing.

G.Support evidence-based public education to teach the public about the risks of misusing prescription drugs and importance of proper drug disposal.

H. Build partnerships among DHHS, the Department of Corrections and community law enforcement to develop multi-sector strategies, coordinate treatment systems and achieve common goals.

I. Develop public education campaigns to help the public understand and destigmatize mental health and substance abuse treatment.

J. Join with the five other New England governors who have agreed to coordinate prescription drug monitoring region-wide to prevent doctor shopping and collaborate to expand access to treatment.

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ACTIONS:

The Affordable Care Act makes more people eligible for health coverage; coupled with the aging population, demands on the health system will increase. As health care delivery and payment evolves, new skills will be required of health care professionals.

A. Require Maines public institutions of higher education to redouble their efforts with health providers to assess needs and gaps, including education in inter-professional teams, and ensure educational pathways are available to fill those gaps.

B. Maximize telehealth to expand access to providers and to their patients.C. Support the direct care workforce by increasing the minimum wage, eliminating barriers to training

and career advancement, and supporting the TANF apprenticeship program as a gateway to health careers.

D. Evaluate Doctors for Maines Future and other FAME loan, grant and loan forgiveness programs to determine their effectiveness in increasing primary care, dental services and other needed professionals in Maine.

E. Support Maines hospitals as they provide structured and supportive teaching environments for Maines next generation of health care providers.

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1 OECD, 2011

10. ENSURE WE HAVE THE WORKFORCE WE NEED FOR THE FUTURE

ACTIONS:

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2 Americas Health Rankings, 2014 edition; Kaiser State Health Facts, Health Care e=Expenditure/Per capita by State of Residence (2009)

3 Elizabeth Bradley and Lauren Taylor. The American Health Care Paradox: Why Spending More is Getting Us Less. BBS Public Affairs, 2013

4 Jennifer Haley et al., Uninsured Veterans and Family Members; State and National Estimates Under the ACA. Urban Institute, 2013

5 Jan, Tracy. (2013, February 23). 44,000 to lose medicaid coverage in Maine. The Boston Globe. Retrieved from http://www.bostonglobe.com/news/nation/2013/02/22/maine-governor-cuts-medicaid-some-gop-colleagues-choose-expansion/QpZusfrOXCvm9EAh91YfnJ/story.html

6 Russell, Eric. (2014, June 19). The average Obamacare premium in Maine: $99. Portland Press Herald. Retrieved from http://www.pressherald.com/2014/06/18/mainers-paying-average-of-99-in-monthly-premiums-on-exchange/

7 The ACA defines small businesses as those with 50 full-time equivalent employees(FTE) and defines full time as 30 hrs. A company with two workers who each work 15 hrs/wk. would count those two workers as one FTE, for example

8 CDC, Chronic Diseases: The Power to Prevent, The Call to Control: At A Glance, 2009

9 US Census Bureau, 2010

10 Cornell University, US Disability Statistics, ACS, 2012

11 Julie Fralich, Muskie School of Public Service

12 Maine CDC/DHHS, Oral Health in Maine, January 2013

13 Maine Health Access Foundation, Health Reform Monitoring Survey, 2013

14 Institute of Medicine, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, (2012)

15 MHMC, Report of the Health Care Cost Work Group, December, 2012

16 Sood N, Ghosh A, Escarce JJ. Employer Sponsored insurance, health care cost growth and economic performance in US industries. Health Services Research, 44:5,Pt 1, pg 1449-64

17 SEHC, Report to the Joint Standing Committee on Insurance and Financial Services, 2/22/2013

18 Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27

19 Americas Health Rankings Senior Re. 2014 Edition. United Health Foundation report

20 The Childrens Safety Network. Maine 2013 Fact Sheet. http://www.childrenssafetynetwork.org/sites/childrenssafetynetwork.org/files/Maine%202013%20State%20Fact%20Sheet.pdf

21 Whiteford, HA et al. Global burden of disease attributable to mental health and substance abuse disorders; findings from the Global Burden of Disease Study 2012. The Lancet. 2013 Nov 9

22 Billings, Randy. (2013, November 22). U.S. homelessness falls but in Maine its up 26%. The Portland Press Herald. Retrieved from http://www.pressherald.com/

23 Stone, Matthew. (2003, September 6). Maines mentally ill more likely to be in prison than hospital. The Bangor Daily News. Retrieved from http://www.bangordailynews.com/

18

24 Leonard J. Paulozzi, L.J., Mack, K.A. & Hockenberry, J.M. (2014)., Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines United States, 2012 Center for Disease Control Morbidity and Mortality Weekly Report July 4, 2014 63(26);563-568.

25 Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013

26 State Prison Health Care Spending Report. 2014, July 8. Pew Charitable Trust. http://www.pewtrusts.org/~/media/Assets/2014/07/StatePrisonHealthCareSpendingReport.pdf

27 Sorg, Marci. 2014, May 23. Number of Drug-Induced Deaths and Pharmaceutical Opioid-Induced Deaths in Maine. http://www.maine.gov/tools/whatsnew/attach.php?id=621052&an=1