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  • LePage's proposed cuts to community public health will put people at risk

    by Ramona du Houx

     Calling Governor Paul LePage's proposed budget “flawed and short-sighted”, physicians and public health professionals are expressing united opposition to the proposal to cut $10 million from Maine’s community public health programs in order to maintain current Medicaid reimbursement levels for primary care physicians in Maine.

    A large crowd attended a press conference at the State House just prior to the public hearing before the Appropriations and Health and Human Services Committees.  Speakers included physicians, high school students, representatives from Maine’s largest health systems, and business leaders in Maine’s rural counties. 

    “The proposed budget presents a false choice to policy makers,” said Doug Michael, President of the Maine Public Health Association and Chief Community Healthy Officer at Eastern Maine Health Systems in Bangor.  “It reflects a lack of understanding about how our collective health system works in Maine, particularly the interconnected relationship between community public health and primary health care.  We also know that preventing tobacco addiction saves lives and reduces health costs.  Abandoning our efforts to help kids resist tobacco use will have the opposite effect, just as it has in other states.” 

    The Affordable Care Act (ACA) included a provision to slightly increase primary care reimbursement rates for two years. But this federal provision has ended and states have to decide whether to continue it. The LePage administration has proposed using the Fund for a Healthy Maine to maintain this slightly higher reimbursement rate. Opponents were united in expressing support for the higher reimbursement rates, but warned against cutting community health to pay for them.

    “To cut community programs to fund primary care is like robbing Peter to pay Paul, or really, killing Peter to pay Paul,” said Dr. Daniel Onion, a primary care physician from Augusta.  “Of all the things we can do to lower sickness and mortality in Maine, smoking cessation is the most important. It prevents smoking related cancers, chronic lung disease, low birth weights, heart disease, and stroke. It is very cost effective because it prevents disease before it happens.”

    The Fund for a Healthy Maine is a special annual revenue stream - not taxpayer dollars - that result from the 1998 legal settlement with the tobacco industry.  Maine was one of 46 states to participate in that settlement.  Since the Fund for a Healthy Maine was created, Maine has seen a 48 percent decrease in youth smoking -- from 24.8 percent in 2001 to 12.8 percent in 2013. 

    Under John Baldacci's administration the federal dollars, from the lawsuit that states waged against tobacco companies, all went back into healthy programs to promote healthrisk awareness about tobacco. Governor Paul LePage's pervious budgets have raided the Fund.  And he's planning to do it again.

    More than one third, 35 percent, of students who smoke and were seen at a school-based health center reported that they reduced their smoking or quit smoking as a result of their visit. 

    Jessica Scheno, a senior at Maranacook Community High School spoke passionately about the importance of school-based health centers, which are slated for elimination in the governor’s budget.  She stated, “My grandmother started smoking at a very young age.  By the age of 54 she developed lung cancer. They had to make a hole in her throat so she could breath and a year later she passed away. No one wants their child, friend or family member to end up like that. That’s why we have to make a change.”

    The Campaign for Tobacco Free Kids reports that kids are twice as sensitive to tobacco advertising as adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure. One-third of underage experimentation with smoking is attributable to tobacco companies’ advertising. 

    The tobacco industry spends approximately $40.9 million in Maine every year marketing their products.  Also in Maine 2,400 adults die each year from their own smoking.  Approximately 27,000 kids now under 18 and alive in Maine will ultimately die prematurely from smoking.  And 1,300 kids under the age of 18 become new daily smokers each year.

    According to the Maine Center for Disease Control website, the Healthy Maine Partnerships are “where communities, schools, hospitals, businesses, and volunteers are working together at the state and local level to make Maine a healthier place to live and work”. 

    “Keeping employees healthy doesn’t start at the doctor’s office,” said Theresa Fowler, Director of the Central Aroostook Chamber of Commerce.  “It starts on Main Street, in our schools, at worksites and in communities.  A business’ most important asset is its employees.  Businesses need a strong community public health system in order to grow and thrive.  We need to be doing more, not less to keep our children and workers healthy – that’s an investment in Maine’s future and in Aroostook County’s future.”

    Public health opponents say that by proposing to cut almost 40 Maine CDC positions, representing about 10 percent of their workforce, and cutting funding to Maine’s community-based public health infrastructure, Governor LePage’s budget leaves Maine people vulnerable to the impact of infectious disease outbreaks, public health emergencies, and emerging public health threats. 

    Deborah Deatrick, Senior Vice President for Community Health for MaineHealth, the state’s largest health system that employs more than 17,000 people, joined the call to reject the proposed cuts.  “Maine’s health system is unique, but it works,” said Deatrick. “We need a strong public health system at the state and local levels to assure that the health of entire communities, not just the patients of an individual doctor or hospital, is protected and promoted.  Now is not the time to put the health of our people at risk."  

    Last December, Maine’s overall health ranking slipped to number 16 in the country, its lowest ranking in more than two decades.  With Governor John Baldacci's Dirigo Health Care, 2002- 20011- we were ranked 8th healthiest in the nation.  Cutting positions and programs, eliminating 40 key positions in the Maine CDC will make it worse.  Furthermore destroying TB control,  STD programs and gutting the Fund for a Healthy Maine will add to healthcare costs and put lives at risk.