Back in the early 1990s, I worked at a library with a reference librarian who taught me so much. I’ll never forget a conversation we had about the Internet as it was beginning to take over our lives.
She said she welcomed the new way of proliferating information, but she was worried a bit, too. She said knowledge was a deep lake, and the Internet was going to make it so people could just stick their toe in and think they knew everything they needed to know.
Her caution has stuck with me over the years, especially now that I’m blogging and fearful of becoming a “toe-dipper” for the sake of generating content. I think too much “toe-dipping” is contributing to our over-simplified, either/or political discourse. Complex issues get broken down into soundbites that get repeated and shape how we talk and what we talk about.
In Maine, the many complexities that make up our Department of Health and Human Services are a big chunk of our government and a big chunk of our political discourse. Seeking more than a toe-dip on the legislative side of the equation, I met with Rep. Drew Gattine, D-Westbrook, chair of the Health and Human Services Committee at Bagel Mainea in Augusta.
Gattine is serving his second term. He is a health care program manager with a legal background that includes being a former assistant attorney general. When we talked, I was struck by his ability to speak passionately about our state’s moral responsibility to its most vulnerable citizens, while maintaining a sense of fiscal responsibility to taxpayers.
Gattine takes the idea of efficient, effective programming seriously in both his legislative and professional roles. As he put it, “Taxpayers have the right to expect if they are investing their dollars, they are getting good value.” Gattine would prefer that discussions about welfare reform looked at “program integrity — looking at programs end to end, to make them run efficiently and effectively as possible.”
He said that “welfare reform should be laser focused on programs meeting their goals, providing support to folks they transition to higher levels of independence and protecting kids.”
He said he feels there’s more to welfare reform than “administratively nibbling around the edges” and thinks Republicans and Democrats “can agree that the goal of the program is what should be focused on when we talk about reform.” He used the Temporary Assistance for Needy Families program as an example.
Since the LePage administration instituted a 60-month cap on TANF benefits in 2012, the case load has been cut more than in half. Gattine would have no problem with such a reduction if the decrease represented families, “mostly single moms with kids,” who had “successfully moved to independence.”
Gattine wants to know “what happened to those kids?”
He’s right to wonder. A 2014 Portland Press Herald article directly links the cap with increased spending in local general assistance spending. A Maine Municipal Association staff member quoted in the article said, “caps don’t address need,” and “the cap may have improved the outlook for the TANF program, but it also shifted burden.”
Gattine emphasized that, “at the very least, we need to use those 60 months as effectively as we can to help moms and kids succeed.”
Documentation around welfare reform wasn’t Gattine’s only concern when it came to the committee’s needs for information from the LePage administration. He finds the current state of affairs at Riverview Psychiatric Center, including 47 incidents involving tasers and pepperspray and the loss of federal certification, “very discouraging” — especially considering that just 10 years ago it “was built and opened and represented a new era of how we were going to take care of people.”
Gattine said the conversation about the path forward, the path toward “improving how we care for people needs to be a very honest, fact-based dialogue, but the department doesn’t want to interact.” He has yet to see “a case made for a separate 50-bed forensic facility” as proposed by the LePage administration. He said our state has managed forensic clients for roughly a 100 years and referred to it as a “core function of our health and human services.”
From Gattine’s viewpoint, the committee needs good information from the department “to make fact-based decisions.” The department has billed the proposed facility as the only solution to getting re-certified by the federal government. Gattine says he’s seen no information to support this conclusion, though, and no discussion of alternatives considered, like changes to the current facility or expansion.
He said the legislature has shown a “willingness to step up” and support improvements at Riverview. The legislature has provided additional funding for the hospital five times in two years, yet the department continues to show an unwillingness to work collaboratively with legislators. Officials from the department have only recently agreed to appear again before legislators to discuss the Riverview situation after repeated requests for appearances.
Gattine hopes these meetings will be fruitful. He hates to hear issues and bills characterized as “going nowhere” or “dead on arrival” and has a positive outlook on the potential for progress when the legislature reconvenes soon. Gattine believes elected officials owe it to the people and businesses in our state to remain open-minded about ongoing conversations regarding the challenges we face.
Gattine described how legislators came together at the end of the first part of the session to pass a veto-proof budget. Legislators are also fairly unified about addressing our state’s addiction epidemic and are making it their first priority.
The Health and Human Services, Appropriations, and Criminal Justice committees are holding a public hearing on a proposal that funds 10 new drug enforcement agents, supports and expands available treatment, and also addresses education and prevention. The hearing is Tuesday, Jan. 5, the day before the legislature reconvenes. Gattine acknowledges that what is being considered is not an entire solution, but a starting point.
He said he, himself, wanted a greater understanding and reached out to providers, community members and law enforcement. Gattine said he quickly learned how real this crisis is. “Some of the most interesting conversations were with law enforcement” because they are the first to say we can’t arrest our way out of this crisis. He said police chiefs and prosecuting attorneys are “strong advocates for improving, end to end, the way we take care of this.”
But lack of treatment access is hindering progress. Gattine said he met with the folks running Operation Hope at the Scarborough Police Department, and they are routinely sending addicts seeking treatment out of state to get help. He said addressing the treatment side of a comprehensive plan highlights bigger medical and resource problems.
Gattine said “most of the people who need help are uninsured,” and providers can’t afford to stay in business without compensation. Which is why he is hopeful about a more well-rounded discussion when it comes to yet another proposal to expand MaineCare under the Affordable Care Act. He said there’s an expansion bill that has been carried over from the first part of the session sponsored by Sen. Tom Saviello, a Republican from Wilton.
Again, the issue of MaineCare expansion is both human and financial for Gattine, and our drug crisis is a concrete example. Not only has Maine not expanded MaineCare under the ACA, but the LePage administration cut eligibility in 2014, reducing the rolls from approximately “350,000 to 285,000.” Gattine said a significant percentage of these uninsured people have mental health, substance abuse and other medical issues that require care, forcing providers to service these clients for free or to survive somehow on private pay.
Gattine talked about an independent financial study he reviewed that crunched the numbers behind the reality of not expanding MaineCare. For every dollar in state spending, Maine is losing the ability to leverage it for federal funds. The clients cut in 2014 garnered two-thirds of the funding for their coverage from the federal government.
Clients under the expansion would have or could garner 100 percent of the funding for their coverage from the federal government. Without MaineCare expansion, Gattine said our state is missing out on “3,000 health care jobs” and on funding for increased treatment access for addicts. Without expansion, Gattine said Maine will have to fund any increases in treatment out of state funds.
Gattine referred to other states with Republican governors that have chosen to expand their Medicaid programs. Some have expanded the program as the federal government suggested; others have modified the expansion to be more palatable to conservative lawmakers. He thinks Maine could find a way to do the same.
Even though MaineCare expansion bills have been passed five times by the last two legislatures with some bipartisan support and vetoed five times by Gov. Paul LePage, Gattine hopes the need to bolster our health care infrastructure is evident enough to solidify ample bipartisan support to survive a possible veto this time.
Treatment access for addicts is not the only part of our health care infrastructure causing him concern. Gattine is also the chair of a commission studying “Difficult to Place” patients. These are people whose behavioral health and medical health needs require levels of care not currently available in our service provision system. Some may need a nursing home level of care, but their behavioral health needs make the traditional nursing home setting inappropriate.
These patients are best served in geropsychiatric settings, however Maine only has three such facilities, and none, Gattine said, are north of Waterville. Further, he added, none have been added in 20 years. I chimed in that I’ve long thought that particular population seemed to get thrown out with the bathwater when the state closed AMHI.
The commission recently produced its first report that included recommendations, which Gattine characterized similarly to the proposal to address the addiction epidemic: It’s not a complete solution but a comprehensive starting point. Besides the geropsych population, Gattine said “improving home care must be a big part of the discussion” about how best to serve the other subgroups that make up this “Difficult to Place” patient group, including the elderly disabled.
Gattine said home care can “ultimately be less expensive” and is more humane; it’s what most people want. As things stand now, Gattine has met with hospital administrators who have patients ready for discharge who wait “hundreds of days” in the hospital for appropriate services and settings in the community. He called this situation “not only a huge money loser, but inhumane and heartless.”
Ever balancing the human and the financial, Gattine is looking forward to reconvening. In his experience, the second part of the session, which is shorter in length, ramps up quickly, and he thinks the tempo could contribute to progress on key issues.
If the legislature can operate the way Gattine does, we all have reason to hope. He wanted to talk only about our very real challenges and about potential solutions that meet Maine citizens’ needs.