BREWER, Maine — MaineCare’s unmet obligations to hospitals, the state’s contentious certificate of need program, mandatory nurse-to-patient ratios and other indigestibles were on the menu Thursday morning at a breakfast meeting for aspiring lawmakers and the incumbents they hope to unseat.

The event was hosted by Eastern Maine Medical Center and The Acadia Hospital and took place in the Cianchette Building at the Brewer campus of Eastern Maine Healthcare Systems, the hospitals’ corporate parent. Also attending were hospital officials and members of the EMHS citizen’s advisory council.

In her opening remarks, EMMC President and Chief Executive Officer Deborah Carey Johnson said the goal of the meeting was twofold: to bring lawmakers and candidates up to date on legislative issues affecting Maine hospitals, and to give members of the citizens group an opportunity to ask questions of their political representatives.

At the top of the agenda was the state’s failure to make good on a backlog of MaineCare payments dating to 2005, including some $116 million owed to the seven hospitals in the EMHS system alone. Mer Doucette, vice president and chief financial officer at EMMC, said the problem dates back to the Baldacci administration’s expansion of MaineCare eligibility and coverage without a commensurate increase in state funding. MaineCare is the name of the state’s Medicaid program for low-income and disabled individuals.

“The idea was that hospitals would find ways to increase efficiency and hold down utilization,” Doucette said, “but that’s not what has happened.” He explained that each year, the state prepays hospitals for estimated MaineCare utilization, then is supposed to make up the difference at the end of the year between the estimated utilization and the actual utilization. It is a combination of high utilization, inadequate prepayments and unpaid end-of-year balances that has created the debt owed to hospitals, Doucette said.

As a result, he said, “hospitals throughout the state are strapped for cash.” At EMMC, he said, the situation could cause deferred renovations and expansions. It could get to the point where “we won’t be able to serve the needs of the region,” he said.

Also up for discussion, and another factor in EMMC’s expansion plans, was the Maine’s certificate of need program. In Maine and a handful of other states, hospitals must obtain permission to invest in significant new facilities or equipment by demonstrating that the comprehensive benefit to the community offsets added costs to the health care system. EMMC is waiting to hear the verdict on its petition to embark on a $200 million expansion of its State Street campus.

Citizen advisory council member and former EMMC chief of medicine Dr. Alan Boone expressed frustration that the state owes hospitals millions of dollars yet stands in the way of needed expansions and improvements.

“Is there any hope of getting rid of the certificate of need?” he asked of the seasoned legislators at the breakfast.

Assistant Senate Minority Leader Richard Rosen, R-Bucksport, said he introduced a bill in the last session to repeal the certificate of need requirement, but it garnered only three votes of support. Rosen also spoke in favor of deregulating private health insurance companies, arguing that New Hampshire’s less-regulated environment has resulted in “a more robust private market,” a greater choice of insurance products, and lower enrollments in the state’s Medicaid program.

Responding to Rosen, Sen. Elizabeth Schneider, D-Orono, said deregulation is not the answer. “We have a major health care crisis nationwide,” she said. “What’s needed is a significant overhaul of the health care system. … It’s not just about opening up our markets so people can make more money.”

Schneider said there is broad agreement in Augusta that the state should honor its financial obligations to Maine hospitals, but there is simply not enough money to go around. “We have finite resources and infinite need,” she said, adding that she expects the budget shortfalls of recent years to worsen in the future. The state’s first priority, she added, should be to ensure the well-being of those in the greatest need.

About 14 candidates for state office attended the breakfast, including incumbents, challengers and several first-timers.

Bangor Republican Douglas Damon, a first-time candidate for House District 16, said he appreciated the hospitals’ invitation. “First you have to understand the problem before you can solve the problem,” he said. Damon, who is running against Democrat Steven Butterfield, said the MaineCare expansion and low reimbursement rates are to blame for many of the woes afflicting health care in Maine.

“Everything is so important, but how can we pay for it?” asked Ruth-Marie Spellman, a Brewer Democrat running against Republican Michael Celli in House District 21. “We have a lot cut out for us.”

Meg Haskell is a curious second-career journalist with two grown sons, a background in health care and a penchant for new experiences. She lives in Stockton Springs. Email her at