This Kitty makes me Smile!

This kitty makes me smile so I thought I'd share him with you to brighten your day! -Helen

Rockland Lobster Festival

The MSEA/SEIU Local 1989 Solidarity Committee will be marching in the Rockland Lobster Festival Parade this coming Saturday August 2, 2008. The Parade starts at 10:00 AM but the lineup starts way earlier. I plan to be there by 8:00 AM. Trust me if your not there by 9:00 AM you’ll never get anywhere close to the lineup location to find us. This is an event we have done for several years now and it is fun. They actually have invited us to come back now the last couple years. The lineup will occur at the intersection of North Maine Street and Broadway, Rockland, Maine. We usually line up at the entrance to the school right near that intersection. I believe it is the High School. Look for people in Purple t-shirts. Bring yours if you have one. Those members that come and participate in the parade qualify for the week’s free time share to be drawn at the MSEA Convention this year. This comes from an email I received from Steve Keaton. I hope you have fun in the parade!

This QUEEN-SIZED QUILT Could be Yours!

Handmade and donated by MSEA-SEIU Director and Chief Steward Penny Whitney-Asdourian this queen-sized quilt shown above will be raffled at the 2008 MSEA-SEIU Convention this fall. The quilt measures 92" x 106". Penny made the quilt in a "Crazy Eight" pattern using 100 percent cotton and batting. All raffle proceeds will benefit our union's political action program, Political Action by Service Employees and Retirees (PASER). Look for raffle tickets at upcoming MSEA-SEIU and SEIU events. To find out where you can secure a raffle ticket, call 1-800-452-8794.

New York Times Coverage of HCAN

July 8, 2008 New Group Demands Health Care Reform By Michael Falcone About halfway through a news conference in Washington, where the heads of major labor unions and liberal advocacy groups lined up one after another to push a multi-million dollar campaign for health care reform, it was time for the auto mechanic from Bar Harbor, Me. to speak up. “This is my busiest time of year and I shouldn’t be here,” said David White, who owns a small auto repair shop in the coastal resort community. But Mr. White showed up anyway to tell a story about his struggle to provide health care to his workers. “I’m proud to have paid the entire cost of platinum health coverage for my employees and their families. I considered it the right thing to do,” he said. “However when our insurance doubled in two years something had to change.” Mr. White said he was forced to downgrade to a lesser-priced policy, raise rates and lay off one employee for six months to make up for the higher premiums. “I was literally in tears laying this out to my men,” he said. “And I’m not really fond of crying.” A stand-in for other small business owners throughout the country, Mr. White was handpicked to speak by organizers of the new group Health Care for America Now, which officially kicked off its $40 million campaign to help all Americans access quality, affordable health care. The group is spending $1.5 million during the next two to three weeks on an advertising campaign, which includes television, print and online ads. Organizers said they would spend $25 million over the next five months on additional paid media and millions more on a grassroots effort that includes placing staff in 45 states. It will also put pressure on members of Congress in key districts to support reform. The first 30-second television spot will air on national cable channels as well as some local Washington stations. “One thing is crystal clear,” said Richard Kirsch, National Campaign Manager for Health Care for America Now, “If we want health care reform that works for us, we cannot trust the insurance industry to make it happen.” Health Care for America Now is made up of more than 100 organizations and received its initial funding from 13 groups that are part of its steering committee as well as a $10 million grant from The Atlantic Philanthropies. Members of the steering committee include MoveOn.org, the American Federation of State Community and Municipal Employees, the National Education Association and the Planned Parenthood Federation of America, among others. (A full list can be found on the group’s website, see link at right.) Each steering committee member group contributed at least $500,000 to the campaign — some gave much more. Mr. Kirsch said that his group was not taking a specific stand — just yet — on the health care proposals offered by the two presumptive presidential nominees, Senator John McCain and Barack Obama, but emphasized that it is the government’s responsibility to guarantee affordable coverage for all Americans. The campaign, he said, will mean that “the health insurance industry won’t have the battlefield to themselves,’ during this election year. “They will have to answer to the American people.” Elizabeth Edwards, wife of former presidential candidate John Edwards, who is a health care reform advocate and coalition supporter was not at Tuesday’s event at the National Press Club because she was attending the funeral for former Senator Jesse Helms of North Carolina. But in a statement she said: “Millions of Americans are sitting around their kitchen table at night, wondering why it is so difficult to afford the basics these days — especially health care. They come from all walks of life, but they have one thing in common: they know our health care system is broken, and they want a fair, common-sense solution that makes quality coverage affordable for everyone. Our mission is to make sure their voices get heard in Washington D.C., and everywhere else.

Workgroup – BOI Meeting, July 14, 2008

This last meeting of the Direct Care Worker Workgroup and the Bureau of Insurance was an informative one in that the spotlight was on direct care workers and their employers. Elise Scala from MainePASA and the Muskie School of Public Service at USM and Kurt Wise from MECEP talked about statistics pertaining to the direct care workforce. Things like the number of workers that receive some sort of assistance like MaineCare, the number of hours workers get a week and the fact that many workers do not want more hours because they may lose their MaineCare eligibility. It was mentioned that 72% of workers are part-time. Employers were represented by Joan Donahue Thompson from Hummingbird Home Care, Mollie Baldwin from Home Care for Maine, Eunice Spooner from Alpha One and Mary Lou Dyer from the Maine Association for Community Service Providers. They said that employers don’t find it financially feasible to provide insurance to their direct care workers because of low reimbursement rates. Employers also stated that the ones that can afford to provide health insurance can only cover their employees, not employees’ families. It was mentioned that the lack of benefits is also a concern for consumers. When workers worry about coverage or their health, they talk about it with people around them and their consumers. That in turn makes consumers worry. Joyce Gagnon from MainePASA and I talked about the challenges direct care workers face. Low wages, no benefits, being tied to the state budget and its shortfalls. I mentioned the cut to the homemaking program and that it meant a cut in hours each consumer receives which in turn equals a cut in wages for workers. I also said that it is a grave injustice to this workforce that we are not eligible for health insurance through the work we do. Several mentioned that the reimbursement rate paid by MaineCare is too low. MaineCare reimbursement for Direct Support Professionals used to include a line item for health insurance, but like everything else tied to the state financially, it got cut a few years ago. A suggestion was made to create a risk pool of all direct care workers in Maine. Why not? There are a lot of us out there across the state. The obstacles come when addressing the way to pay for it and with the different codes BOI set before us at the July 1st meeting. I’m hoping this meeting was an eye-opener for those around that table that don’t know too much about the Direct Care Workforce here in Maine. The next meeting is scheduled for July 30, 2008 at BOI in Gardiner. The meeting time is 9-11. The meeting is open to the public. If you’re interested in attending and need directions or more info on the workgroup, please send an email helen.hnsn@gmail.com.

HealthCare United - Maine

Yesterday, Grant Schott, HealthCare United's Maine organizer, held a meeting to get ideas on how to start moving this campaign forward in Maine. There were four interested individuals there, myself included. One was a social worker from southern Maine and another was a former union sister who used to work through Alpha One. Grant asked us if we'd be willing to help out with this campaign in Maine. We all made suggestions of groups to contact and try to work with. Grant specifically asked for help with canvassing and making phone calls. SEIU is working on this campaign across the nation. Please see the post of July 18th about HealthCare United. If there are any members of 771 who are interested in working on this campaign, please contact me helen.hnsn@gmail.com or Grant grant@healthcareunited.org for more information. This is a great way to meet other health care workers in Maine and share ideas on reform and work towards making those reforms a reality.

MSEA-SEIU Job Posting

Wanted: MSEA-SEIU members willing to take leave from their current jobs to work full time or part time in 2008 to elect people who share our values. These are paid positions. This is hard but rewarding work. To apply, contact Alec Maybarduk at 1-800-452-8794 or alec.maybarduk@mseaseiu.org

SEIU'S HealthCare United

Healthcare United- http://www.healthcareunited.org/ is a new national organization of healthcare workers uniting as a force in the 2008 elections and beyond, striving to make health care reform a top issue with the public and the politicians. We are building a network to be a force in the first 100 days of the next administration when health care reform is debated. Through Healthcare United, healthcare workers are making a difference in many ways- including registering health care workers to vote, finding out where candidates stand on health care issue, writing letters to the editor and letters to elected officials, and, above all, spreading the word about Healthcare United. There are two upcoming events, and we would love to see you at one of them- HCU 2008 Election planning meeting, Sat, July 19th, noon, HCU office at 574 Congress, 2nd floor, where will strategize on how we will make a difference in Maine in the three months leading up to Election Day, as well as provide more information about HCU and a HCU house party/ info meeting in Raymond Maine on Sunday July 20th at 4 p.m. Refreshments will be served. Even if you can only stay for part of the events, please stop by, you can RSVP by replying to this e-mail, or visiting the website- http://healthcareunited.org/states/maine For more information, contact: Grant Schott, HCU organizer, 207-514-4245, grant@healthcareunited.org

Health Insurance Workgroup Receives Press Coverage in Waldo County

Legislature taps group to explore health coverage for direct-care workers By Victoria Wallack, State House Reporter The Republican Journal AUGUSTA (July 16): A special committee created by the Legislature is looking for ways to provide health coverage to workers who take care of elderly and disabled in their homes or in institutions — jobs that largely are paid for by Medicaid, but either don’t offer health insurance or pay enough to allow workers to buy it. The original proposal that never made it to the floor for a vote this year was to put the workers in DirigoChoice, the state subsidized health insurance plan. That plan is facing its own financial difficulties, however, and for now enrollment is closed. The Insurance and Financial Services Committee voted instead to ask the state’s Bureau of Insurance to look at ways of making sure that more than 22,000 direct-care workers in the state have insurance and how to pay for it. The bureau has created the Direct-Care Workforce Health Coverage Working Group to help with the task, and it is meeting this summer. Funding no doubt will involve taxpayer dollars — either through a direct health insurance subsidy or by raising the Medicaid payments to the institutions and agencies that employ direct-care workers so they can offer insurance. The rate of uninsured ranges from a high of 34 percent for some home-based workers to 16 percent for those working in nursing homes and residential care facilities, according to a survey of some of the larger health-care providers. The number of uninsured correlates to low wages. Median wages in the direct-care industry range from $8.58 for home-based workers to just more than $10 for those working in long-term care institutions. Outgoing Senate President Beth Edmonds sponsored the legislation that would have put direct-care workers in Dirigo but said health insurance is just part of the problem. The overriding issue is making sure they earn a decent wage, she said. “I just want to make sure that we as a state keep trying to figure out how to raise the income of these people,” Edmonds said. “One, it’s the right thing to do and two, it’s a very important piece of the workforce that we need to make sure is stable and surviving.” Advocates argue that if wages and benefits aren’t increased, the state will not have enough workers to take care of Mainers in their homes as they age. The state has the highest median age in the country, and by 2030 will have 26.5 percent of its population age 65 or older, putting it second behind Florida. Mila Kofman, the state’s new superintendent of insurance, said her goal is “getting every single long-term care worker and their families insured.” “I’m not taking anything off the table,” Kofman said, including DirigoChoice as an option for coverage. She agreed that public funds most likely will be part of the proposed solution. "I think it’s realistic to say that for moderate-income wage earners, current prices of private coverage make it very difficult to buy purely private coverage,” she said. The bureau is due to report back to the Legislature by Oct. 1, and any proposal would require legislative approval. Rep. Jonathan McKane, R-Newcastle, who serves on the Insurance and Financial Services Committee, voted against creating the bureau study, saying direct-care workers don’t need to be singled out. “We all need health insurance and direct care workers are, of course, important. But, we need to make insurance affordable for everyone, not just certain groups. The government is kind of choosing the winners and losers,” he said. The Maine State Employees Association and its national parent, the Service Employees International Union, have gotten involved, organizing the Maine Direct Care Workers Union to lobby for pay increases and insurance coverage. Union spokesman MaryAnne Turowski, who serves on the health coverage working group, said the issue is inequity. “Our concern is these are health-care workers delivering health-care services, often with public dollars, and they don’t have health-care themselves,” Turowski said. The SEIU, with its local affiliates, is targeting lower-income service providers nationwide as part of its organizing efforts. Not only have they organized direct-care workers, but last year they organized home-based child-care providers — the majority of whom have state-funded care contracts. The Legislature earlier this year voted to recognize the new child-care union as a bargaining unit."

Dirigo Health featured at Hearing in Washington, DC

Maine's Dirigo Health Reform Highlighted in Federal Hearing WASHINGTON, D.C. – Maine's experience in pursuit of universal health coverage was a focus of a congressional hearing this morning. The House Ways and Means Health Subcommittee invited Trish Riley, Director of the Governor's Office of Health Policy and Finance, to deliver testimony during a hearing on state health care coverage initiatives. The Subcommittee, chaired by Congressman Pete Stark (D-CA), asked Riley to discuss how Maine enacted and implemented its own version of health reform, and to assess the difficulties in achieving universal health care and the need for national leadership in health reform. Riley, representing Maine, was one of two state officials who provided oral testimony. Massachusetts' Secretary of Health and Human Services, JudyAnn Bigby, M.D., also spoke at the hearing. A third member of the panel, Jack Lewin, M.D., Chief Executive Officer, American College of Cardiology, had served as Director of Health for the State of Hawaii from 1985 to 1994.In her testimony, Riley noted the political difficulty of funding universal health care. She also stated that while coverage is a key goal of Maine's Dirigo Health Reform, this must be pursued in tandem with efforts to reduce health care costs for all while increasing quality. Maine's Dirigo Health Reform effort addressed "an inefficient health care system which led to unaffordability of health insurance and a growing number of people who were under - and uninsured," Riley said.Since Dirigo Health Reform was implemented, it has achieved $110 million in documented savings by the Superintendent of Insurance. This year the Maine Legislature created an alternative funding mechanism for Dirigo Health and implemented new reforms in the independent insurance market. The new funding method for Dirigo is being challenged and may appear on the ballot this November.Riley's written, submitted testimony follows. For more information on the hearing, including testimony of the other presenters, please see http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=640 Statement of Trish Riley, Director, Maine Governor's Office of Health Policy and Finance, Augusta, Maine Testimony Before the Subcommittee on Health of the House Committee on Ways and Means July 15, 2008 Thank you for this opportunity to talk with you about lessons learned at the state level about health care reform. Perhaps the most important lesson about state health reform is that it comes in waves, each building on the lessons of the past and learning from the challenges states find in building sustainable health reform over time. But each wave ultimately collides with the critical question – who pays? I have been fortunate to have been directly involved in many of these efforts as a former Medicaid director and to have worked closely with the reforming states in my service over the past several decades with the National Academy for State Health Policy. Enactment of Medicaid in the 1960s was arguably the beginning of state health reform, although the initial wave of state initiated reform began in the 1970s when Hawaii enacted the first mandate requiring most employers to offer health coverage, advanced soon after President Nixon's health reform -- that included a similar provision – had failed. In the decade of the 1970s the first high risk pools were created. In the 1980s Washington State established the subsidized Basic Health Plan, Massachusetts enacted the Health Security Act and Oregon created the Oregon Health Plan. Children's health plans began in Minnesota and Vermont. By the early 1990's 46 states had adopted insurance reforms, children's health programs grew in other states and Medicaid waivers yielded Arizona Access, TennCare and RiteCare, Medicaid managed care based programs to expand coverage. Each of these initiatives had their advocates and detractors, some failed, some changed, most held on in some form but following the failure of the Clinton health plan in the early 1990's state action again stalled and states were in the ebb of a third wave of reform.In 2003, Maine led the fourth wave with the establishment of our Dirigo Health Reform. Our approach was comprehensive health system reform, focusing on affordability and driven by Maine's per capita health spending, which ranks the second highest in the U.S., by then the highest rates of uninsured in New England, decline in employer sponsored plans and by limits in state budget capacity. In 2002 state and local revenues in the United States had the slowest growth since records were kept. Absent any sustainable, new sources of revenue, Governor Baldacci sought to achieve health reform by improving the efficiency and effectiveness of the health care system. By improving the system's efficiency, savings would be created and reinvested in health care access. Clear goals are important: "Covering the Uninsured" is not the same goal as "making sure every man, woman, and child has access to affordable, quality care". Covering the uninsured generally implies that we will find adequate financing to bring those now without coverage into the insured tent - covered through one or more of the myriad of coverage options available today or by creating special plans for the uninsured. Such an approach generally accepts the status quo in how care is delivered and coverage provided. But with growing pressure on the affordability of our employer based system, more costs are shifted to employees and coverage can become less comprehensive. As a growing number of people use more of their incomes for sometimes less coverage, more people are underinsured - forestalling needed care for fear of incurring out of pocket costs they cannot afford. And the literature is filled with data documenting concerns with quality of care. Our goal of assuring every man woman and child has access to affordable; quality care seeks to provide health security for all - those without coverage; those with inadequate coverage and those who fear rising costs will jeopardize their coverage.Numerous studies have documented that the U.S. spends far more than other developed nations yet we leave 47 million uninsured and do not achieve better health outcomes or quality for that additional investment. In fact, we pay for redundancy, inefficiency, variation and oversupply. Recently, McKinsey Global Institute published "Accounting for the Cost of Health Care in the United States" that concludes that even after adjusting for its higher per capita income levels, the United States spends some $477 billion more on health care than peer countries. McKinsey notes that higher health spending in the U.S. is not explained by higher disease burden but by these factors: 1. Higher input costs – salaries, drugs, devices and profits, (e.g.: we use 20% fewer drugs yet pay 50-70% more for them and we are the largest consumers of medical devices in the world). 2. Inefficiencies and complexity in the system's operational processes (e.g.: we have 3-6 more scanners than Germany, UK, France and Canada). 3. Costs of administration, regulation and intermediation of the system.McKinsey's study reinforces Maine's approach to comprehensive, system reform, stating "most components of the US health care system are economically distorted and no single factor is either the cause or the silver bullet for reform". While it is unlikely that Americans, who value choice, will adopt all the provisions that make other countries' health care more affordable, unless Americans are ready to embrace higher costs and a greater investment of our GDP in health, then the cost issues must be addressed head on. In crafting the Dirigo Health Reform, Maine's strategy was to affect cost, quality and access together, reflecting our conclusion that we had an inefficient health care system which led to unaffordability of health insurance and a growing number of people who were under - and uninsured. We built the program by expanding Medicaid for the poorest of our citizens, establishing a subsidy program for those just beyond Medicaid eligibility; launching comprehensive activities to improve health and reduce the costly burden of chronic disease; creating the Maine Quality Forum to remediate costly variation in the system; initiating a variety of cost containment mechanisms; requiring medical loss ratios in the small and non-group markets; increasing transparency through price posting and standardized reporting by insurers and hospitals; supporting electronic medical record diffusion; strengthening certificate of need; establishing a capital investment fund as an annual budget for new capital investment and facilitating collaboration among providers. Our cost containment goal is to assure coverage remains affordable for those who buy it privately but subsidizing health coverage remains a tool to meet the affordability gap for those with lower incomes. The foundation of Maine's coverage expansion was Medicaid. From that base we built a sliding scale subsidized insurance plan, DirigoChoice, targeted to those 3 times the poverty level who were employed in small businesses with fewer than 50 employees, were sole proprietors or individuals – categories that include the majority of uninsured - and built the reform on the employer based system. Specifically, the plan pooled small businesses to achieve economies of scale and purchasing power and adopted medical loss ratios in the small group and individual market to help make those markets more affordable. DirigoChoice is a voluntary program, recognizing that unless and until insurance became more affordable, mandates would not be tolerated. The program is financed through an assessment on insurers and those who administer self- insured plans that can only be levied if Dirigo's comprehensive reforms result in documented savings. When the Dirigo Health Reform began in 2003, Maine had the highest rate of uninsured in New England. In the years following, as Medicaid expansions took hold and DirigoChoice became the fastest growing product in the marketplace, every New England state saw its rate of uninsured increase; only Maine saw its rate fall to the lowest in the region by 2006. But our progress has stalled, lacking adequate financing. While $110 million in savings has been independently documented since the program began, those savings have been contentious, subject to court challenge and highlight the complexity of cost containment in health care. Payers of the surcharge assert that reducing the rate of growth of health care costs is not the same as cost savings. The Legislature enacted alternative financing this session, including taxes on beer, wine and sugared beverages, but this alternative is also being challenged. Politics Trumps Policy –The process of enacting and implementing reform is as important as the reform. To launch Maine's reform, stakeholders were convened in a Health Action Team that met often and in public to guide the Governor's office in developing the original proposal. The Legislature created a Special Joint Committee on Health Reform with bipartisan members from the health, insurance and appropriation committees.The reform debate played out largely between two camps - those who wanted de-regulation and market based solutions like high risk pools, arguing that lower costs would assure more coverage and others who wanted more investment to sustain comprehensive coverage to cover all the uninsured. Long negotiations resulted in significant amendments to the original bill and found a middle ground that won a unanimous committee report and strong bi-partisan support in both chambers. Both the Health Action Team and the Joint Committee were dissolved once the bill was enacted. Numerous commissions, workgroups and an independent Board of Trustees for the Dirigo Health Agency assured citizen input throughout the implementation of the reform, but each group was responsible for a part of the reform only. In hindsight, with oversight of the reform split among different legislative committees and no one single stakeholder group to provide guidance for the overall reform, a vacuum was created that allowed the parties to "return to their corners" when the inevitable implementation challenges occurred. Amendments to the original bill, that eliminated a planned global budget and a fixed assessment that could not be passed on to premium payers, reduced the ability to generate stable, predictable funding and attain the amount of cost savings initially envisioned. As the program was launched, additional revisions were required that further challenged the ability to meet enrollment target timetables developed with the original legislation and never revised. Rather than recognize that these unexpected factors would slow but not deter program enrollment, proponents of alternative strategies quickly declared Dirigo a failure and revived advocacy for their favored market based reforms, which created a challenging environment for program modification and mid -course improvements. As Maine's experience clearly shows, enacting health reform is tough enough - few states have done so - but implementing reform is even tougher. The devil is indeed in the details and health reform is a work in progress. But to achieve that progress, all parties, with strong leadership, need to commit to it and to work together to make mid course corrections rather than to see each bump in the road as an opportunity to defeat reform. Medicaid is a critical component for state- based reform but needs reliable, counter cyclical financing and clarity in its coverage for eligible, employed beneficiaries. Should national health reform maintain the current employer based system, Medicaid's role will remain critical. Medicaid is the essential building block in state health reform and is of paramount concern to the states and to Congress. As states face recessions and budget challenges, Medicaid's funding formula needs to keep pace with rising costs and demand. Since de-linking welfare and Medicaid eligibility and imposing work requirements, an increasing number of low wage and particularly part-time workers, work each day in firms large and small, and qualify for Medicaid - often ineligible for or unable to afford workplace coverage. The premium assistance provisions within the Medicaid program are difficult to administer, pay only for employee share of premium and require state match. Additional policy debate needs to address where the role of the Medicaid program ends and the role of the private employer begins. As costs escalate, private employers are increasingly reluctant to offer coverage to part-time workers and to make Medicaid eligible employees part of their workplace health plan. On the one hand, employers face difficult trade offs as the costs of health care grows. Increasingly employer- based coverage has passed more and more cost on to employees. As lower wage employees pay a larger part of their incomes for health care, we are witnessing a new and growing problem of underinsurance. But employers must balance the costs of health care against the ability to create jobs or increase wages and states need to be cautious in what demands they place on the very employers who assist in "welfare to work" programs or who, subject to state regulations they find intolerable, self insure, and abandon the consumer protections of the fully insured marketplace. A design feature of the original Dirigo Health Reform sought to pool all revenues to the Dirigo Health Agency( employer contributions, employee contributions and others), and use those pooled state resources to match Medicaid for eligible employees and their dependents. CMS has rejected our approach, which will soon be reviewed by the courts. The states that followed us in this fourth wave of state health reform relied heavily on Medicaid, unlike Maine which coupled system savings with program financing. Vermont accepted federal flexibility in exchange for a block grant - like approach to Medicaid. Massachusetts built its program with $400M in Medicaid funds that had been supporting their uncompensated care. We appreciate the strength of Vermont's initiative but find the block grant approach, which abandons a long established health care entitlement program, to be counter- intuitive to efforts to expand access and, like most states, we did not have access to the Medicaid funds now supporting Massachusetts' landmark reform. It's time for a national policy to achieve affordable, quality health coverage for all. States serving as laboratories of innovation have gained public attention and achieved much, filling a void in the absence of national reform. The laboratories of democracy were at work testing reforms reflected in later Congressional action. Many states had adopted insurance regulations before HIPAA was enacted; had well running children's health programs before SCHIP was born and developed Patients' Bills of Rights before Congress took them up. The many and varied state experiments have been operational since at least the early 1970's. While states have done extraordinary work to lay the foundation for reform, each state is operating relatively independently based on very different health systems, coverage and costs and reflecting different state priorities. While experimentation has generated significant reforms, it has also created state- to -state variation that may also account for fragmentation and complexity across the country which drives costs. Over three decades of state health reform, and the reams of studies and evaluations analyzing them, suggest to me that it is time to get out of the laboratory and learn from decades of state experimentation. This is certainly not to say that there will not be a role for the states in any emerging national health reform but that a national solution-and national financing - is essential. We cannot reform our health system piecemeal or even by further state by state imitative. In the spirit of federalism, the national government must commit to a national policy that achieves affordable, quality health care for all of us.We need a national policy that makes the roadmap clear that will achieve the reforms needed to address cost and quality and to cover all of so that the U.S. can take our place as health leaders – not as the country that spends twice as much, doesn't get any better health or quality and leaves 47 million without any coverage. There are several obvious first steps that the Federal government can take. Complexity and redundancy are costs in the system. Streamlining and creating a single system – that does not necessarily require a single payer- would help. The Federal government should examine its considerable purchasing power across Medicare, Medicaid, FEHBP, Champus and others toward standardizing reporting, payment policy, benefits, eligibility and quality metrics. If states are to play a role in health care reform, they need the capacity to work in a level playing field. ERISA prohibits much creative work and even the collection of key data from self insured businesses. In the end, then, the ultimate question remains – who pays? For those of us who believe we are already paying more than we need to through cost shifting of the uninsured and the inefficiency in our health care system, cost containment needs to be a part of any reform. But ultimately, the nation's uninsured, a growing number of under-insured and all of us who have coverage now and fear for its future, need a reliable and sustainable source of financing to affordable, quality care -that does not sacrifice the access expansions in place now- that only a strong and consistent national policy can assure.

Heatlh Care for Health Care Workers Join National Campaign

Health Care for America Now, a national grassroots campaign seeking to win affordable, quality health care for all Americans, launched on July 8 with events across the country. PHI’s Health Care for Health Care Workers campaign recently joined the new campaign. In three key HCHCW states, HCHCW staff and partners participated in launch events, seizing the opportunity to focus attention on the health care needs of direct-care workers: Pennsylvania. HCHCW Community Organizer Simone Baer spoke about the thousands of direct-care workers caring for the state’s most vulnerable citizens who lack health care coverage of their own. The event was covered by the Pittsburgh Post Gazette. Iowa. Iowa’s HCHCW partner, the Iowa CareGivers Association, participated in the launch on the steps of the state capitol. The ICA is one of 18 initial members of a growing campaign in Iowa that is working to assure that the next President and Congress pass legislation guaranteeing quality, affordable health care for all. ”As a key battleground state in the Presidential election, Iowa will be a focal point for debate over the respective candidates’ plans to reform the health care system,” said ICA Policy Director John Hale. “The ICA and direct-care workers will be involved in those debates, and will insure that the candidates recognize the unique needs of direct-care workers in getting and keeping adequate and affordable health care coverage.” Maine. Helen Hanson, a direct-care worker from China, Maine, represented the Maine Direct-Care Worker Coalition, a HCHCW partner, at the launch event on the steps of her state’s capitol. Helen spoke of her struggle with health care bills after routine tests that were not covered by her catastrophic coverage plan. Another HCHCW partner, the Maine Center for Ecomomic Policy, also participated in the launch event, which was covered by the Portland Press Herald. Things will be heating up as the Presidential campaign moves toward November. Visit the Health Care for America Now website to find out how you can get involved. Allison Lee, HCHCW National Campaign Manager

Show your Solidarity: Maine Potato Blossom Festival Parade in Fort Fairfield

MSEA-SEIU's Solidarity Committee will be appearing in the Maine Potato Blossom Festival Parade in Fort Fairfield this coming Saturday (July 19, 2008). Line up starts at 11:00 AM at Fort Fairfield High School on High School Drive. Parade to start at 1:00 PM. Looking for some support from Area I chapters especially those from Aroostook County to march with us in support of quality public services. If you need a ride from the Bangor Area or above please contact Steve Keaton Steven.Keaten@maine.gov as he knows of two cars that will be going up from the Waterville area. Please wear your purple shirt and pass this along to your other chapter members from Area I. Members who participate qualify for the time share week to be drawn at Convention in October.

Groups join in campaign for Affordable Health Care

Advocates line the steps of the State House to call on politicians to pass health-care legislation. By MATTHEW STONE, Blethen Maine News Service July 9, 2008 Portland Press Herald AUGUSTA — Calling it the first order of business for a new president and Congress, speakers from a collective of advocacy groups launched a campaign on the State House steps Tuesday morning urging politicians in Augusta and Washington to take action on health care. "We're asking one question: Which side are you on?" said Ali Vander Zanden, a health- care organizer with the Maine People's Alliance. Vander Zanden urged politicians to choose between siding with a health-care system that she said supports profits for insurance companies or a system that ensures coverage for all. With sign holders lining the steps behind her, Vander Zanden and others called on state and national leaders to pass health- care legislation. "In our vision, the quality goes up and the price goes down," she said. Laura Harper, director of public policy for the Maine Women's Lobby, said: "We certainly don't intend to wait another 30 years for guarantees of affordable health care. We're tired of waiting." The advocates' announcement on Tuesday was short on specifics. "This is a movement to educate Americans," Vander Zanden said. "We are not campaigning on a specific campaign plan." The campaign launch in Augusta was one of 45 similar events staged across the country, organizers said. "We believe in a choice between public and private insurance plans," Vander Zanden said. "What we want is a uniquely American solution." The Maine People's Alliance and the Maine Women's Lobby collaborated with union leaders, Maine Equal Justice Partners, Engage Maine, Planned Parenthood of Northern New England, Equality Maine and the Maine Center for Economic Policy to announce the push. China resident Helen Hanson, president of the Maine Direct Care Workers Union, spoke about her struggle to make ends meet while she and her husband purchase their own catastrophic insurance coverage. "Since November 2007, I have had my yearly mammogram and two abdominal ultrasounds," Hanson said, speaking above the hum of public works trucks on State Street. "All of these are out-of-pocket costs to me." Bruce Hodson, president of the Maine State Employees Association, praised Maine's Dirigo Health program, but said the program does not go far enough. "It is up to us to build the political will to find solutions to the high cost of health care," he said. email from Representative David Cotta

Health Care for America Now

Join us in a new campaign to win Quality, Affordable, Healthcare for All Once again the stage is set for another monumental battle over the future of the American health care system. It will be the most significant domestic political battle since the passage of Medicare – affecting one sixth of the U.S. gross domestic product. Our organizations have come together to build a movement and mobilize the financial and organizational resources to reach our historic goal. Our task is to plan a strategy, create the political environment, and assemble the political and organizational resources that will overcome the formidable array of forces that will oppose fundamental change. Please join the campaign: We invite organizations who support our Statement of Common Purposes and our passion for winning health care justice in America to join our campaign. We are sending this invitation to organizations that represent numerous constituencies across America: community groups; unions; businesses; faith-based groups; health care providers; women; communities of color; seniors; people with disabilities; people with serious and chronic illness; advocacy and policy groups; students; political organizations; and all others who share are vision and values. All campaign members may participate in campaign activities and may join campaign Operating Committees (field; policy and legislation; communications; coalition building; development). Contact Melinda Gibson at info@healthcareforamericanow.org if you have questions about the campaign let Melinda know too, and one of the Organizing Committee members will get back to you. Thank you for joining us in the fight for Quality Affordable Health Care for All. Campaign Goal and Strategy Campaign Goal: To create a nationwide movement to win the implementation of health care reform that conforms to our principles, expressed in our Statement of Common Purpose. Our goal is to build a base of grassroots activism and a national movement at all levels of our democracy that will give powerful voice to the growing demand for action, advance our agenda for health care change, and answer those forces who argue that substantial governmental involvement is not necessary to guarantee quality affordable health care for all. Strategic Unity: The campaign will seek to build strategic unity among the broad array of forces that share the campaign’s goal. Strategic unity has three basic elements: 1) Working within a common frame and similar messages; 2) Implementing the basic elements of a common campaign plan; 3) Moving together, with urgency, along a similar time line. Strategic Building Blocks: 1. Build a base to reach beyond the base. The campaign will work with its members to educate an army of activists around the country who understand and are able to communicate about what we are working for in health care reform, what we are working to prevent and who will enlist their neighbors, co-workers, friends and family in the campaign. The campaign will activate our base by combining and creating a new synergy between traditional community and political organizing and the new modes of organizing we see through the Web and through movements that lead millions of people to wear plastic “live strong” bracelets. The campaign will build local and state coalitions that engage organizations and activists around the nation. 2. 360-degree communication. The campaign will implement a communications plan that fills the American public space with our message and messengers. The plan will be built on earned, new and paid media and will target local and national news and opinion, the new media of Internet, blogs and text messaging, paid advertising on the web, TV and print. 3. Policy and research: The campaign will develop research and policy capacities on multiple tracks to influence the larger national dialogue and media coverage, and to shape the content of any final reform. The campaign’s research will educate the public on the issues and will educate and cultivate opinion leaders and experts who can convey and credential our messages, principles, and ideas so that they have the broadest possible reach. We will develop detailed policy briefs on each element of our Statement of Common Purpose and use these briefs to evaluate and influence reform proposals. 4. Grassroots lobbying and civic engagement: The campaign will organize Americans to educate members of Congress about the campaign’s Statement of Common Purpose, demonstrating strong public support for policies that work to achieve quality, affordable health care for everyone in our nation. The campaign will do this on a bi-partisan basis, communicating with members of Congress across the nation, with the understanding that reform must have the broadest support. The campaign’s civic engagement activities will lift our message in the discourse leading up to the November 2008 election. 5. Development: The campaign’s fundraising plan aims at raising or leveraging tens of millions of dollars, prioritized through a detailed planning process that establishes tiers for each element of the campaign plan. Funds, both 501(c)3 and 501(c)4, will be raised from foundations, organizations and individuals, with plans for large donor fundraising and small donor through the web, house parties, events and other grassroots activities. Statement of Common Purpose We believe that all of us benefit from healthy communities, where we all have access to affordable, quality health care from a provider of our choice, at the time we need it, at a cost we can afford. Our mutual goal is affordable, quality health care for everyone in America and for our nation. Our current health care system in America is not affordable for families, businesses or government. We need an American solution to secure our families’ health and a healthy economy. All of us, individuals, employers and government have a shared responsibility to realize comprehensive reforms in our health care system. Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing: A truly inclusive and accessible health care system in which no one is left out.

A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.

A standard for health benefits that covers what people need to keep healthy and to be treated when they are ill. Health care benefits should cover all necessary care including preventative services and treatment needed by those with serious and chronic diseases and conditions.

Health care coverage with out-of-pocket costs including premiums, co-pays and deductibles that are based on a family’s ability to pay for health care and without limits on payments for covered services.

Equity in health care access, treatment, research and resources to people and communities of color, resulting in the elimination of racial disparities in health outcomes and real improvement in health and life expectancy for all.

Health coverage through the largest possible pools in order to achieve affordable, quality coverage for the entire population and to share risk fairly.

A watchdog role on all plans, to assure that risk is fairly spread among all health care payers and that insurers do not turn people away, raise rates or drop coverage based on a person’s health history or wrongly delay or deny care.

A choice of doctors, health providers and public and private plans, without gaps in coverage or access and a delivery system that meets the needs of at-risk populations.

Affordable and predictable health costs to businesses and employers. To the extent that employers contribute to the cost of health coverage, those payments should be related to employee wages rather than on a per-employee basis.

Effective cost controls that promote quality, lower administrative costs and long term financial sustainability, including: standard claims forms, secure electronic medical records, using the public’s purchasing power to instill greater reliance on evidence-based protocols and lower drug and device prices, better management and treatment of chronic diseases and a public role in deciding where money is invested in health care.

MSEA-SEIU Local 1989 Solidarity Events for 4th of July

July 3, 2008 (Thursday)-Parade in Jay, Maine-Starts at 5:00 PM. Set up is at 4:00 PM at MEMCO, a business on Maine Street in Jay, Routes 2 & 4. Anyone needs at ride from Augusta I know of two cars going from that area just e-mail me back for details. July 4, 2008 (Friday our day off for most)-Parade in Houlton, Maine-Starts at 10:00 AM. Set up is at 9:00 AM at St Mary’s Church on upper Military Street, Houlton, Maine. That group is fired up about an issue. I did that parade last year and had a wonderful time. July 4th, 2008 (Friday)-Parade in Augusta. Maine-Starts 11:00 AM. Set up is at 10:00 AM at Shaw’s Plaza, Western Avenue, Augusta, Maine. We will be helping Donna Doore decorate a float. July 4th, 2008 (Friday)-July 4th Solidarity Celebration 5:30 PM-dark at he Solidarity Center, 20 Ivers Street, Brewer, Maine. Featured musical guests are David Mallett, Bill Morrissey and Shawn Mercer. Also includes Union Chili Cook-off with $50 cash prize as well as salads, desserts, and roasted organic lamb. Door Prizes raffle, supervised children’s tent, a FAM and union produced musical “Unconventional Wisdom” and a great view of the fireworks. What could be better? Remember to wear your purple and all these events qualify as an entry for the free donated timeshare week to be drawn at MSEA’s convention in October. The more events you participate in this summer, than the better your chances to win.

Second Meeting with Superintendent of Insurance

The second meeting was today with Deputy Superintendent Judy Shaw. Ms. Kofman had a prior engagement. This session consisted of the Bureau of Insurance putting forth Maine insurance codes options. There were seven code options that were discussed. Some made good sense, some made none at all, where direct care workers are concerned. The options presented were: Private Purchasing Alliance, Small Group Health Plan, Multi-Employer Welfare Arrangement (MEWA), Trustee Group, Labor Union Group, Association Group and Other Group. The Private Purchasing Alliance is a corporation that is set up to provide health insurance to its members through one or more affiliated carriers. There are certain insurance laws and rules that the corporation operates under. One nice thing about this is that it can include workers who are not affiliated with an employer, like our Alpha One folks. These unaffiliated workers do become a separate risk pool. I hate that term "risk" but it is term that insurance companies use. A risk pool is a rated group of individuals. It has nothing to do with how "sick" that group is. I think it has to do with the type of work you do, your age and possibly where you live that puts you into a certain "risk" pool. I think SEIU Local 503 in Oregon has set up its health insurance for its members this way. The Small Group Plan is one that is for employers with 50 or fewer employees. One drawback with this is that insurance companies require that 75% of all eligible employees have to participate in the plan. One plus is that eligible employees must work at least 10 hours per week. Community rating applies to these plans. Community rating is that rates cannot differ based on health status. This would be something that would work for Direct Care Workers. The Multi-Employer Welfare Arrangement did not seem like a good way to go. Those employers in the arrangement pool their risk and collectively self-insure. They create their own healthcare insurance plan. The MEWA defines what the plan looks like and what it offers and what the rates are. A big draw-back of MEWAs are that the employers in the arrangement are held liable for the obligations of the MEWA. If the MEWA cannot pay its obligations, the member employers pay an assessment. Another draw-back, those who are not employed by an employee of the arrangement cannot get coverage. A Trustee Group is a group of individuals insured under a policy that is issued to a trust that is established by two or more employers or by two or more labor unions or similar worker organizations. The trust is the policy holder. Those eligible are all the employees or the employer or all the union or organization members. SEIU Local 775 out in Washington has set up its healthcare insurance this way. The group wanted more information on this. Labor Union Group was the next code. The union/organization is the policyholder and those members of that union/organization may be insured. This group may not be eligible for small group community rating. More information was requested for this code. Association Group is a lot like the Labor Group in that a group of individuals may be insured under a policy issued to an association or a trust. The association must have at least 50 people. It must be organized and run in good faith for other purposes, not for just buying insurance. It must be in existence for at least two years before obtaining insurance. The association is the policyholder. The insurance is available to individuals and employers. The last code was Other Group. This is a group formed under 2808, an insurance law or rule. The only thing I have on this is that Dirigo is an example. Under the Small Group Plan, there was discussion as to the definition of employee in the purposes of insurance code. The group will hear from someone in the Department of Labor on that definition. You wouldn't think it would or could be so complicated, but it definitely is. Either you're working for an agency that matches you up with consumers, and that agency runs payroll to pay its workers; or you work independently, directly for a consumer. That consumer handles your payroll and workmen's comp. Either way, you're an employee. There was talk of "underground employees," those who are matched up with a consumer and unknowingly to the consumer, the consumer bears the burden of insurance and comp. All in all this meeting went well. There was concern that workers themselves were not being considered, it was mostly employers that were. My take was that the Insurance Bureau was giving us some tools to work with. The next meeting is scheduled for Monday July 14th at 10 am at the Bureau of Insurance Offices in Gardiner. These meetings are open to the public. If there are any direct care workers out there, interested in attending, please get in touch with me helen.hnsn@gmail.com I can fill you in a little on what the next meeting will be about and how this is all working.

First Meeting with Superintendent of Insurance

On June 17, the first meeting of the summer working group organized by Maine Superintendent of Insurance Mila Kofman was convened. The working group was established to look into how affordable health coverage can be made available to all of Maine’s direct-care workforce. The first meeting was a useful start. A somewhat formal set of introductory remarks set out the scope and intent of the summer’s discussions. The meeting was attended by several members of the Direct Care Worker Coalition (DCWC), including Helen Hanson, Joyce Gagnon, Mollie Baldwin, and me. There were also representatives from Harvard Pilgrim, the Maine State Chamber of Commerce, MaineCare/DHHS, Dirigo Health, and the Governor’s Office (Karynlee Harrington and Trish Riley), as well as five or six members of the Bureau of Insurance (BOI) staff. Senator Sullivan of the Insurance and Financial Services Committee and Representative Campbell of the Health and Human Services Committee also attended, both speaking at length and in strong support of direct-care workers and the need to find a real solution to the question of affordable coverage. The overarching goals of the working group - as defined by the superintendent and the legislators – appear very promising. The superintendent made clear her own longstanding interest in and work on these issues, as well as repeatedly clarifying that the goal of the group was to find a way to provide truly affordable coverage to direct-care workers and their families. She insisted that all options were on the table for discussion. Despite early attempts by some participants to immediately begin looking at the obstacles to coverage - particularly those related to funding sources for subsidizing costs - the superintendent insisted that the group’s first several meetings must focus entirely on educating ourselves and discussing various models and possible solutions before any attempts to torpedo solutions due to cost concerns. Senator Sullivan stated that she was not interested in market reforms. She also said she expects not only a report by October 1st but “bipartisan legislation” to be drafted from the report for consideration in the next legislative session. I believe that this is enormously positive. It seems like the superintendent, the deputy superintendent (Judith Shaw, who will be heading up this effort for the BOI), and various well-positioned legislators are all taking this very seriously. The superintendent has made her staff available to do research between meetings, and has already expressed interest in having Health Care for Health Care Workers staff talk to the group about models from other states. Everywhere I look I see reason for us to be hopeful, and to take this effort seriously. Summer is a hard time to get people together (and to want to really dig into the nitty-gritty details of various coverage models and relevant political strategizing), but I recommend we put all possible effort into this endeavor . This seems like a very good opportunity for the DCWC and one that we would do well to use to our best advantage. The next meeting is scheduled for Tuesday, July 1 at 10 a.m. at the Bureau of Insurance in Gardiner. Kurt Wise Fiscal Policy Analyst Maine Center for Economic Policy I apologize for the delay in getting this posted. -Helen