Amid rising costs, lawmaker wants to restart conversation about universal health care
One legislator is pushing to explore the possibility of a publicly funded universal health care system for Maine, which would expand coverage to more than 59,000 currently uninsured residents.
During a public hearing on Wednesday, proponents stressed the urgent need for a better health care system, though the state's affordable health care office said there is 'no path forward' for establishing such a program right now.
One bill, LD 1269, proposes a comprehensive study to analyze the costs and feasibility of a universal health care plan. Another, LD 1883, offers a detailed blueprint for a state-wide system called the All Maine Health Program that would provide comprehensive coverage to all Maine residents.
If passed, Maine would be the only state in the country to shift to a universal health care system.
During the hearing before the Health Coverage, Insurance and Financial Services Committee, Rep. AnnMarie Mastraccio (D-Sanford), who introduced both bills, said a state-wide system has not been studied comprehensively since 2002, and that 'it's time to update those numbers and evaluate our options.'
She is aiming to address rising health care challenges including the closure of hospitals in rural Maine, the uncertainty around Medicaid funding, and overall health care costs increasing. Mainers spend more than $18.5 billion annually on health care, nearly 20% of the state's Gross Domestic Product, she said.
'Maine's current health care system is fragmented, inefficient and economically unsustainable,' Mastraccio said.'As legislators, we have a responsibility to make data-driven decisions that promote a sustainable, equitable health care infrastructure that begins with understanding the true costs and potential savings of a universal, publicly funded system.'
Dozens of health care providers, advocates and Mainers who have struggled with medical costs testified in support of the bills, highlighting the urgent need for reform. They pointed to the lack of access to providers in rural areas, racial disparities in health care access in the state and the financial strain on both patients and providers because of the patchwork system of insurance coverage.
'The burden of this poor health infrastructure falls disproportionately on women of color, Black and Indigenous women and low income and rurally located women,' said Lily James, advocacy coordinator for the Maine Women's Lobby.
For example, 65% of pregnant Black Mainers receive adequate prenatal care in 2022, compared to 87% of white Mainers, according to Maine Department of Health and Human Services data. And 22% of pregnant Mainers have to travel more than 45 minutes to access a birthing hospital, according to a 2023 report that James cited.
'The All Maine Health Program would be life changing, and in many cases, life saving for so many Mainers and will pave the way for the desperately needed changes to Maine's health care infrastructure,' James said.
A November 2024 report from the Maine Center for Economic Policy found that, based on current demographics and insurance coverage, the cost of such a program would roughly equal the amount Mainers spend now, between $17.8 and $19.3 billion.
Testifying on behalf of the plan, James Myall, a policy analyst for MECEP who authored the report, said that, unlike the current system, the cost of a universal system could be offset by other revenue streams, such as federal grants or increasing taxes on the wealthiest Mainers.
'This means that most Mainers will pay less under the proposed plan than under the status quo, while also being free of the stresses that come from being unable to afford copays and deductibles, worrying about in-network coverage, or switching insurance providers,' he told lawmakers.
Meg Garratt-Reed, director of Maine's Office of Affordable Health Care, which was established by the Legislature in 2021, testified against both bills, saying the state isn't in a position to implement them with the current financial constraints and the amount of change that would be required to implement the program. While she acknowledged that Maine's health system is flawed and praised the intent behind the bills, she said a single-payer program would be too costly and complex to set up right now.
The All Maine Health Program aims to save money by removing insurance companies from the system, which would reduce administrative costs like billing as well as shareholder profits. But Garratt-Reed said those savings wouldn't be enough to offset the added expenses in the plan. The bills would expand what's covered, increase payments to providers, and do less to limit unnecessary or overly costly treatments — all of which would drive up overall spending.
She also said the bills would move away from the current cost-control system used by Medicare and MaineCare, Maine's Medicaid system, which set fixed prices for services. Instead, the state would have to negotiate rates with each provider — a more complex and less efficient process that could lead to even higher costs.
The proposal also relies on using federal money (such as Medicaid and Medicare funds) to pay for the new system — but federal law doesn't let states reallocate money designated for specific programs without special permission, she said. And the federal government is very unlikely to give that permission, Garratt-Reed said, especially under the current political situation, pointing to congressional Republicans' proposal to drastically cut Medicaid funding.
'I think we can all agree that our current health care system is flawed, and that many people suffer because of those flaws. However much we may wish that we could recreate our nation's health care system from the ground up, we have a responsibility to those people to pursue solutions that have real potential to ease their suffering,' she said.
'The reality is there is no path forward for implementing such a program in Maine now or in the immediate future.'
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New York Post
8 hours ago
- New York Post
Rehab can keep you out of jail — but become a prison itself
Chris Koon didn't read the fine print. Sitting in the Cenikor Baton Rouge rehab center's intake office in 2015, flanked by his mom and grandmother, he signed where told. 'A lot of it read like legalese,' writes Shoshana Walter in 'Rehab: An American Scandal' (Simon & Schuster, Aug. 12). 'Incomprehensible but also innocuous, like something you might see before downloading an app on your phone.' Koon felt lucky. He wasn't going to prison. Just days earlier, he'd been arrested for meth possession. The alternative to five years in state prison? A brutal two-year Cenikor inpatient program. Koon took the deal. In signing the intake documents, he agreed to 'receive no monetary compensation' for work he did, with wages going 'directly back to the Foundation.' He signed away his right to workers' compensation if injured. He forfeited his food stamps, disability payments and any other government assistance. And he agreed to 'adopt appropriate morals and values as promoted by the program.' Koon's story isn't an outlier — it's a glimpse into what Walter calls 'America's other drug crisis.' While overdoses and opioid deaths dominate headlines, far less attention goes to the 'profit-hungry, under-regulated, and all too often deadly rehab industry,' writes Walter. Across the country, thousands of treatment programs are propped up by federal policies and rooted in a distinctly American blend of punishment and personal responsibility. People were 'lured to rehab with the promise of a cure for what ailed them,' Walter writes, 'only to repeatedly falter and fail inside a system that treated them like dollar signs.' The idea hard labor can cure someone isn't new. After the Civil War, US slavery was abolished except as punishment for a crime. That loophole became the foundation for a forced-labor system that conveyed newly freed black people into prisons and chain gangs. Over time, prison officials began marketing this arrangement as 'rehabilitation.' As Walter writes, this legacy has been repackaged for the modern drug crisis. The Affordable Care Act promised expanded treatment access through Medicaid. But the rehab industry that exploded in response was lightly regulated, profit-driven and increasingly dangerous. The result: thousands of people like Chris Koon, lured into treatment by courts, cops or family members, only to find themselves stuck in a system that looked less like therapy and more like punishment. They include women like April Lee, a black woman from Philadelphia. Despite growing up in addiction's long shadow — her mother died from AIDS when Lee was just a teenager, after years of selling sex to support a crack habit — Lee didn't start using drugs herself until after having her second child, when a doctor prescribed her Percocet for back pain. That opened the door to addiction. Child-welfare authorities eventually took her kids. Fellow users nicknamed her 'Mom' and 'Doc' for her uncanny ability to find usable veins, no matter how damaged. April Lee returned to her recovery house — as an unpaid house monitor. April Lee / ACLU She entered recovery in 2016. Every morning at 6, 18 women gathered in the dining room of one of two overcrowded houses to read from the Bible. Lee stayed 10 months. With nowhere else to go, she returned — this time as a house monitor, working without pay in exchange for a bed. 'She was still early into recovery, and she felt stressed by the intensity of the job,' Walter writes. 'On top of that, she wasn't getting a paycheck, so she couldn't save up money to leave.' 'Don't really know how to feel right now,' Lee wrote in her journal. 'The lady I work for — for free, mind you — wont me to watch over women witch mean I have to stay in every night.' She felt physically and emotionally trapped. 'I wanted to snap this morning. Miss my children so much.' Like so many others, Lee found herself stuck in the recovery-house loop — forced to work, unable to leave and earning nothing. She helped with chores, mainly cooking and cleaning. Residents' food stamps stocked the kitchen. Lee loved to cook, and she made comfort food for the house: mac and cheese, fried chicken, beef stew. But all the warmth she gave others couldn't buy her a way out. For others, like Koon, it was about more than just forced labor. During his first 30 days at Cenikor, the other patients policed each other. If one person broke a rule, the entire group might be punished with a 'fire drill' in the middle of the night. 'If anyone stepped out of line or did something wrong during the drill, they'd have to stay awake even longer,' Walter writes. Discipline was obsessive. In his first month, Koon sat in a classroom with about 30 other residents, most sent by courts like he was, reciting rules out loud, line by line. There were more than 100. 'He could get in trouble for not having a pen, not wearing a belt, for an untied shoelace, for leaving a book on the table, for his shirt coming untucked,' Walter details. Koon learned the punishment system fast. A common one was 'the verbal chair,' in which any participant could order him to sit, arms locked and knees at a 90-degree angle, and stare silently at the wall while others screamed at him. 'Go have a seat in the verbal chair. Think about having your shirt untucked,' they'd say. And Koon, like everyone else, was expected to respond, 'Thank you.' There were others. 'Mirror therapy,' where he'd stand and yell his failings at himself in the mirror. 'The dishpan,' where he'd be dressed in a neon-green shirt, scrubbing floors and dishes while loudly reciting the Cenikor philosophy, 'a paragraph-long diatribe about self-change,' Walter writes. And the dreaded 'verbal haircut,' when another resident, sometimes even a staff member, would berate him as part of his treatment. Dressed up as a therapeutic community, Koon thought instead, 'This is like a cult.' Walter believes he wasn't far off. Everyone was required to tattle. Koon had to turn in weekly at least 10 'pull-ups' — written reports detailing rule infractions committed by fellow residents. If he didn't, he could lose points and with them privileges like phone calls, family visits or permission to grow a mustache. Confrontations were public and ritualized: Residents would sit in a circle around one or two people forced to listen as everyone else denounced them. 'They took turns confronting that person, professing their faults and errors, while the person was permitted only to say 'thank you,'' Walter writes. Staff called it 'The Game.' He saw grown men cry. He heard women called bitches and sluts. He realized many employees were former participants enforcing the system that once broke them. Not everyone saw a problem. 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He proposed to his childhood sweetheart, Paige, moving in with her two daughters, and finding the stability he'd been chasing for years. He went back to school to learn welding, and the daily rhythms of family life kept him grounded. 'He hasn't taken a drug recreationally for eight years,' Walter writes. Lee's path out took longer, and her recovery was, as Walter writes, 'in some ways a stroke of luck.' She left the house after landing a job at a law firm that helped women reunite with their children in foster care — a world away from the nights she'd once spent tricking at the Blue Moon Hotel but one that barely covered her bills and pushed her just over the poverty line, cutting off assistance. She earned her GED, took online college courses, regained custody of her kids and bought her own home by 2021. 'And yet many days she felt she was teetering on the edge, one crisis or unpaid bill away from making a terrible mistake,' Walter writes. That year, she returned to Kensington, where her addiction had once thrived, bringing fresh food and water to people still living on the streets. As for Cenikor, its time in the shadows ended, at least temporarily. Investigators found evidence of exploitation: residents forced to work without pay, unsafe housing conditions, staff-client relationships, even overdoses inside the facilities. The state of Texas fined Cenikor more than $1.4 million in 2019, but the agency struck a settlement, and it continued to operate. Koon and Lee don't represent everyone who's experienced addiction, treatment or recovery. But they do reflect a system that often promises far more than it delivers. 'When rehab works, it can save lives,' Walter writes. 'It can mend families and be among the most redemptive narrative arcs in a person's life.' 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Chicago Tribune
12 hours ago
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Illinois SNAP Education program eliminated amid federal cuts: ‘It's heartbreaking'
In a makeshift classroom in a Roseland low-income housing complex, nine women watched nutrition educator Denetria Adams saute a glistening mix of carrots, celery and onion. Tammy Spivey, 60, raised her hand from the back row. 'What's worse, cooking oil or lard?' 'Lard,' Adams answered, stirring the steaming mirepoix with practiced ease. 'It clogs your arteries.' Across the room, fellow educator Christine Davis jumped in. 'We always want to make sure we're being cognizant of the type of fat that we're putting into our bodies.' She rattled off a list of healthier alternatives. Sunflower oil, olive oil, avocado oil. Spivey jotted down the names on her note sheet, then underlined each word twice. It was the sixth session of a cooking class run by the Supplemental Nutrition Assistance Program Education initiative, or Snap-Ed. For weeks, Mercy Housing residents gathered to cover nutrition basics, build kitchen skills and learn how to stretch their food stamps. 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The president's recent tax-and-spending legislation has slashed billions in federal food benefits and significantly reduced Medicaid access. Spivey, a former quality control technician, has relied on food stamps and disability checks for as long as she can remember. When she used to cook for her now-grown daughter, both were essential to keep food on the table. She couldn't always afford to prioritize nutrition. 'They cutting out the wrong things,' Spivey said. 'It's not right.' In addition to nutrition education classes, SNAP-Ed programming includes food access directories, social media campaigns and advocacy work. According to staff, those initiatives prevent more than 5,000 cases of obesity and nearly 600 cases of food insecurity across Illinois each year. For many low-income families, budgeting for healthy food options can be a challenge, experts say. That can lead to long-term health issues, including chronic diseases and nutritional deficiencies. But nonprofit research organization Altarum estimates that every dollar invested in the Illinois program returns between $5.36 and $9.54 in health care savings. 'People want to be healthier, they want to be physically active, but they don't have the resources,' said educator Adams, as she spooned out heaps of rice. Despite its documented success, the Republican-led House Committee on Agriculture said in May that the program has yielded 'no meaningful change' since its inception in 1992, wasting taxpayer money. Funding will officially run dry Sept. 30, the end of the federal fiscal year. This fiscal year, Illinois received nearly $20 million in funding for the program. About $5 million went to UIC, and the rest was funneled to the University of Illinois Urbana-Champaign for statewide work. With the funding slashed, roughly 250 staff members will lose their jobs across the U. of I. system. 'These are people that are their communities building trust,' said Germán Bollero, dean of the U. of I. College of Agricultural, Consumer and Environmental Sciences. 'That is at the core of our mission: transforming society to be a better place. It's heartbreaking.' Each year, SNAP-Ed is estimated to reach about one million Illinois residents, working with more than 1,800 community partners. About 1.9 million people in the state receive SNAP benefits, according to the Illinois Department of Human Services. At Mercy Housing, Alma Watson, 63, flipped through the pages of her workbook, filled with lines of her cursive handwriting. She scanned a list of recipes — turkey tacos, skillet chicken breasts and baked sweet potatoes — each paired with nutritional information. 'People don't know, and some people really need it. Like me, for one,' Watson said with a laugh. It's her second time taking the eight-week course at Mercy, where she's lived for 15 years. Participants receive boxes of fresh produce and poultry to re-create recipes at home, enough to last Watson for days. But the real joy is being in the classroom again, she said, learning alongside peers. Most of them also depend on SNAP benefits. 'I love this setting. The people are really nice,' Watson said. 'I just love everything so far.' For SNAP-Ed staff, that positive feedback makes the impending shutdown harder. Educators Adams and Davis are set to lose their jobs in a few weeks, but their greatest concern, they said, is for the communities they serve. Through the window, Davis pointed to a weathered convenience store across the street. Its neon posters advertised tobacco and soda. 'Most of the (nearby) grocery stores aren't really grocery stores. They're markets like that,' she said. '(Residents) don't have much of an option.' Food deserts — areas more than a mile from a grocery store — have plagued the Chicago area for years, particularly on the South Side. While SNAP benefits are an immediate solution, SNAP-Ed helped chip away at those broader systemic issues, Dufelmeier said. After funding runs out, operations will likely cease immediately. 'The impacts from the cuts to our programs you may not see next week, but it's a long-term impact,' Dufelmeier said. After the lesson, each participant received a paper plate with sauteed vegetables, chicken, rice and soy sauce. The room had buzzed with laughter, but it was quieter as everyone ate. One resident ambled to the front of the room for seconds. Adams smiled and dished out another helping. 'Here you go, honey.'
Los Angeles Times
12 hours ago
- Los Angeles Times
Trump cut mental health funding for kids. These L.A. teens are stepping in
There are a lot of reasons why people reach out to Teen Line, a Century City-based hotline that connects young people in crisis to trained teenage volunteers. They call because someone is hurting them or they are afraid of hurting themselves. They text because an important relationship has ended or a troubling conflict has started. They feel disrespected, disregarded, dismissed. At the heart of almost every call, text or email is the same cry of pain: Nobody is listening. So the teenagers on the receiving end do what they wish adults would make time for more often, the thing nobody seems to be doing enough of these days: They listen. Almost every single time, for at least the length of a call or a chat session, it's enough. 'Even if their situation is really difficult, the best that we can do at the start is always just to listen,' said volunteer Mendez, 18. (The volunteers' last names are withheld to protect their privacy and anonymity.) 'And even if we don't have a solution for them, I feel like that is one thing that just helps them so much.' A project of the Los Angeles-based nonprofit Didi Hirsch Mental Health Services, Teen Line is helping to fill an ever-widening gap between the need for mental health support and the resources available. The phone and text lines are available to youth throughout the U.S. and Canada, and the email address can be used by teens anywhere in the world. Volunteers fielded 8,886 calls, texts and emails in 2024. Managers expect the total will surpass 10,000 this year. The percentage of high school students who report feeling consistently sad or lonely has risen steadily in the last decade. A study published last fall by the U.S. Centers for Disease Control and Prevention found that 39.7% of students said they experienced persistent feelings of sadness and hopelessness, and 20.4% had seriously considered dying by suicide. At the same time, government spending cuts have hit many support services. The Trump administration announced in April that it will stop paying $1 billion in federal grants that school districts nationwide have been using to hire psychologists and social workers. The 'Big Beautiful Bill' that Congress passed in May proposes major cuts to Medicaid, the Affordable Care Act and the Children's Health Insurance Program, which millions of Americans rely on to access mental healthcare for themselves and their kids. In July, the administration removed an option on the 988 Suicide and Crisis Hotline that allowed young people identifying as LGBTQ+ to connect directly with counselors specially trained in supporting queer youth. More than 1.3 million queer young people in the U.S. have used the service since its launch in 2022. None of this has deterred the 60 to 70 young volunteers at Teen Line, who commit to 65 hours of initial training and a minimum of two five-hour shifts per month. The program receives no federal funding and relies entirely on grants and private donations. Each evening, eight to 12 high school students file into a sunny office in Century City, often after a long day of classes, homework, practices and part-time jobs. They raid the snack room, settle into cubicles, pick up headsets and spend the next few hours talking and typing with fellow teens seeking support. The lines are open for calls and texts from 6 to 10 p.m. Pacific Time each evening (the text option closes one hour earlier). Emails can be sent any time of the day or night. They share an office with adult volunteers for the 988 hotline. With its collection of hand-painted canvases and stuffed animals, though, the Teen Line corner is easy to pick out in the sea of staid cubicles. Didi Hirsch is by far the largest of the 12 centers in California that respond to 988. Last year, the organization fielded nearly 40% of the 454,146 calls to 988 placed in the state. Total calls to the crisis hotline this year have already surpassed last year's number, with more than 462,000 calls from California alone, a Didi Hirsch spokesperson said. People of any age can contact 988, teens included. But a call or text to Teen Line, which has its own 800 number, guarantees a response from a peer who likely understands better than most well-meaning adults what it's like to be a teenager today. The public discussion about the youth mental health crisis 'really becomes removed from the actual reality of what it's like to be a teen, because the people having these conversations aren't teens. They're people kind of trying to look through the window from outside the glass,' said volunteer Max, 15. The stereotype of today's teenagers as anxious loners hunched over their phones is limiting and inaccurate, she said, as four fellow volunteers nodded in agreement. It's not that teens are cut off from real life. It's that so much is coming at them that it can be hard to know how to field it all. 'Being a teen is a time of huge responsibility, but with so little control and so little power,' Max continued. 'You're not the one making decisions about your education. You're not the one deciding where you live or what you're doing until you get to college, and there's so much pressure to succeed. ... We encourage them to think about their situation differently. We don't hand them a different set of cards, but we encourage them to approach it differently. And I think that's what teens need.' Teen Line isn't intended to be a replacement for long-term therapy or other necessary professional services, Didi Hirsch Chief Executive Lyn Morris said. But it can be a 'stepping stone' for overwhelmed young people who aren't sure where to turn or how to ask for help, she said. Members of every generation have complained in adolescence that adults don't understand them. But given the number of stressors that didn't exist until recently — social media, school lockdown drills, accelerating climate change — today's teenagers are very often justified in feeling that way. 'We don't have experience in that stuff,' Morris said. 'Thank God the teens have each other.' It's too soon to know how cuts to 988 and other services will affect Teen Line's caller volume. Volunteers said they're already hearing from people affected by recent policy changes. This includes teens who live in states that ban abortion and are worried that they might be pregnant, and those who tried calling the 988 suicide hotline but couldn't get through to any operators in their state. In the meantime, for adults concerned about the adolescents in their own lives, volunteers offered some sage advice. Before whisking the phone away from a teen who's too absorbed in their screen, ask what they're trying to distract themselves from. Listen to teens' opinions when they're moved to share them. And don't be afraid to say the hardest things out loud. 'Beating around the bush can be really suffocating,' said Jules, 17. 'Suicidal ideation, suicidal thoughts, self-injury, stuff like that — just not calling it for what it is can be really harmful. ... Just letting them get it off their chest, and not keep it in or be ashamed of their thoughts, can have a really big impact. You don't realize how much of a relief speaking and talking about it and being listened to can have.' If you're a young person in need of mental or emotional support, contact Teen Line by calling (800) 852-8336 from 6 p.m. to 10 p.m. PST; texting TEEN to 839863 from 6 p.m. to 9 p.m. PST; or emailing any time at
