Despite frequent articles and op-eds about problems in our health care system (cost, access, inadequate workforce, hospital closures, burnout, insurer-provider tensions, complexity, etc.) there has been little if any coverage of a bill proposed this legislative session that would have addressed these problems in a comprehensive and coordinated way. That bill is LD 1883, An Act to Enact the All Maine Health Act, introduced May 1 by Rep. Anne-Marie Mastraccio, D-Sanford.

This act would replace our current health care system with one covering all residents and replace current funding with income-based and payroll taxes.

At the bill’s Health Coverage, Insurance and Financial Services Committee hearing on May 14, forty-six testifiers spoke in support of the bill. The main arguments were that all Maine residents would be covered, coverage would be affordable because income-based health care is a human right, such plans work in other countries and our current system is too complex. Nineteen testifiers spoke in opposition, with the four main arguments being unknown cost, other state plans have failed, it would upset the marketplace and it would reduce choice. Interestingly, 11 of the opposing testimonies consisted of short, identical, direct quotes from the testimony of a spokesperson for the Maine Policy Institute, a free market think tank.

After discussion at its work session one week later, the committee voted Ought Not to Pass (ONTP). As a co-author of Maine AllCare’s reform plan that formed the basis of LD 1883, I was disappointed with this outcome and would like to suggest four possible reasons for the committee’s decision: complexity, cost, competition and contingency.

Complexity: Sweeping reform of the health care system would, admittedly, be challenging, and the committee members were understandably reluctant to get into the details of the bill and debate them. Well aware of what many call the crisis of our health care system, though, they could have amended the bill to a study of its provisions as preparation for more informed consideration in the future.

Cost: This is a major concern with any reform proposal but what the committee may not have had time to consider here is how much we now spend on health care (administration-heavy premiums, cost sharing, sales and other taxes, goods and services price inflation, facility fees, wage restriction, charity, crowdfunding, middlemen cuts, administration-heavy provider prices, etc.) compared to the cost of the LD 1883 plan. The committee also voted ONTP on an associated bill, LD 1269, which would have directed the Office of Affordable Health Care to study that cost, though it did ask the Office to provide information about any previous studies.

Competition: Maine’s 186 legislators introduced 4,256 bills this session, 145 of which the Health Coverage, Insurance and Financial Services Committee handled, including LD 1883, which members had 20 days to process. It may be that the Maine Legislature will not be able to pay proper attention to complex bills like LD 1883, and critique stakeholder lobbying, until a limit is put on the number of bills legislators can introduce per session, something 21 other states have done.

Contingency: In 2021, the Legislature passed a bill similar to LD 1883 but amended it to prevent it from going into effect until Congress passed legislation “authorizing a state to obtain a waiver to establish a state-based universal health care plan.” This precedent may have affected the committee’s ONTP vote but need not have. That earlier bill didn’t necessarily restrict future bills like LD 1883, which requires the Legislature to approve a final cost study before the bill would be implemented.

Whatever the reasons for the negative vote on LD 1883 were, and before it’s too late, it will behoove us all, especially our legislators, to study comprehensive and coordinated ways to address the problems in our current health care system, including proposals like LD 1883.

(Correction, June 30: A previous version of this op-ed misstated the number of days available to the Health Coverage, Insurance and Financial Services Committee to review 145 bills, which was 20 days.)