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Tuesday, June 27, 2017

Senator McConnell alert- hospital workers instructed to oppose Republican health plan

"Ohio's acute care hospitals would see uncompensated care costs rise 76 percent from 2017 to 2016 under the House Republicans' AHCA version, while they would leap 165 percent in Kentucky,"- letter to the Cincinnati Inquirer. (Although Senator Mitch McConnell represents constituents in Kentucky, he's a frequent contributor to the Cincinnati Inquirer, a newspaper circulated in Kentucky)
Opinion in the Cincinnati Inquirer

There's no trouble cruising the opinion or "op-ed" sections of our nation's newspapers. Almost every one, large and small alike, have a juicy opinion worthy of blogging into cyberspace.

This particular letter describes how hospital workers in Cincinnati are being instructed to oppose the Republican moves to repeal the Affordable Care Act, aka "Obamacare". 

 As one pundit on the MSNBC morning TV shows said, people were largely unaware of how their individual health insurance policies were being administered when they had coverage under Obamacare, but they'll surely remember who will be taking it away from them, against their will.

By Anne Saker and Randy Tucker- Inquirer reporters

CINCINNATI, Ohio- Local hospital officials are watching with trepidation as the U.S. Senate works on its bill that would repeal parts of the Affordable Care Act.

Their concern: If thousands of Medicaid patients across Greater Cincinnati get thrown off the government health plan, hospital spending on millions of dollars of uncompensated care will explode and put renewed stress on budgets.

Much of the financial pressure would come from removing benefits from the roughly 697,000 Ohioans – including 59,406 people in Hamilton County – who got coverage from the ACA's Medicaid expansion, according to the U.S. Centers for Medicare and Medicaid Services.

At Cincinnati Children’s Hospital Medical Center, president and CEO Michael Fisher urged employees Monday to contact elected representatives and to campaign through social media against the Senate bill as harmful to children.

More: Senate health care bill would lead to 22 million more uninsured, CBO says

Cincinnati Children's is the 11th largest employer in Ohio and the second largest in the Cincinnati region, with more than 15,000 workers.

“We do not believe this legislation, as written, will meet the health needs of all kids,” Fisher’s letter said. “Because kids don't vote, they often don’t have a voice in politics. They rely on us to speak up for them.”

Officials of UC Health, the region’s academic health center, worked on a statement about repeal efforts to go to employees Tuesday, said spokeswoman Kelly Martin.

UC Health’s community benefits reports – annual statements, required under the ACA, on how much care hospital systems give away or subsidize – illustrate the staggering amounts of money potentially involved.

In 2012, before the ACA fully took effect, UC Health provided $48.2 million in charity care and covered $16.1 million in unpaid Medicaid costs, reports on UC Health's website show. But in 2015, with the ACA in full effect, UC Health spent $3.4 million in charity care and $7 million in unpaid Medicaid costs.

Uncompensated care in 2015 at Cincinnati Childen's included $216 million in free or discounted services; the comparable figure for 2012 wasn't immediately available.

Nationwide, uncompensated care dropped 22.2 percent nationally from 2012 to 2015, according to the American Hospital Association. Hospitals saved a total of $6.2 billion on uncompensated care, including charity cases and bad debts (when bills for services were unpaid).

The drop occurred in the 31 states, including Ohio and Kentucky, that expanded Medicaid benefits, according to a recent report for the Commonwealth Fund. Costs essentially held steady in the states that declined the expansion.

Ohio's acute care hospitals would see uncompensated care costs rise 76 percent from 2017 to 2016 under the House version, while they would leap 165 percent in Kentucky, a separate Commonwealth Fund report concluded. The report, which noted the Senate bill cuts Medicaid more deeply than the House version, say operating margins would drop 1.8 percent in Ohio and 5.6 percent in Kentucky.

At Mercy Health, spokeswoman Nanette Bentley declined to describe the impact of an ACA repeal on Ohio’s largest health-care provider and its fifth largest employer. But she said that in Cincinnati, 16.8 percent of Mercy Health patients now are on Medicaid, and the ACA “provided for preventive health coverage to those in need of care who couldn’t previously access it.”

Fisher said in his letter to employees, “We’re very concerned that the proposed Senate bill (as did the AHCA House bill) will do harm to most of the children who depend on Medicaid.”

Fisher said more than 45 percent of Cincinnati Children’s patients, or about 133,000 children, are on Medicaid, and the Senate bill could cut services for children by more than $40 billion over 10 years. In Ohio alone, he said, “Medicaid funding for kids could drop as much as 17 percent or $1.6 billion over that same period.”

Like Fisher of Cincinnati Children’s, Mark Clement, TriHealth’s president and CEO, urged his system’s employees to speak to lawmakers about the Senate bill.

“Every health organization in the country is opposing it and has entered into advocacy to approach legislators, approach senators,” Clement said. “Between now and 2026, more than $5 billion in federal funding will be reduced to support the Medicaid program. That will impact every healthcare provider. It will impact access, and ultimately the health of the community we are entrusted to serve.”

Despite years of complaints about the ACA, the prospective changes to the law proposed this year have ignited fears that millions of lower-income and disabled adults and children, including thousands of Greater Cincinnati residents, could lose coverage from Medicaid.

The Ohio Hospital Association has been vocal in opposition to the repeal measures now in Congress. John Palmer, director of media and public relations, said the association estimates the Senate’s version of ACA repeal could trigger a shortfall in Ohio’s Medicaid program that could approach $1 trillion over 10 years.

In Dayton, officials at Premier Health, which includes Atrium Medical Center in Middletown, said in a statement that the proposed cuts “would have a staggering impact on Premier Health, Ohio’s hospitals and the U.S. health care system, and would severely limit hospitals’ delivery of care and their economic impact."

The statement noted the House version of the repeal, similar to the Senate’s, would cost Premier $862 million in Medicaid reimbursement over the next decade. The cuts also would boost Premier's uncompensated care costs by $182 million.

Officials at CareSource, Ohio's largest Medicaid managed-care provider, also based in Dayton, said the repeal efforts would set back years of progress at a critical moment when Ohio is struggling against the opioid epidemic.

"Lives are at stake,” said president and CEO Pamela Morris. "In 2016, Medicaid paid for 24 percent of the medications used for treating opioid addiction. In the five states with the highest opioid overdose mortality rates – Ohio being … a standout nationally – Medicaid covered 41 percent of opioid treatments.''

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Monday, June 26, 2017

Maine health care providers urge Sen. Susan Collins to oppose GOP health care bill

Dr. Sam Zager, obstetrics nurse Jaime Johnson, Dr. Elizabeth Rothe and Dr. Chuck Radis, spoke at a press conference at Central Maine Medical Center, on Friday morning.

By Patty Wight, Maine Public
Posted June 24, 2017, at 2:27 p.m.

LEWISTON, ME- Maine health providers from across the state spoke in Lewiston, on Friday to denounce the Senate health care bill and urge Sen. Susan Collins, a Republican, to oppose it.

Portland family physician Dr. Sam Zager said the Senate bill will cut off care for patients.

“I think this gets to the core of what it means to have a civilized society,” he said. “Are we going to turn people out? Are we going to toss them off the ship and let them drown at sea? Or are we going to acknowledge that we have a responsibility for the welfare of those around us?”

The Senate bill would partially cut funding for the Medicaid program, which pays for the majority of long-term care costs for seniors and people with disabilities.

Other provider objections included saying the bill would be financially devastating for patients and Maine’s health care system. Dr. Elizabeth Rothe of Lewiston says many Mainers will lose insurance.

“Our nonprofit hospitals will continue to treat patients regardless of their ability to pay. But they’re consequently going to see large increases in the amount of uncompensated care that they give,” Rothe said. “This is going to lead to bigger budget deficits. It’s going to lead to hospital cuts and potentially closures.

At a press conference in Lewiston, obstetrics nurse Jaime Johnson, who practices in Norway, said she’s concerned for her patients and for her 7-year-old son, who was born with congenital heart disease.

“From the moment that he was born, Fin had a pre-existing condition and he will be one for the rest of his life. He is one of 229,000 Mainers who bear such a title,” Johnson said.

The Senate health bill would weaken protections for people with pre-existing conditions.

Also at a press conference, rheumatologist Dr. Chuck Radis said the health care proposal would cause millions to lose insurance.

“We need to improve the Affordable Care Act rather than replace it with failed strategies that the rest of the world has moved on,” he said. “Health care is a right in the industrialized world, and it’s becoming a right in many countries that are not industrialized.”

The Senate bill would allow insurance companies to charge older people five times more than younger consumers.

The group Maine Providers Standing Up for Health Care is urging Collins to vote against the bill and to press her Republican colleagues to do the same.

This article appears through a media partnership with Maine Public.

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Republicans with health insurance vote others out of coverage

This original letter to the editor was originally published in Daily Bulldog published in Franklin County, Maine. In my opinion, it makes no sense for the Congress, that covers every member with government paid health insurance for themselves and for their families, to impose lack of coverage for their constituents.

Police Remove Disabled Protesters Outside Mitch McConnell’s Office

NEW SHARON, Me- The Republican controlled Senate led by Kentucky Republican Senator Mitch McConnell, released their draft of the American Health Care Act, (aka "BCRA) which is intended to replace the the existing Affordable Care Act (aka the popular "Obamacare"). 

Polls show that a majority of Americans are in opposition to the Republican controlled House version of this legislation, and with good reason. There is no guarantee of coverage for preexisting conditions- even the "high risk pool" is inadequately funded with no assurance of how it will be reimbursed; Medicaid would be cut by over $800 billion; programs like Planned Parenthood would be defunded; and insurance premiums are expected to go up, not down. All of these cuts are deemed (by Republicans) as necessary to fund an enormous tax break for some of our wealthier citizens. In fact, President Barack Obama calls the Republican plan a major shift in economic wealth, a cut in taxes for the rich while the middle class and poor take on the expense of paying for their own health care.

People in both political parities are justifiably outraged at the secret process by which the Senate came up with these cuts to healthcare.

What are you going to do about it? 

We could take a lesson from the courageous activists with disabilities, who staged a peaceful demonstration outside Senator McConnell's office today in Washington DC. 

Capitol police removed the demonstrators, handcuffing some people in wheelchairs and carrying others out by force. These demonstrators are some of the American citizens who stand to lose the most from the proposed Medicaid reductions, and they were willing to face injury and arrest to make their point. 

We should all be humbled and inspired by their leadership.

Henry Washburn
New Sharon- Maine

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Sunday, June 25, 2017

Coal miners alert - Black Lung disease symptomiatic of Trump presidency

While endowed with abundant natural resources, Appalachia has long struggled and been associated with poverty. In the early 20th century, large-scale logging and coal mining firms brought wage-paying jobs and modern amenities to Appalachia, but by the 1960s the region had failed to capitalize on any long-term benefits from these two industries.

Although Donald Trump made empty campaign promises to vulnerable unemployed (and even employed) coal mine workers, the fact is, the stigma of "black lung disease" is now a metaphore for the failed administrative agenda.  "16 tons and what will they get?".

A letter to the editor in the Dallas Chronicle

Coal is the cause of Appalachia poverty. 

Three classes of people colonized the 13 colonies: Landed gentry settled the agriculturally rich piedmonts, poor white trash, predominately Scotch-Irish immigrants, retreated to the mountains, and slaves.

The landed gentry are the genesis of oligarchs. Poverty precipitates from oligarchs exploiting “poor white trash” and slaves. That exploitation is abundantly clear in Appalachia.

In the 1870s and 80s charlatans deceived the cash strapped Mountain People from Alabama to Vermont to gain mineral and timber rights in exchange for tax payments. The tricksters convinced the mountaineers they still owned “their land” although all they had was surface rights.

Every deed contained language to the effect, “…right to enter... carry away all coal…without liability for injury or damage to the surface...right to have and use all spaces without charge…” The robber barons swindled the coal from the Clampetts!

My family owned a dairy farm in southwestern Pennsylvania. In 1949, my father raised the Washington County fair champion Holstein heifer.

A gas-well derrick fell, killing his prized cow. Because of the coal company’s deed language, my dad received no compensation. A few years later, the coal company razed our early 1800s log home and strip mined. Our story dominates the regional history, see the PBS series Appalachia.

Appalachia mining is a continual battle of simple, religiously fundamental mountain people against the oligarchs.

Tennessee Ernie Ford’s famous ballad of “16 tons” is a description of life of coal miner families, “… slack in your pants and soaked with sweat, St. Peter don’t you call me because I can’t go… I owe my soul to the company store…” A small step above slavery, it was survival of catastrophic mine explosions and black lung disease.

The presidential election is another coal black chapter in that exploitation. Ryan/McConnell/Trump have rescinded a regulation preventing dumping mine waste in streams although a 2014 spill into the Elk River made water in 9 counties undrinkable.

A new epidemic of black lung has combined with silicosis to render miners’ remaining lives to misery. Cory Robertson’s companies have declared bankruptcy (a Trump trick) leaving miner’s families without health insurance and states full of toxic superfund sites. Wyoming is the new mark. Robertson’s fortune grows as Appalachia remains with broken bodies and ruined environment. Appalachia voted heavily for Trump as the miners sang, “Praise the Lord and breathe the coal dust.” John L. Lewis rolled over in his grave. More to come…

Terry B. Armentrout

(MaineWriter note- Black Lung Disease is sadly as much a metaphor for poverty as it is a diagnosis for a terminal illness.)

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Saturday, June 24, 2017

Opposition pressuring Susan Collins to reject Senate Republican health bill

Lewiston Sun Journal- by Steven Collins

Dr. Connie Adler a Family Practice physician from Farmington Maine and Jaime Johnson, R.N., a labor and delivery nurse, spoke at the June 23, 2017 press conference at Central Maine Medical Center in Lewiston, about the devastating impact of the Republican repeal and replace bill.

LEWISTON, Me: Working as a long-term substitute teacher and with a baby on the way, 31-year-old Tom Kelley figured he was young enough and healthy enough to “coast a little”, without coughing up scarce cash for health insurance.

Then the Lewiston man noticed something unsettling, went to his doctor and learned that he really ought to have an ultrasound test that would likely help determine what was going on.

Kelley made some phone calls and learned the test would cost somewhere between $500 and $1,500.

Fortunately for him, this happened during a window of time that anyone could sign up for health insurance through the Affordable Care Act so, with days to spare, he picked up a $26-a-month policy.

It turned out to be a wise move. Diagnosed with cancer, Kelly has had surgery and a CAT scan already and is nearing the end of a round of chemotherapy that, with luck, will cure him completely.

Now with a three-week-old daughter, Ada, he has shelled out a total of $800 in addition to his monthly policy payments, a drop in the water compared to the many thousands of dollars in medical bills he’s racked up.

“I’m glad I got insurance and I don’t know what I would have done without it,” Kelley said Friday.

As he watches politicians in Washington wrangle with a proposed overhaul of the health care system — one that could make it harder for people with pre-existing conditions to get affordable care — Kelley said he’s worried about what could happen.

“It’s frustrating” he said. “(Those in Congress) all have insurance. Sometimes I think they really can’t relate to the average Mainer.”

A grassroots group of more than 400 health care professionals, Maine Providers Standing Up for Healthcare, is trying to hammer home the idea that Republican efforts to revamp President Barack Obama’s ACA threaten to leave tens of thousands of Mainers who now have insurance out in the cold.

A handful of doctors and nurses connected to the group that formed this spring said they’re worried the proposal will wind up forcing some rural Maine hospitals to close, crimp efforts to help opioid addicts, worsen an already troubling infant mortality rate, make mental health care scarce, hurt seniors who rely on MaineCare and cause many people to put off medical care until their problems become more dangerous and expensive.

“People don’t realize how crucial Medicaid is,” said Julie L’Heureux, a nurse.

Vulnerable Mainers will be “at great risk” if backers are successful in pushing the Senate bill into law, Dr. Elizabeth Rothe, a family practitioner in Lewiston, said during a news conference Friday at Central Maine Medical Center.

One of her patients, for example, has a 10-year-old daughter on MaineCare with cystic fibrosis who requires $15,000 worth of prescription drugs every month. If the GOP allows insurers to have lifetime limits on how much can be spent, Rothe said, that girl could wind up “very sick” or perhaps die.

Jaime Johnson, a labor and delivery nurse in Norway, said her son Finley, 7, “has a pre-existing condition from birth” because of a congenital heart problem that’s already required him to undergo three major surgeries.

She said she’s concerned that having a condition like Finley’s will land children in a high-risk pool that’s so expensive that parents will be forced to delay proper treatment or extend waiting periods between necessary surgeries.

It turned out to be a wise move. Diagnosed with cancer, Kelly has had surgery and a CAT scan already and is nearing the end of a round of chemotherapy that, with luck, will cure him completely.

Now with a three-week-old daughter, Ada, he has shelled out a total of $800 in addition to his monthly policy payments, a drop in the water compared to the many thousands of dollars in medical bills he’s racked up.

“I’m glad I got insurance and I don’t know what I would have done without it,” Kelley said Friday.

As he watches politicians in Washington wrangle with a proposed overhaul of the health care system — one that could make it harder for people with pre-existing conditions to get affordable care — Kelley said he’s worried about what could happen.

“It’s frustrating” he said. “(Those in Congress) all have insurance. Sometimes I think they really can’t relate to the average Mainer.”

A grassroots group of more than 400 health care professionals, Maine Providers Standing Up for Healthcare, is trying to hammer home the idea that Republican efforts to revamp President Barack Obama’s ACA threaten to leave tens of thousands of Mainers who now have insurance out in the cold.

A handful of doctors and nurses connected to the group that formed this spring said they’re worried the proposal will wind up forcing some rural Maine hospitals to close, crimp efforts to help opioid addicts, worsen an already troubling infant mortality rate, make mental health care scarce, hurt seniors who rely on MaineCare and cause many people to put off medical care until their problems become more dangerous and expensive.

“People don’t realize how crucial Medicaid is,” said Julie L’Heureux, a nurse.

Vulnerable Mainers will be “at great risk” if backers are successful in pushing the Senate bill into law, Dr. Elizabeth Rothe, a family practitioner in Lewiston, said during a news conference Friday at Central Maine Medical Center.

One of her patients, for example, has a 10-year-old daughter on MaineCare with cystic fibrosis who requires $15,000 worth of prescription drugs every month. If the GOP allows insurers to have lifetime limits on how much can be spent, Rothe said, that girl could wind up “very sick” or perhaps die.

Jaime Johnson, a labor and delivery nurse in Norway, said her son Finley, 7, “has a pre-existing condition from birth” because of a congenital heart problem that’s already required him to undergo three major surgeries.

She said she’s concerned that having a condition like Finley’s will land children in a high-risk pool that’s so expensive that parents will be forced to delay proper treatment or extend waiting periods between necessary surgeries.

“This may not kill my son immediately,” she said, “but it could in the end cost him years of life.”

A GOP-backed Senate bill unveiled this week, which aims to return more decision-making to the states, would make drastic changes to the ACA, including a major reduction in Medicaid spending and the elimination of most of the taxes that undergirded Obamacare’s financing. It would also potentially make it more difficult for people with pre-existing conditions and low incomes to get coverage.

Dr. Peter Shaw, a retired cardiologist, said the Senate proposal puts many ordinary people in danger “to pay off the plutocrats” whose taxes would be reduced under the proposed legislation.

Though retired, Dr. Charles Radis said the country’s health care system “is in drastic need of surgery.” He insisted that what’s required is to repair Obamacare, not repeal it.

But supporters of the overhaul argue that Obamacare is stumbling in many states, with too many rules and too little concern for the bottom line.

Maine’s two senators, Republican Susan Collins and Independent Angus King, are both skeptical about the Republican measure they may be asked to vote on next week.

For Tom Kelley, the important thing is that people can get affordable insurance.

When he first realized that he faced a lot of medical bills ahead, he said, he worried that it could be “extremely difficult.”

“Before I went bald, I had a few more gray hairs” from the fretting, he said.

His experience has made him appreciate the need for insurance in a way that he never could have while he was healthy.

That’s why it worries him that the GOP bill seems to make the problem worse for millions of people instead of making it better.

Chris Hansen, president of the American Cancer Society Cancer Action Network, said the Senate measure “could greatly harm millions of cancer patients, survivors and those at risk for the disease.”

He said a provision in the Senate bill allows states to waive essential health benefits, jeopardizing protections for those with pre-existing conditions.

“Without guaranteed standard benefits, insurance plans would not have to offer the kind of coverage cancer patients need, or could make that coverage prohibitively expensive,” Hansen said.

In addition, he said, “plans could also once again set annual or lifetime caps on care, forcing individuals to choose between their life and life savings.”

Radis said Collins ought to show “true leadership” and break with her party on the proposal. Collins has denounced the House version of the bill, but is waiting for a Congressional Budget Office analysis of the Senate rewrite before making a decision on it.

Given that the Senate bill appears to be “just as poisonous to the health and wellness of Mainers as the bill that passed the House,” Dr. Sam Zager, a Portland family physician said, Collins “must vote against any bill that reduces meaningful coverage."

“She seems to be coming around,” Zager said.

Margaret Craven, a former Democratic legislator from Lewiston, said Collins and her colleagues need “to stop undermining and ruining the ACA” and listen to medical experts who are speaking out.

“I’m more inclined to trust what doctors say about health care than a politician,” Kelley said.

Kelley said if Collins sat at his dining room table, he would tell her “to do the right thing for her constituents.”

Meanwhile:  Senator Angus King blasts the GOP healthcare bill while Susan Collins studies it

Denouncing the Republican health care bill Thursday, independent U.S. Sen. Angus King of Maine, called it a “really cruel” bid to take health care away from the poor, disabled and elderly “so very wealthy people can get a tax cut.”

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Friday, June 23, 2017

Maine rising infant mortality rates point to problems in northern Maine

Statement by Dr. Dora Mills

Dr. Dora Anne Mills of the University of New England was the Maine State Health Director from 1996 to 2011.

"I was shocked to learn that Maine’s rates are the only ones in the country that are increasing, i.e., worsening."

This is critical, because infant mortality – the rate at which babies die in the first year of life – is the most accurate pulse we have on the health of a society. 

It reflects not only the health of people at their most vulnerable time of life – that is, infancy – but also of women during and after pregnancy, and of the entire family and community, since any environmental toxin, public secondhand tobacco smoke, or other community-wide health issue often exerts their heaviest impact on infants.

I remember in the 1990s when Maine enjoyed the lowest – the best – infant mortality rates in the country, and was even on par with the lowest of any country in the world. So, I was stunned to learn that our rates have increased to the 43rd worst state in the country.

In digging into the data, I also learned not all of Maine has fared worse over the years. Compared with the 1990s, Maine’s more southern and urban infant mortality rates have stayed about the same, and in some cases even improved. For example, York County has seen a 31 percent improvement.

However, in most of Maine’s rural counties, the rim counties, rates have dramatically worsened. Some of these counties in Maine have infant mortality rates on par with Croatia, Romania, and Botswana. In other words, Maine’s worsening infant mortality rates seem mainly because of declining health of babies, families, and communities in rural Maine.

At first I thought maybe this decline was caused by one or two issues, such as the opioid addiction epidemic. So, I examined other health data, such as those for cancer, diabetes, drug addiction, heart disease, obesity and smoking, and compared county trends over the last 10-30 years. I learned that in most of these measures of health, rural Mainers are less well off than their more southern and urban counterparts, and are often worse off than several years ago. Any statewide declines in these issues over the last few years are often primarily because of worsening health of people in rural Maine.

As an example, death rates from cancer have declined across the country and state. However, mortality rates in rural Maine, which were already for the most part higher than the statewide rate, have not declined as much the last 10 years, causing an even wider gap, with rural Mainers dying from cancer at increasingly higher rates than their more urban counterparts. I also looked at childhood poverty, which is a barometer of the health of children in a community, since children living in poverty are more likely to be in poor health. Defined in 2015 by a household income less than $24,000 for a family of four (two adults and two children), poverty rates for children in Maine also vary widely by county, with rural counties faring worse and having worsened in the last 20 years. For instance, childhood poverty rates in Aroostook, Franklin, Oxford, Piscataquis, Somerset, and Washington counties are the highest in the state and have increased over the last 20 years.

By contrast, Cumberland and York counties have the lowest childhood poverty rates in Maine, and stayed about the same as 20 years ago. With the widening divide between rural and southern Maine, counties such as Piscataquis and Washington have childhood poverty rates approaching one-third of all children, and rates that are nearly three times that seen in York and Cumberland counties.

What can we do? The most critical step is to make sure Maine’s health care and public health systems across the state are sufficiently resourced to assure all Mainers have access to health care and live in healthy communities. This includes access to health care providers, health insurance (including MaineCare), public health nursing, community-based public health organizations, and governmental public health professionals at the regional and state levels. As a result, there should be readily available health care that includes drug and tobacco addiction treatments, sufficient preparedness for emergencies, and community-wide prevention on many issues such as nutrition education, cancer screening, and walkable communities. Because the economic health of a community is intrinsically related to its overall health, economic strategies that focus on rural areas are also important.

There is much beauty in rural Maine, found in its people, pristine lakes, mountains, woods and fields. However, just as we have built roads and power lines in rural Maine, we also must assure there are adequate pipelines to preserve and improve the health of those living there.

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Wednesday, June 21, 2017

World Refugee Day - tribute from Justin Trudeau

Canadian crest
Ottawa, Ontario
June 20, 2017

The Prime Minister, Justin Trudeau, issued the following statement on June 20, World Refugee Day:

"On World Refugee Day, we honour the strength and resilience of the millions of people around the world fleeing conflict, insecurity, and persecution. We solemnly acknowledge the hardships they face, celebrate the significant contributions they make to our communities, and recognize the dedication of those who help them.

“Today, over 65 million people are displaced around the world, and more than 22 million of them are refugees. 

They flee unlivable situations in their homelands, crossing deserts and seas to escape, and carrying dreams of a new life even as they struggle with intense loss. These hardships particularly affect women, who bear different and disproportionate effects of conflict and insecurity.

“Canadians are fortunate to live in a country shaped, over the centuries, by the dreams and hard work of millions of immigrants and refugees. Today, we recognize their dignity and potential. Despite the hardships they face, these individuals make many contributions to shape the diverse, strong, and prosperous country Canada is today.

“Canada has a long tradition of welcoming refugees, and today, Canadians continue to help newcomers establish their lives here with compassion and openness. In recent years, communities across the country have welcomed over 40,000 Syrian refugees. Their generosity illustrates the spirit of compassion that defines us as Canadians. When we embrace our differences and come together to welcome newcomers, we strengthen our communities in enduring ways.

“Rising conflict, insecurity, and persecution today have led to migration levels not seen since the Second World War. We have a global responsibility to respond to this crisis and to support those who are forced to leave home. We must address the root causes of forced migration by seeking diplomatic solutions for violent conflicts and standing united in the fight against terrorism. We must also redouble our efforts on climate change, so that it does not further exacerbate insecurity in the world.

“Today, I call on Canadians and people around the world to stand with people seeking shelter from enormous hardship and violence. Refugees are forced to leave home, but they carry with them dreams for their children and the hope of creating a better world. Let us show compassion for their plight, recognize their dignity, and continue to see ourselves in each other.”

Merci!  Thank you Prime Minister Justin Trudeau.

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Tuesday, June 20, 2017

History will have the last word about Donald Trump on Twitter

"I have offended God and mankind because my work did not reach the quality it should have."- famous last words: Leonardo da Vinci quote

(@realdonaldtrump does not understand the damage done by his tweets- or does he?)
@realdonaldtrump: Appears to disregard the caustic spirit of his 140 character "tweets"; but history will have the last word to interpret the intentions of every one of them.
Okay! I promise to NOT write a top 10 list of anything relating to Donald Trump. Nevertheless, as his uncontrolled Tweets continue to accumulate, spewing out of his @realdonaldtrump handle, it's now been upheld by the US 9th District Federal Court that these messages are official directives.

Therefore, it makes perfect sense to consider how @realdonaldtrump will be engraved in history, while he stumbles, fumbles, lies and accuses people, during his many Twitter tirades.

In other words, for mysterious reasons known only unto himself, @realdonaldtrump obviously wants to be recorded in history as the author of his own universe, defined by his "tweets".  

Fortunately, historians have the the last word about the @realdonaldtrump documented 140 character social media missives.  

Although each of the @realdonaldtrump tweets stands alone in their caustic tones, the summary of them, in the aggregate, relates to some of the worst prose ever recorded by any leader. 

Regardless of what type of organization a person is involved in, the leadership always attempts to put the best light on the associations' comings and goings on.  Not so with @realdonaldtrump! In fact, on Twitter, he's like the reinvention of Nero fiddling while Rome burns, totally oblivious to the damage inflicted to his legacy and to those who will be embarrassed to defend their associations with him, after he is out of office.

Therefore, rather than write about DonaldTrump's irresponsible "tweets", I've decided to give @realdonaldtrump a lesson on how history has graded others with regard to their most memorable quotes.  In other words, if "tweets" had existed when these notables were quoted, how would they be judged in today's social media archives? These examples are the social media equivalent of "tweets" by the authors.

For example, the documented last sentence on the "Last Will and Testament" issued and witnessed, as directed by Adolf Hitler, on April 29, 1945 (this is sickeningly akin to "Hitler's last words":

Above all I charge the leaders of the nation and those under them to scrupulous observance of the laws of race and to merciless opposition to the universal poisoner of all peoples, International Jewry.”

Beatles, John Lennon: Shortly before he died was interviewed for a US magazine. He was quoted: “Christianity will end, it will disappear. I do not have to argue about that. I am certain Jesus was O.K., but his subjects were too simple. Today we (the Beatles) are more famous than Jesus.” Lennon died on Dec 8/1980 from gunshot wounds.

Thomas Andrews, the builder of the infamous "Titanic": After the construction of Titanic, a reporter asked how safe the Titanic would be. With an ironic tone he said: "Not even God can sink it."

Titanic set sail from America to Europe on April 10, 1912. An unprecedented tragedy occurred after four days sailing in the Atlantic Ocean. The ship hit a large iceberg on April 14-15, and sank to the bottom of the ocean, killing 1517 passengers with only 706 survivors. Andrews died on the ship.

In other words, beware of the tone of @realdonaldtrump tweets because, inevitably, they will be recorded in the archives of world famous quotes, to be judged by eternity. 

Many have warned @realdonaldtrump about the damage his "tweets" rants will (and already have) been responsible for causing; but he obviously disregards the cacophony of advice.  

In fact, the @realdonaldtrump "tweets" have the impact of being like "dog whistles" to the his zealous followers. In other words, they seem on inspire those who hear their caustic message, while the remainder of us are appalled by their divisiveness and the immaturity they demonstrate about @realdonaldtrump.

I hope @realdonaldtrump can learn something from this blog.

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Monday, June 19, 2017

Stop the secrecy! Block the GOP secret healthcare conspiracy

Although it's impossible to understand how a group of 13 male Senators, who took an oath to uphold the Constitution of the United States, continue to negotiate about 1/6 of US economy related to healthcare in secret, the results will be devastating to the GOP- and they've been duly warned about the political consequences.

WASHINGTON — The Senate is closing in on a health care bill that could affect coverage for tens of millions of Americans and overhaul an industry that makes up one-sixth of the economy.

Only one problem: Almost no one knows what’s in it. (Is this the newest GOP conspiracy against the American people?)

Attention:  Senator Mitch McConnell

"I think it's being written, uh, by someone somewhere but I'm not aware of who or where," Sen. Rand Paul, R-Kentucky, deadpanned to NBC News. "If you get a copy of it, will you send me a copy?"

In a striking break from how Congress normally crafts legislation, including Obamacare, the Senate is conducting its negotiations behind closed doors. The process began five weeks ago, after the House passed its version of health care reform, with a small working group of 13 senators rather than the broader committees who usually handle the issue.

The opaque process makes it impossible to evaluate whether there are any significant changes coming to health care. There are no hearings with health experts, industry leaders, and patient advocacy groups to weigh in where the public can watch their testimony or where Democrats can offer amendments.

“We'll let you see the bill when we finally release it,” Senate Majority Leader Mitch McConnell (R-KY) told reporters on Tuesday. He added that “nobody is hiding the ball here” and that people were “free to ask anybody anything.”

Free to ask, but answers are another matter. Republican senators are still negotiating over specific pieces of a bill, but they say they’re close enough to producing legislation that they could hold a vote within weeks. They have been tight-lipped on the details, leaving Americans with only a trickle of leaked ideas that are often vague or speculative.

Health and Human Services Secretary Tom Price said in a hearing on Thursday that his staff had provided "technical assistance" to senators working on the bill, but that he had not seen any "legislative language" himself.

Democrats are justifiably complaining about being shut out, but even some Republican senators have said they’ve had difficulty getting information about the legislation and wished there were more public opportunities to register concerns.

Americans must block this horrible health care initiative and prevent the secret process used to create a regressive public policy.

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Sunday, June 18, 2017

Donald Trump and the law- like oil and water

Donald Trump is obviously over his head in legal trouble. Neverhteless, he is in conflict with the lawyers he's hired to help save him from the political turmoil, of his own creation. This disregard for the law will untimately implode his leadership. It's more damaging to him and his reputation than any single mistep he as made in his short tenure in the White House.

President Trump’s Disdain for the Rule of Law

Democracy isn’t possible without the rule of law — the idea that consistent principles, rather than a ruler’s whims, govern society.

You can read Aristotle, Montesquieu, John Locke or the Declaration of Independence on this point.

You can also look at decades of American history. Even amid bitter fights over what the law should say, both Democrats and Republicans have generally accepted the rule of law.

President Trump does not. His rejection of it distinguishes him from any other modern American leader. He has, instead, flirted with Louis XIV’s notion of “L’état, c’est moi”: The state is me — and I’ll decide which laws to follow.

This (arrogant!) attitude returned to the fore with James Comey on Thursday, when he testified about Trump’s attempts to stifle an F.B.I. investigation. I realize that many people are exhausted by Trump outrages, some of which resemble mere buffoonery. 

But, it’s important to step back and connect the dots among his many rejections of the rule of law.

They are a pattern of his presidency, one that the judicial system, Congress, civic institutions and principled members of Trump’s own administration need to resist. Trump’s view of the law, quite simply, violates American traditions.

David Leonhardt walks through the major themes:

LAW ENFORCEMENT, POLITICIZED. People in federal law enforcement take pride in trying to remain apart from politics. I’ve been talking lately with past Justice Department appointees, from both parties, and they speak in almost identical terms.

They view the Justice Department as more independent than, say, the State or Treasury Departments. The Justice Department works with the rest of the administration on policy matters, but keeps its distance on law enforcement. That’s why White House officials aren’t supposed to pick up the phone and call whomever they want at the department. There is a careful process.

Trump has erased this distinction.
He pressured Comey to drop the investigation of Trump’s campaign and fired Comey when he refused. 

Trump has called for specific prosecutions, first of Hillary Clinton and more recently of leakers.

The attorney general, Jeff Sessions, is part of the problem. He is supposed to be the nation’s head law-enforcement official, but acts as a Trump loyalist. He recently held a briefing in the White House press room — “a jaw-dropping violation of norms,” as Slate’s Leon Neyfakh wrote. Sessions has proclaimed, “This is the Trump era.”

Like Trump, he sees little distinction between the enforcement of the law and the interests of the president.

COURTS, UNDERMINED. Past administrations have respected the judiciary as having the final word on the law. Trump has tried to delegitimize almost any judge who disagrees with him.

Trump's Twitter tantrum, on Monday, took a swipe at “the courts” over his stymied travel ban.

(MaineWriter - this Trump tweet is distressing because the number of people who respond are clearly misguided.)

Donald J. Trump

We need to be smart, vigilant and tough. We need the courts to give us back our rights. We need the Travel Ban as an extra level of safety!
7:17 PM - 3 Jun 2017

It joined a long list of his judge insults: “this so-called judge”; “a single, unelected district judge”; “ridiculous”; “so political”; “terrible”; “a hater of Donald Trump”; “essentially takes law-enforcement away from our country”; “THE SECURITY OF OUR NATION IS AT STAKE!”

“What’s unusual is he’s essentially challenging the legitimacy of the court’s role,” the legal scholar Charles Geyh told The Washington Post. Trump’s message, Geyh said, was: “I should be able to do what I choose.”

TEAM TRUMP, ABOVE THE LAW. Foreign governments speed up trademark applications from Trump businesses. Foreign officials curry favor by staying at his hotel. A senior administration official urges people to buy Ivanka Trump’s clothing. The president violates bipartisan tradition by refusing to release his tax returns, thus shrouding his conflicts.

The behavior has no precedent. “Trump and his administration are flagrantly violating ethics laws,” the former top ethics advisers to George W. Bush and Barack Obama have written.

Again, the problems extend beyond the Trump family. Tom Price, the secretary of health and human services, has used political office to enrich himself. Sessions failed to disclose previous meetings with Russian officials.

Their attitude is clear: If we’re doing it, it’s O.K.
CITIZENS, UNEQUAL. Trump and his circle treat themselves as having a privileged status under the law. And not everyone else is equal, either.

In a frightening echo of despots, Trump has signaled that he accepts democracy only when it suits him. Remember when he said, “I will totally accept the results of this great and historic presidential election — if I win”?
 The larger message is that people who support him are fully American, and people who don’t are something less. Trump tells elaborate lies about voter fraud by those who oppose him, especially African-Americans and Latinos. Then he uses those lies to justify measures that restrict their voting. (Alas, much of the Republican Party is guilty on this score.)

The efforts may not yet have swung major elections, but that should not comfort anyone. They betray the most fundamental democratic right, what Locke called “the consent of the governed.” 

They conjure a system in which the benefits of citizenship depend on loyalty to the ruler.

Trump frequently nods toward that idea in other ways, too. He still largely ignores the victims of terrorism committed by white nationalists.  

TRUTH, MONOPOLIZED. The consistent application of laws requires a consistent set of facts on which a society can agree. The Trump administration is trying to undermine the very idea of facts.

It has harshly criticized one independent source of information after another. The Congressional Budget Office. The Bureau of Labor Statistics. The C.I.A. Scientists. And, of course, the news media.

Trump attacks the media almost daily, and McClatchy has reported that these attacks will be part of the Republicans’ 2018 campaign strategy. Trump has gone so far as to call journalists “the enemy of the people,” a phrase that authoritarians have long used to paint critics as traitors. “To hear that kind of language directed at the American press,” David Remnick, the editor of The New Yorker, has said, “is an emergency.”

All Americans, including the president, should feel comfortable criticizing the media. (I certainly do.) Specific media criticisms are part of the democratic cacophony. But Trump is doing something different.

He demonizes sources of information that are not sufficiently supportive. He tells supporters that they can trust only him and his loyal mouthpieces 
to speak the truth. La vérité, c’est moi.

The one encouraging part of the rule-of-law emergency is the response from many other parts of society. Although congressional Republicans have largely lain down for Trump, judges — both Republican and Democratic appointees — have not. 

Neither have Comey, the F.B.I., the C.B.O., the media or others. 

As a result, the United States remains a long way from authoritarianism.

Unfortunately, Trump shows no signs of letting up. Don’t assume he will fail just because his actions are so far outside the American mainstream.  
The rule of law depends on a society’s willingness to stand up for it when it’s under threat. This is our time of testing.

Letter the NYTimes editor:

David Leonhardt is right-writes Eric Orts: 

“The rule of law depends on a society’s willingness to stand up for it when it’s under threat.” 

In this spirit, a group of more than three dozen faculty at the Wharton School of the University of Pennsylvania has joined an “Open Letter to Legislators and Others to Support the Rule of Law.”

As we say in the letter, President Trump often invokes his Wharton education “as evidence of his intelligence and business acumen,” but as Wharton professors we maintain that our school has always stood for “professional and moral values,” including “responsibility and accountability in both private and public sectors, and supporting the rule of law in the United States and around the world.”

This is not a time of business as usual or politics as usual. Republicans, as well as Democrats and independents, must support the rule of law, the foundation of our constitutional democracy and system of free enterprise.

ERIC W. ORTS, PHILADELPHIA- a professor of legal studies and business ethics at the Wharton School.

In summary- this article by Leonhardt and the subsequent letter to the editor by Orts, demonstrate in professional narrative how Donald Tump and the rule of law are impossible to reconcile. Like oil and water. American must dump the administration's concoction.

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Friday, June 16, 2017

A President under investigation puts administration at risk

Trump says he is under investigation for firing James Comey- ABC News

Officials who served on Trump's transition team have been instructed to preserve all documents that could be pertinent to the Russia investigations conducted by Congress and the special counsel.

Deputy AG Rod Rosenstein privately signals to colleagues he may have to recuse himself from Russia probe- Daily News

Is it possible the blind scales of justice will truly save the United States of America from an executive branch implosion, by indicting Donald Trump and forcing an impeachment?

America must remove, by Constitutional methods, the unstable tyrant, Donald Trump, as soon as possible. And, the Trump administration must, likewise, resign.

So, let me get this right? I'm obviously not a lawyer, but watching television news and following Twitter, makes me feel more confident about my judicial opinion. Here's what I think:

If Attorney General Jefferson "Jeff" Sessions can't prosecute Donald Trump for obstruction of justice because he removed himself from the Russia investigation; and now the Assistant Attorney General Rod Rosenstein ponders whether or not he must also recuse himself for whatever reasons, then who is qualified to indict Donald Trump, for obstruction of justice? 

In fact, the entire investigation will have to go to the Congress for enactment of Articles of Impeachment, where the trial then goes before the people. Meanwhile, anything can happen to harm America while this political tragedy, wrapped in espionage, continues. As this stomach turning continues, Americans are abandoned, like dingy boats without paddles, lacking competent political leadership. In fact, politically speaking, the United States of America, at this time, is heading directly for a catastrophic governmental "iceberg".  We won't need to look for extraterrestrial forces to destroy our nation. In fact, there's no more need for SETI sites (Search for Extra Terrestrials), because plenty of internal stresses are in place, right now, to dismantle our nation's unity. 

Deputy Attorney General Rod Rosenstein has privately admitted to colleagues that he may have to recuse himself from the ongoing federal probe into whether any associates of President Trump coordinated with Russian efforts to meddle in the 2016 race, ABC News reported Friday.

Although Rosenstein hasn't yet requested Justice Department attorneys to provide him their legal opinion about a potential recusal, it is reported that he has spoken, in recent weeks, with Associate Attorney General Rachel Brand, his own deputy, about the possibility of her taking on his responsibilities as the top overseer of the Russia probe, ABC News reported.

I'm a non-lawyer who stands watch, while the political news unfolds, and growing anxiety about the future is consuming our national energies, In my opinion, all of Donald Trump's administration must be directed to find their legal life preservers and search for the safety boats.  

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Thursday, June 15, 2017

Hospital acquired antibiotic resistance- Medscape

Be aware of the consequences of antibiotic adverse effects

Medscape Reports 
(Just my opinion, but sometimes, less might be better?)

Be careful about taking too high a dosage of antibiotics

Antibiotic-Associated Adverse Events Common

One in five hospitalized patients experienced adverse drug events (ADEs) when prescribed antibiotics, according to a study published online June 12 in JAMA Internal Medicine.

"Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs," write Pranita D. Tamma, MD, MHS, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues.

Researchers retrospectively reviewed the medical records of 1488 adult patients who had received antibiotics for at least 24 hours while hospitalized at Johns Hopkins Hospital between September 2013 and June 2014. The study excluded patients receiving antibiotics for noninfectious indications, antituberculosis regimens, or topical or inhaled antibiotics.

Patients were monitored for antibiotic-associated ADEs occurring within the first 30 days after receiving antibiotics. These included gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic events. 

Moreover, patients were monitored for 90 days for the development of Clostridium difficile infection (CDI) or incident multidrug-resistant organism (MDRO) infection.

The researchers found that 298 (20%) of patients experienced at least one antibiotic-associated ADE. The study authors also found that 287 patients (19%) were receiving antibiotic regimens that were not clinically indicated. Among these patients, 56 (20%) experienced an ADE, including 7 cases of CDI.

A total of 324 ADEs occurred overall; of those, 186 (57%) happened within 30 days and 138 occurred within 90 days. Of the 138 ADEs occurring within 90 days, 54 (39%) were cases of CDI and 84 (61%) were MDRO infections.

Further, the researchers found that for every additional 10 days of antibiotic therapy, patients experienced a 3% increase in the risk for an ADE.

The median age of the patients in the cohort was 59 years (interquartile range [IQR], 49 - 69 years), and more than half of the patients were female. The median hospital stay was 4 days (IQR, 2 - 9 days), and the most frequently prescribed antibiotics were third-generation cephalosporins, parenteral vancomycin, and cefepime.

The authors point out that, unlike previous studies that relied on administrative data, "infectious diseases physicians and pharmacists reviewed all patient medical records to identify ADEs and to determine whether they were most likely attributable to recent or current antibiotic use using strict, predefined criteria."
Nevertheless, limitations in the study were noted. For example, antibiotic stewardship programs differ from hospital to hospital, so antibiotic prescribing and subsequent ADE rates will differ. Furthermore, the study did not include patients seeking out-of-network care or those receiving prolonged or inappropriately broad antibiotic therapy. Thus, underestimation of ADEs is possible.

"Our findings provide quantitative data about the risk of ADEs that clinicians should consider when weighing decisions to initiate or discontinue antibiotic therapy and lend further credence to the importance of antibiotic stewardship to optimize patient safety," the researchers conclude.

This study was funded by an investigator-initiated grant from Pfizer Independent Grants for Learning and Change and The Joint Commission. The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online June 12, 2017. Abstract

Cite this article: Antibiotic-Associated Adverse Events Common - Medscape - Jun 12, 2017.

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Consequences: Fallout from Congressional support of AHCA

Congressman Bruce Poliquin - alert!

Two news reports from Maine's Second District

What was Congressman Poliquin thinking?  Obviously, when he voted to support the GOP supported AHCA, he was not thinking about his Second District constituents, in Maine.

Americans, including Maine's Second District constituents, warned Congressman Bruce Poliquin about the disastrous consequences of his vote to support the American Health Care Act (AHCA) in the House of Representatives.  

Now, the apparent consequences of Poliquin's wrong minded vote has come home to roost.  Health facilities in Maine's second district are feeling the pain. My prediction wasn't psychic, but based on rationale. You can't risk cutting patients access to health care and expect providers to afford paying for the delivery of care.  

LEWISTON, Me- Jeff Brickman, president and chief executive officer of Central Maine Healthcare, said the closing of an urgent care facility in Auburn and a clinic in Mechanic Falls is part of an overall cost-reduction effort to put the health system on a more sustainable financial footing.

Central Maine Healthcare, an integrated health system that includes Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital, is closing facilities in Auburn and Mechanic Falls in a cost-cutting step that will eliminate 31 jobs.

The Lewiston Sun Journal reported that CMHC will close an urgent care facility in Auburn in about a month and a clinic in Mechanic Falls in September as part of its overall effort to reduce costs. Both facilities, the newspaper reported, were losing money.

CMHC CEO Jeff Brickman told the newspaper the job reductions — which include nine physicians — would reduce the health system's expenses by 8% to 10%.

Brickman became president and CEO of CMHC last September, replacing Peter E. Chalke, who had announced his retirement earlier in the year.

Three months later, Brickman hired Illinois-based consulting firm Kaufman Hall to develop a plan for the hospital system's future in the face of a significant budgetary shortfall in 2016, telling the Sun Journal, at that time, that he was working diligently "to make sure that we can sustain this organization for the long term."

CMHC is one of Androscoggin County's largest employers, with about 4,200 employees at Central Maine Medical Center in Lewiston, hospitals in Rumford and Bridgton, the Dempsey Center, the Central Maine Heart and Vascular Institute and medical practices throughout central, western and mid-coast Maine.

Moody's downgrades Eastern Maine Health Services (EMHS), bond rating

Moody's Investor Services downgraded the credit rating of Eastern Maine Healthcare Systems, to "Ba1", with a negative outlook.

Brewer-based EMHS, an integrated health delivery system with a workforce of more than 12,000 and nine hospitals throughout the state, including Eastern Maine Medical Center in Bangor and numerous smaller rural hospitals, issued the following statement Wednesday about the downgrade:

"Moody's informed EMHS earlier this year that a downgrade from Baa3 was being considered. Last month, EMHS senior leadership met with representatives of Moody's in New York and discussed the system's improved financial performance while also revealing a solid plan for continued improvement.

"These are challenging times for healthcare providers, both in Maine and throughout our nation. EMHS' proactive five-year strategy is both innovative and forward-thinking. EMHS is building an enterprise-wide electronic medical records system, organizing our more than a thousand employed providers into a single medical group, and continuing to advance our successful population health strategy. EMHS also continues to optimize the performance of our newest member hospitals, which were brought into the system experiencing multiple years of financial distress. Time and hard decisions have led to improved operations and we expect that trend will continue. EMHS believes that these initiatives are essential to the future of a high-performing healthcare organization serving the state of Maine. EMHS leadership remains confident in our ability to deliver increasingly positive outcomes in the months and years ahead.

"While EMHS is disappointed with Moody's decision, it will not affect care delivery, business operations, or our ongoing focus on performance improvement. Additionally, while EMHS has no plans to enter the bond market for any additional debt for the foreseeable future, we look forward to revisiting our rating with Moody's next year."
Congressman Bruce Poliquin, Maine's Second District

Congressman Poliquin must stop hiding from his wrong minded AHCA vote and express outrage at the closing of Central Maine Health Care's urgent care access. Moreover, there must be a supportive statement from Congressman Poliquin, to counter the downgraded Moody's rating. Unfortunately, neither of these responses has been forthcoming, thus far.

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