An Act To Create a Single-payer Health Care Program in Maine
Maine Legislature, Session 129, LD 1617
Committee: Health Coverage, Insurance and Financial Services
Sponsors: SYLVESTER, BELLOWS, BAILEY, BROOKS, HANDY, MADIGAN, MAXMIN, TALBOT ROSS, TEPLER, WARREN

Legislative Document
No. 1617
H.P. 1169
House of Representatives, April 23, 2019
An Act To Create a Single-payer Health Care Program in Maine
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative SYLVESTER of Portland.
Cosponsored by Senator BELLOWS of Kennebec and
Representatives: BAILEY of Saco, BROOKS of Lewiston, HANDY of Lewiston, MADIGAN 
of Waterville, MAXMIN of Nobleboro, TALBOT ROSS of Portland, TEPLER of Topsham, 
WARREN of Hallowell.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA c. 167 is enacted to read:
CHAPTER 167
MAINE SINGLE-PAYER HEALTH CARE PROGRAM
§2041.  Establishment
The Maine Single-payer Health Care Program, referred to in this chapter as "the 
program," is established to provide for the health care of residents of this State. The 
program must be designed in accordance with the requirements of this chapter and may 
not be implemented before January 2022 as provided in this chapter.
§2042.  Design of program
1.  Design requirements.  The Department of Health and Human Services, in 
consultation with the Department of Labor and the Department of Professional and 
Financial Regulation, Bureau of Insurance, shall design the program to provide coverage 
for health care services from participating providers within the State if those services are 
necessary or appropriate for the prevention, diagnosis or treatment of, or maintenance or 
rehabilitation following, injury, disability or disease. At a minimum, the program must 
provide:
A.  Coverage for the following health care services:
(1)  Hospital services;
(2)  Medical and other professional services furnished by participating providers;
(3)  Laboratory tests and imaging procedures;
(4)  Home health care for residents of the State requiring services performed by 
or under the supervision of professional or technical personnel, including, but not 
limited to, home health care for acute illness, personal care attendant services and 
the medical component of home health care for chronic illness;
(5)  Rehabilitative services for residents of the State receiving therapeutic care;
(6)  Prescription drugs and devices;
(7)  Mental health services;
(8)  Substance use disorder treatment;
(9)  Primary and acute dental services;
(10)  Vision appliances, including lenses, frames and contact lenses;
(11)  Medical supplies, durable medical equipment and selected assistive devices; 
and
(12)  Hospice care;
B.  Delivery of covered health services through organized delivery systems;
C.  Payment for covered health care services provided to a resident while the resident 
is in the State or out of the State.  The program must pay for a reasonable amount 
charged for medically necessary emergency health care services; and
D.  Fair rates of compensation with participating providers and organized delivery 
systems and negotiation with pharmaceutical companies for similarly classified 
pharmaceuticals.
§2043.  Implementation
1.  Implementation.  Upon enactment of authorizing legislation establishing 
financing for the program, the State shall implement the program in phases as required in 
subsections 2 to 4.
2.  Phase one.  Beginning in January 2022, the State shall provide coverage through 
the program for a resident of the State who is not eligible for coverage under the 
MaineCare program and who has an income that is below 250% of the federal poverty 
level.
3.  Phase 2.  No later than January 2024, the State shall provide coverage through the 
program for a resident of the State who has an income between 250% and 400% of the 
federal poverty level.
4.  Phase 3.  No later than January 2026, the State shall provide coverage through the 
program for a resident of the State who has an income above 400% of the federal poverty 
level.
5.  Waiver; request for federal approval.  The Department of Health and Human 
Services and any other affected department or agency of the State shall apply for all 
waivers, exemptions and approvals from the Federal Government that are necessary to 
fully implement the program.
For the purposes of this section, "federal poverty level" means that measure defined 
by the federal Department of Health and Human Services and updated annually in the 
Federal Register under authority of 42 United States Code, Section 9902(2).
Sec. 2.  Single-payer Implementation Task Force.  The Single-payer 
Implementation Task Force, referred to in this section as "the task force," is established to 
oversee planning and implementation of the Maine Single-payer Health Care Program, 
established in the Maine Revised Statutes, Title 5, chapter 167, as follows.
1. Appointments; composition.  The task force consists of members appointed as 
follows:
A.  Four members of the Senate, appointed by the President of the Senate, including 2 
members of the party holding the largest number of seats in the Senate and 2 
members of the party holding the 2nd largest number of seats in the Senate, of whom 
at least one member is a member of the Joint Standing Committee on Health 
Coverage, Insurance and Financial Services, at least one member is a member of the 
Joint Standing Committee on Health and Human Services and at least one member is 
a member of the Joint Standing Committee on Labor and Housing or the Joint 
Standing Committee on Taxation; and
B.  Five members of the House of Representatives, appointed by the Speaker of the 
House of Representatives, including 2 members of the party holding the largest 
number of seats in the House of Representatives and 2 members of the party holding 
the 2nd largest number of seats in the House of Representatives, of whom at least one 
member is a member of the Joint Standing Committee on Health Coverage, Insurance 
and Financial Services, at least one member is a member of the Joint Standing 
Committee on Health and Human Services and at least one member is a member of 
the Joint Standing Committee on Labor and Housing or the Joint Standing Committee 
on Taxation.
2.  Consultants.  The chairs of the task force may appoint the following persons as 
consultants to the task force:
A.  One person representing the interests of hospitals;
B.  Two persons representing the interests of health care providers, including one 
person from an organization representing physicians and one person from an 
organization representing nurses;
C.  Two persons representing the interests of health care consumers;
D.  One person representing the interests of employers with fewer than 50 employees; 
and
E.  One person representing the interests of employers with 50 or more employees.
3. Chairs.  The first-named Senator is the Senate chair of the task force, and the first-
named member of the House of Representatives is the House chair of the task force.  The 
chairs may invite individuals with expertise in health care policy, health care financing or 
health care delivery to assist the task force.
4. Appointments; convening.  All appointments must be made no later than 30 days 
following the effective date of this Act.  The appointing authorities shall notify the 
Executive Director of the Legislative Council once all appointments have been made.  
When the appointment of all members has been completed, the chairs of the task force 
shall call and convene the first meeting of the task force.  If 30 days or more after the 
effective date of this Act a majority of but not all appointments have been made, the 
chairs may request authority and the Legislative Council may grant authority for the task 
force to meet and conduct its business.
5. Recommendations.  The task force shall submit recommended legislation by 
January 15, 2021 to the First Regular Session of the 130th Legislature to fully implement 
the Maine Single-payer Health Care Program.  The task force shall include in its 
recommended legislation provisions to:
A.  Transfer responsibility for administering the MaineCare program and the 
children's health insurance program established in the Maine Revised Statutes, Title 
22, section 3174-T from the Department of Health and Human Services to the Maine 
Single-payer Health Care Program;
B.  Transfer responsibility for administering any other state or federal health care 
program to the Maine Single-payer Health Care Program;
C.  Apply for all waivers, exemptions and approvals from State Government and the 
Federal Government that are necessary to transfer health care funding from the 
Federal Government and from any state departments and agencies to the Maine 
Single-payer Health Care Program;
D.  Transfer to the Maine Single-payer Health Care Program all state and federal 
funds associated with programs for which the Maine Single-payer Health Care 
Program will assume responsibility;
E.  Enable the Maine Single-payer Health Care Program to receive the appropriate 
federal fund contribution in lieu of the federal premium tax credits, cost-sharing 
subsidies and small business tax credits provided in the federal Patient Protection and 
Affordable Care Act or its successor acts;
F.  Ensure that the State's expenditures for health care services, including the State's 
responsibility for providing matching funds for the MaineCare program and other 
federally supported health care programs, do not fall below the expenditure levels for 
health care services in the year preceding the effective date of this Act;
G.  Effectuate a smooth and efficient transfer of the programs and responsibilities and 
enable affected departments and agencies to assist the Maine Single-payer Health 
Care Program in the assumption of its duties; and
H.  Establish an ongoing revenue stream to adequately fund the Maine Single-payer 
Health Care Program.
6. Oversight of planning.  At every meeting of the task force, the Commissioner of 
Health and Human Services, the Commissioner of Labor and the Superintendent of 
Insurance or their designees shall brief the task force on planning issues, progress, 
challenges and the timeline for implementation.
7. Compensation.  The legislative members of the task force are entitled to receive 
the legislative per diem, as defined in the Maine Revised Statutes, Title 3, section 2, and 
reimbursement for travel and other necessary expenses related to their attendance at 
authorized meetings of the task force. Those persons appointed as consultants not 
otherwise compensated by their employers or other entities that they represent are entitled 
to receive reimbursement of necessary expenses and, upon a demonstration of financial 
hardship, a per diem equal to the legislative per diem for their attendance at authorized 
meetings of the task force.
8. Quorum.  A quorum is a majority of the members of the task force.
9. Staffing.  The Legislative Council shall provide staff support for the task force. To 
the extent needed when the Legislature is in session, the Legislative Council may contract 
for such staff support if sufficient funding is available.
10. Experts; additional staff assistance.  The task force may solicit the services of 
one or more outside experts to assist the task force to the extent resources are available. 
Upon request, the Department of Health and Human Services, the Department of 
Professional and Financial Regulation, Bureau of Insurance and the Department of Labor 
shall provide any additional staffing assistance to the task force to ensure the task force 
has the information necessary to make the recommendations required by subsection 5.
Sec. 3.  Contingent effective date.  The Maine Revised Statutes, Title 5, section 
2043, subsections 2, 3 and 4 take effect only upon the enactment into law of legislation 
providing financing for the Maine Single-payer Health Care Program established in Title 
5, chapter 167.
SUMMARY
This bill establishes a single-payer health care program in the State that provides 
health care services for Maine residents. The bill directs the Department of Health and 
Human Services to consult with the Department of Labor and the Department of 
Professional and Financial Regulation, Bureau of Insurance to develop the program.  The 
bill requires the State to implement the program in 3 phases, based on income, beginning 
in 2022 for those residents not eligible for the MaineCare program. The bill also creates 
the Single-payer Implementation Task Force to advise the departments and make 
recommendations to fully implement the single-payer health care program. The program 
may not be implemented in 2022 without prior legislative approval.