Maine Public Health Association

MPHA Mission The Maine Public Health Association is dedicated to improving and sustaining the health and well-being of all Maine residents by advocating for polices and environments that promote public health and health equity. Our diverse membership has a common interest in protecting and advancing the health of residents through advocacy, education, research and service. MPHA is the Voice of Public Health in Maine

Maine Challenges 75% of healthcare costs are the result of chronic disease. Tobacco and Obesity are the leading causes of preventable death and disease in Maine. Tobacco related illness and associated lost productivity cost Maine $1.1 billion annually. Maine is the most obese state in New England with 65% of us obesity/overweight.

Maine Challenges Maine spends approximately $8 billion on healthcare costs each year. The Fund for a Healthy Maine, Maine’s only source of State funds for prevention, accounts for only.6% of Maine’s total health care expenditure.

Fund for a Healthy Maine: Creating Opportunity for Greater Health and Lowering Costs for Everyone

The Challenge Maine’s Current Health Cost Investment Structure*Investing in Prevention Reduces Overall Health Costs Greater investment in preventive medicine and education helps to dramatically reduce chronic disease, thus decreasing long-term treatment costs to Maine and its residents. *Charts represent the total funding to each health-related function. Prevention Pre- Disease Treatment Care for Disease Prevention Pre-Disease Treatment Care for Disease

Overview of the FHM The Fund for a Healthy Maine (FHM) was created by the Maine Legislature in 1999 to receive and disburse Maine’s annual tobacco settlement payments. Maine participated in the national tobacco settlement because many Maine people have suffered disease and death as a result of tobacco use encouraged by the deceptive practices of the tobacco industry. The Fund for a Healthy Maine is not taxpayer dollars. Because of its special source, the FHM has a special purpose – to prevent disease and promote good health among Maine children and adults. The FHM is meant to “supplement, not supplant” existing dollars!

Overview of FHM (cont.) FHM revenue is not part of Maine’s General Fund account. It originates in the FHM account and only ends up in the General Fund if lawmakers divert it there. FHM program allocations are made directly from the FHM account and do not pass through the General Fund. By statute, allocations from the FHM must be used to supplement, not supplant, appropriations from the General Fund. It was intended that the FHM be used for new and expanded programs. The FHM was not intended to be used to balance the state budget or spent on non-health- related programs.

90% Program Spending 10% FHM Trust Fund -Child Care -Oral Health - School Health Program -Tobacco Prevention, Treatment & Control -Home Visitation -Substance Abuse Prevention & Treatment -Prescription Drugs for the Elderly The Vision: New and Expanded Health Programs Allocation Since Inception: The Vision

Overview of FHM (cont.) Unfortunately, these provisions have been ignored in the past and the FHM has lost 27% of its resources ($219.8 million) to the General Fund – a significant missed investment in getting and keeping Maine people healthy.Unfortunately, these provisions have been ignored in the past and the FHM has lost 27% of its resources ($219.8 million) to the General Fund – a significant missed investment in getting and keeping Maine people healthy.

27% Diverted to General Fund and Sick Care -Child Care -Oral Health -Home Visitation -Prescription Drugs -Tobacco Prevention and Treatment -Substance Abuse Prevention & Treatment -School Health Program The Reality: $219.8 million diverted or approved for diversion through FY 13 73% Prevention Spending (allocated or reserved) Allocation Since Inception: The Reality

Overview of FHM (cont.) The Maine Legislature decides how FHM dollars are allocated within the eight FHM categories. FHM allocations and diversions are currently decided as part of the state’s overall budget process. In FY 13 the Legislature eliminated prevention programs in order support the MaineCare program – supplanting general fund dollars with FHM funds.

Purpose of the FHM FHM funds should not replace General Fund allocations to MaineCare. WHY? BY LAW: FHM funds must be used to “supplement, not supplant” General Fund spending. FUNDING PROVIDED: FHM monies already go to fund healthcare initiatives for children and parents. ORIGINAL INTENT: Founders believed the FHM should be used primarily to prevent disease, improve health status, and reduce future health costs. FISCAL RESPONSIBILITY: 75% of healthcare costs are the result of chronic disease, and most chronic disease is preventable. PREVENT The best way to get health care costs under control is to PREVENT chronic disease, not pay for it after the fact.

FHM Impact-Once in a Lifetime Opportunity The success of FHM programs will directly affect Maine’s ability to stabilize health costs and their impact on Maine businesses, individuals, and the state budget. The success of FHM programs will directly affect Maine’s ability to stabilize health costs and their impact on Maine businesses, individuals, and the state budget.

Purpose of the FHM Preventing chronic disease Improving health status Reducing future health costs

FHM Programs: Budget Allocations by Major Category in FY 2013 Total Allocations: $54,315,709 * Smoking Cessation and Prevention Category includes funding for Vaccines and non-tobacco related HMP work. Total actual Tobacco funding is $7.5M in FY 13. *

FHM Programs: Overview The Legislature established eight categories of allowable health program spending: o Smoking prevention, cessation and control activities, including, but not limited to, reducing smoking among the children of the State; o Prenatal and young children's care, including home visits and support for parents of children from birth to 6 years of age; o Child care for children up to 15 years of age, including after-school care; o Healthcare for children and adults, maximizing to the extent possible federal matching funds; o Prescription drugs for adults who are elderly or disabled, maximizing to the extent possible federal matching funds; o Dental and oral health care to low-income persons who lack adequate dental coverage; o Substance abuse prevention and treatment; and o Comprehensive school health programs, including school-based health centers.

FHM Programs: Tobacco High school smoking declined by 61% between 1997 and Maine’s Tobacco HelpLine has served over 75,000 Maine residents since its inception in The Healthy Maine Partnerships (HMPs) are engaged in over 800 health initiatives across the state to change local attitudes about tobacco use, and increase physical activity and healthy eating. The HMPs have enlisted 2,300 volunteer coalition members throughout Maine.

Opportunities Every $1 taken from FHM prevention programs will add at least $7.50 to Maine’s future health costs. Savings estimates go higher, but one thing is clear: the FHM is an investment in our future health and financial well-being. Every $1 taken from the FHM today will be $1 that is not available to fund prevention programs for our most at-risk citizens that improve oral health, reduce substance abuse, enhance physical activity opportunities, provide child care and home visits to new parents, support family planning, and prevent tobacco use among Maine children. Every one of these efforts will significantly reduce Maine’s health care costs. The FHM is a nationally recognized success story. Maine’s use of tobacco settlement dollars and specifically Maine’s tobacco prevention and treatment program continue to draw both national and international recognition for their comprehensive approaches to preventing costly health care.

Opportunities Maine has made tremendous progress in reducing tobacco use, but significant challenges remain. 15.2% of Maine youth smoke, health costs from tobacco use still total over $600 million per year, and 2,200 people still die every year from smoking. Tobacco companies are anxious for Maine to ease up. Despite being a small state, Maine has made life difficult for the tobacco companies and their allies. They want Maine to make the same mistakes as Massachusetts and Florida, where youth smoking rates skyrocketed when tobacco programs were reduced. Tobacco companies oppose cigarette price increases and want you to believe that “we’re all done” when it comes to keeping kids from smoking. Yet they are far from done in promoting their deadly products - spending $59 million every year in Maine to find the “replacement smokers” their internal documents describe.

Opportunities Protecting the Fund for a Healthy Maine is Maine’s best hope for getting health care costs under control. Support of the Fund for a Healthy Maine means supporting reduction in health care costs, preventing chronic disease and helping Maine people get healthy!

MPHA Needs You MPHA has 3 Policy Committees open to all members: Tobacco Obesity Broad Public Health We coordinate the Friends of the Fund for a Healthy Maine. We need you to be our ears to the ground in your community. We need you to become a member of MPHA.