A nurse practitioner in one of New England’s poorest areas, Perry knows that bad health outcomes are often tied to poverty. One goal of her initiative to tackle sickness and poverty together is the creation of a statewide model.Poverty - Maine ; Medical care - Maine

Anne Perry

English

Research Papers in Economics

Communities & Banking    17
Poverty 
first person
Anne Perry
Maine State Representative, Washington County
Health  and 
Rep.  Anne Perry with Stuart Arnett (left) and Will Armitage of the Federal Reserve Bank of Boston’s 
Community Development Advisory Council at Southern Maine Community College, South Portland, 
July 2008. Photograph: Caroline Ellis
Anne  Perry,  Washington  County’s 
representative  to  the  Maine  State 
Legislature, grew up in Winterport, 
a small town on the Penobscot River 
near Bangor. She trained as a nurse 
and worked in northern New York, 
where she raised a family, served on 
school boards, and helped to organize 
health-care initiatives. 
Returning to Maine, Perry attended 
Bangor’s Husson College for her nurse 
practitioner  degree  and  decided  she 
wanted a rural practice. She searched 
the  Northeast  and  fell  in  love  with 
Washington  County,  the  “sunrise” 
county at the easternmost tip of the 
United  States.  As  the  second  person 
in a two-person practice, she was soon 
organizing residents to tackle public 
health problems. Her activism led to 
an invitation to run for the legislature, 
where she has added statewide health 
initiatives to her portfolio.18    Winter 2009
What made you choose Washington 
County in 1998?
Both  the  rural  feeling  and  the  cultur-
al diversity. We’re 6 percent minority. We 
have Native Americans on two reservations 
and Hispanics who originally were migrant 
laborers. We  have  Canada  across  the  riv-
er,  with  its  Acadian  and  British  cultures. 
There’s also the fishing industry culture and 
the wilderness culture. 
And soon you were doing  
community organizing?
Yes. In my first two years, we diagnosed four 
people with drug-related hepatitis C; three 
were symptomatic in their 20s, very unusu-
al. I asked the state people, “Do you have 
any hepatitis C statistics?” They said, “You’re 
from Washington County? Boy, have you 
got a problem!” Around the same time, the 
U.S. attorney out of Bangor told us we had 
OxyContin abuse. Concerned citizens got 
together to consider the options. 
In December 2000 four of us created 
NADA,  Neighbors  Against  Drug  Abuse, 
and  organized  a  workshop.  We  invited 
every Washington County medical provid-
er in the phone book, counseling agencies, 
state agencies, representatives from city and 
town  government  and  the  district  attor-
ney’s office, the county sheriff, the police, 
the schools. A coalition formed to bring in 
treatment  services.  We  got  drug  counsel-
ing from a federally qualified health cen-
ter and later a for-profit methadone clinic. 
Some people were unhappy with that part, 
but by the time the clinic opened, the com-
munity was ready. Then NADA applied to 
Maine’s Office of Substance Abuse for pre-
vention assistance and received an $81,000 
18-month grant. 
How does your support for  
gambling mesh with improving  
health outcomes? 
The  Native  Americans  have  been  trying 
since the early 1990s to bring in a casino 
or a racino (harness racing with slots). Peo-
ple are poor here and need some kind of the 
economic  development.  Statewide  voters 
keep saying no. Some say gambling brings 
in drug abuse. They have it backwards. All 
you have to do is be poor for a long time 
and lose all hope of making any progress, 
and you’ve got drug abuse. 
Why did you run for the  
legislature in 2002?
I  was  visible  because  of  the  drug-abuse 
fight. U.S. Senator Susan Collins asked a 
NADA member to present before the Con-
gress about rural OxyContin abuse. Anoth-
er group I was involved with talked to the 
governor,  the  Office  of  Substance  Abuse, 
and the Maine DEA to encourage the gov-
ernor to work with the Canadian premier 
on cross-border drug issues. 
One  day,  after  that  meeting,  I  was   
seeing  a  patient,  and  our  receptionist 
knocked on the door, her eyes as big as sau-
cers. “The Speaker of the House is on the 
phone!” So I’m thinking, “Uh-oh, maybe 
I missed some protocol.” I felt I was being 
sent to the principal. But the Speaker just 
said, “Would you consider running for the 
state house of representatives?”
My first response was, “I can’t. I’ve got 
to  work.” Then  I  started  thinking  about 
important issues that could be addressed on 
a state level. I said I’d think about it. I was 
in a practice with one doctor. I couldn’t take 
six months off. The doctor was great. She 
looked at the floor, she looked to the side, 
she looked at me, and she sighed. “I’ll prob-
ably vote for you and hope you lose.” 
A nurse practitioner agreed to fill in, 
with me working one day a week while we 
were  in  session.  But  after  my  reelection, 
which I won with 70 percent of the voters, 
my substitute was no longer available, and 
I felt I had to resign from the practice. Cal-
ais Regional Hospital set up a rural health 
clinic not long after, so I did get a job after 
the session.
What has been your  
legislative focus?
I was appointed to what is now called Insur-
ance and Financial Services. We worked on 
health insurance among other things. I was 
on the health-care reform committee that 
helped create the Dirigo health-care legisla-
tion to reduce the number of uninsured. I 
also was appointed to Health and Human 
Services.  The  biggest  concern  was  what 
medical costs were doing to businesses and 
to consumer access. 
Where do things stand with 
state health insurance?
Dirigo is a three-legged stool—cost, quality, 
access. First, we have the Advisory Coun-
cil on Health Systems Development, which 
looks at all areas, but especially costs. Sec-
ond, the Maine Quality Forum gathers data 
on quality and outcomes. Third is access—
increasing  the  percentage  of  people  with 
insurance—so  the  state  negotiated  with 
an  insurance  company  to  administer  the   
Dirigo product. The idea was that insur-
ance  companies  and  hospitals  would   
subsidize the product by making donations 
equal to their savings, and savings would 
be calculated as the decrease in growth of 
health costs as a result of the Dirigo legis-
lation. The concept of these “savings offset 
payments”  came  about  because  insurance 
companies  and  third-party  administrators 
opposed paying for Dirigo with an assess-
ment on premiums.
Has the savings-offset  
concept worked?
The day it went through, the parties who 
negotiated  for  it  started  litigation  against 
it. The Dirigo process involved having the 
director of the Bureau of Insurance deter-
mine whether the savings claimed were the 
actual savings. 
The  Bureau  has  been  remarkably 
impartial and has backed up its decisions. 
But inevitably, funding Dirigo through “sav-
ings” is not a sustainable solution. The first 
year a hospital might economize and have 
good savings. But the next year’s expendi-
tures get compared to those of that first year. 
So every year the benchmark is at a different 
place and the savings are smaller. 
Dirigo has had a limited run because 
funds  that  would  have  expanded  it  were 
diverted to litigation. We’ve been fighting 
for  financing  from  Day  One.  Recently,  a 
blue  ribbon  commission  looking  for  sus-
tainable  financing  recommended,  among 
other things, new taxes on tobacco, alco-
hol, and sugar drinks, which impact health.   
But  a  new  campaign  may  get  the  taxes 
All you have to do 
is be poor for a long 
time and lose all hope 
of making any 
progress, and you’ve 
got drug abuse. Communities & Banking    19
rescinded. That  would  hurt  other  worth-
while aspects of the legislation, such as a 
program enabling reinsurance for high-risk 
individuals and a pilot project to get young, 
single adults buying insurance. 
Massachusetts now has  
mandatory health insurance.
We’re  looking  closely  at  Massachusetts. 
States know that something has to be done. 
States will push national policy. 
What  drives  our  economic  engine  is 
the  middle  class. They’re  our  consumers, 
our workers, the people who hold the econ-
omy together. And we’re losing them. Busi-
nesses offering good jobs and good benefits 
are  leaving  the  country.  There  are  many 
reasons, but we won’t get companies back 
until we abandon business-financed health 
care. Business can’t afford it. The U.S. medi-
cal system has the world’s highest cost per   
capita,  but  out  of  the  19  industrialized 
nations, it is dead last in preventable mor-
bidity and mortality. 
Describe the new mortality study.
The study came out of Harvard in spring 
2008. In the Northeast, the only statistical-
ly significant decrease in life expectancy was 
for women in Washington County.1 Wash-
ington  County  has  twice  the  unemploy-
ment of the rest of Maine and the lowest 
family income. And poverty affects health 
outcomes.  People  who  are  just  scraping 
by  struggle  to  follow  through  on  health- 
care requirements. 
Washington  County  women  have  a 
191  percent  greater  incidence  of  cervi-
cal cancer than the rest of the state and a 
234  percent  greater  incidence  than  the 
nation. What’s going on? Are women not   
getting preventive care? Do they lack access? 
I learned from one Eastern Maine Health 
Systems  needs  assessment  that  19  per-
cent of Washington County residents were   
uninsured in 2003. My patients with $5,000 
and $10,000 deductibles might as well not 
be insured. 
How are you addressing  
the mortality rates? 
First,  locally.  When  I  saw  the  report,  I 
thought,  “Somebody  ought  to  do  some-
thing.”  Then  I  realized  that  maybe  that 
somebody  is  me.  I  called  the  liaison  for 
Health and Human Services and said, “I’m 
calling  a  meeting,  and  I’d  like  the  Com-
missioner of Health and Human Services, 
the director of the Maine Center for Dis-
ease Control, the director of the minority 
health portion of the HHS, someone from 
the Department of Economic and Commu-
nity Development, and someone from the 
department of labor.” 
At the meeting, I laid out the statistics 
and said, “This is unacceptable. We need to 
work together. It’s a recession, and I’m not 
asking to throw money around. It took 20 
years to get here, and it’s going to take time 
to get out. We need a sustainable process 
and a way to address the health and socio-
economic aspects together.”
What did the state leaders say?
They were absolutely great. They commit-
ted to having a meeting with stakeholders 
in Washington County. I’m organizing the 
event with the help of Maine Healthy Part-
ner (part of our public health infrastructure) 
and  a  group  called  Washington  County: 
One Community. 
We’re one of the few counties in rural 
Maine to have experience working on initia-
tives countywide, and having collaborated 
on economic development, we’ll now tackle 
mortality rates. I believe that building sus-
tainable initiatives depends on state govern-
ment being in touch with the workers on the 
ground. We can do that. And if Washington 
County can do a focused, coordinated effort 
within available resources, the state can take 
what is learned and target similar commu-
nities. With our statewide health plan and a 
new public health infrastructure, we’re in a 
position to do this. Washington County can 
become a model for the state, and I will do 
all I can to make that happen. 
Endnote
See http://www.plosmedicine.org.
1 
We must work  
together.  We need  
a sustainable process 
and a way to address 
the health and  
socioeconomic  
aspects together.
Photograph: Caroline Ellis
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Poverty and health

http://www.bostonfed.org/commdev/c&b/2009/winter/First_Person_Anne%20Perry_Maine_rep.pdf

Poverty and health

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