2020: Winter The Maine Chance

Needles.

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Lambrew in downtown Augusta, Maine’s capital city.

She was thoroughly scared of needles. It had been like that since Jeanne Lambrew ’89 was a little girl and her mother, Patricia Lambrew, R.N., brought home old, sick and suffering neighbors who couldn’t get to a doctor’s office or had no insurance, then gave them their insulin or other shots, gratis. No child likes needles, but most only see them on trips to the pediatrician. For Jeanne, it was different. Maybe it was her sensitive temperament: she calls herself inherently shy. Or maybe it was the scope of her mother’s outreach.

In any case, her dread was imprinted for good.

So much so, it rechanneled her life—and, in one of those idiosyncrasies of fate, did the same for many, many others. Lambrew grew up in a Tudor house in the wooded part of Cape Elizabeth, Maine, near where Winslow Homer had painted waves crashing on the rocks. She spent childhood summers sailing in Casco Bay and is a Mainer to her bones, but she’s technically “from away,” as they say up there, having moved to Maine from Oceanview, N.Y., at age 9. The relocation was meant to grant Jeanne and her two sisters a better quality of life. It also came about because Jeanne’s father, cardiologist Costas Lambrew, had been recruited by Maine Medical Center in nearby Portland.

Healing ran in the family. Apart from her nurse-and-doctor parents, who met on shift at a Manhattan hospital, there were two aunts who were nurses, plus a dentist uncle. Lambrew listened to their stories, and found herself pulled toward the mission of caregiving. But as she tried to clarify her calling, first at Cape Elizabeth High School and then at Amherst, it was clear that nursing and med school were out. “It was not going to be an option for me, because of my fear of needles and blood,” she told me one summer day as we drove through central Maine. Then she half-joked: “I blame my mom.”

Still, in a family like hers, Lambrew had learned there were other ways to look at health care. Her uncle, the dentist, was employed by the New York City public health department and, day in, day out, watched how the infrastructure of urban health worked or didn’t. Meanwhile, her father traveled all over rural Maine for several years, developing regional emergency medical systems and teaching as he went, noting how health care played out from Saco to Caribou.

No one in the executive or legislative branch knew as much as she did.”

“We talked about health all the time in my family,” she recalls. “But the top conversation was not about patients—it was about policy. So, from my earliest days, I remember my parents and aunts and uncle fighting over our health policies. We’d talk about the challenges of intergenerational poverty. How do you teach people to care for themselves? Is it their fault if they don’t, or is it the medical professional’s fault, or the school system’s fault? It was a very argumentative family around the holidays.”

She pauses, then goes on. “But the arguments were all about this: How do we care for each other?”

Wisconsin, North Carolina, Michigan, Virginia, Maine. Each state currently has a commissioner of health and human services who previously had been part of the Obama administration’s massive effort to pass the Affordable Care Act. In January 2019, Lambrew became commissioner of Maine’s DHHS. She now oversees 3,000 employees who serve one-third of the state’s population.

It is an incredible coup for the state, to lure someone with Lambrew’s public health bona fides to come home from Washington, where she spent four years in high-level positions at the U.S. Department of Health and Human Services and 10 with the White House, split between the Clinton and Obama administrations. Under Obama, she was director of the Office of Health Reform. “Jeanne was integral to Obama’s health care reform from the start,” says Ezekiel Emanuel ’79, an architect of the ACA and now chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. “Jeanne was the master of the fine details of the legislation. No one in the executive or legislative branch knew as much as she did. And she was a force in pushing her perspective into the reform.”

Lambrew is on the A-list in D.C., but she exerted her influence behind the scenes and was little known outside the Beltway; the Maine commissioner job is by far the most public-facing post she’s ever held. Christine (Sgarlata) Chung ’89, one of Lambrew’s Amherst friends, gave me some context: “In D.C., where everything and everyone is political, and everyone is chasing personal glory, Jeanne was singular and different. She quietly went about the work of improving the health of our nation.”

There’s visual proof in Lambrew’s Augusta office, which has a lofty view of the state capitol’s copper dome. I saw photos and documents inscribed with thanks for her role in 1997’s Children’s Health Insurance Program. (“We couldn’t have done it without you,” wrote the late Sen. Edward Kennedy, Democrat of Massachusetts.) One wall holds framed collages, which she pieced together, of newspaper headlines and cartoons about Obamacare’s legislative peaks and valleys. But what really stopped me was the ACA Senate roll-call list. Two long columns of yeas and nays, set in a solemn black typeface. It enshrines the breakthrough that so many presidents, arguably from FDR on, had tried and failed to accomplish.

She needed bipartisan support. Would D.C. Republicans sway Maine Republicans?

Then-Sen. Christopher Dodd (D-Conn.) dedicated the roll call to Lambrew. “His committee staff gave it to me, since the job of the administration’s Office of Health Reform was to forge consensus on the details across five committees, two Senate and three House,” she says. “This is why he wrote what he wrote: ‘To Jeanne Lambrew: You kept us all together.’” On the evening the ACA passed, Lambrew had gone home to sleep when her phone rang. It was Obama himself. He wanted her to come back to the White House and celebrate with the others, because she had done so much to make the night a reality.

Lambrew’s CV is 18 pages long. As Obama once told PBS’s Jim Lehrer: “Jeanne Lambrew has a depth and range of experience on health care that few can match.” An early step took place in her Amherst days. In 1988, after her junior year, she landed an internship with the Maine State Health Policy Advisory Council, where she helped produce a report on the state’s nursing shortage—a cause she has taken up anew as commissioner. When George Mitchell, the Maine Democrat who served as Senate majority leader from 1989 to 1995, cited the report at a field hearing of the Senate Committee on Finance, Lambrew’s professional destiny was resolved. As she puts it, “I got hooked.”

After getting a doctorate in public health from the University of North Carolina at Chapel Hill, where she published various studies on rural health issues, she taught at the University of Texas at Austin (where she gained tenure), Georgetown and George Washington University. She also did several think tank stints and advised senators and members of Congress on health policy legislation.

In 2018, Lambrew caught the eye of Maine Gov. Janet Mills, a Democrat, who beat the Republican incumbent Paul LePage. He’d left so many positions at the DHHS unfilled that its workforce had declined 25 percent since 2011. In his last days in office, LePage told the press he’d rather go to jail than implement the Obamacare expansion approved by Maine voters in a ballot referendum; he argued it would bankrupt the state.

In reaction, Mills has prioritized extending MaineCare (the state’s version of Medicaid), as well as strengthening the Maine Center for Disease Control and Prevention and combatting the state’s opioid crisis. It was crucial that Lambrew—Mills’ first hire—knew how to come at these issues creatively and to finesse federal funding to help achieve the governor’s goals without hurting the state budget, plus save money in the long run by focusing on preventative care.

Lambrew was candid with Mills. The DHHS has a daunting portfolio, and some areas—health insurance, prescription drug prices—were in Lambrew’s wheelhouse. But others, such as foster care and housing, were not. Plus, she needed bipartisan support to be confirmed, and she worried Maine Republicans would be swayed by attacks from D.C. Republicans, especially concerning the 2013 ACA enrollment rollout, when the healthcare.gov computer system crashed and it looked like someone would have to take the fall. In The Atlantic, Lambrew was on the list of, as the headline said, “Five People Obama Could Fire Over Obamacare.” She survived, but faced condemnations in the conservative press.

During her confirmation hearings in Maine, she gave detailed policy answers on a spectrum of topics. At one point, a representative asked a lengthy question and joked, “I’m just being a nerd.” Lambrew smiled and said, “I can nerd back.” She was confirmed unanimously.

Since then, she has won support from both sides of the aisle. State Sen. Marianne Moore, a Republican of Washington, Maine, serves on the legislature’s committee on health and human services. “It has been a pleasure working with the commissioner,” she told me. “She’s very knowledgeable and very responsive to the inquiries we make and the concerns we have. I totally feel she is nonpartisan in everything she does. Her main concern is to take care of the citizens of Maine, and she has hit the ground running to get the department in the shape it really needs to be in.”

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Lambrew (center) served on a 2018 panel in Cambridge, England, discussing prescription drug affordability. In Maine, a green light has now been given to tackle prescription drug costs, including starting a program to import safe and low-cost medication from Canada. | Chris Williamson/Getty images

I struggle with some cognitive dissonance as we head out the door. Lambrew has worked closely with so many national luminaries, but here she is folding herself into my rental car so I can drive us up to Bangor and she can grab a hummus-and-pretzel lunch at a convenience store. A few members of her staff will meet her there for visits to the city’s DHHS regional office, to a local innovative housing agency and to the Bangor Area Recovery Network, which works with those trying to recover from addiction to opiates and other drugs.

We’re using the hour-plus ride for some Q&A. Lambrew is friendly and gracious, but admits that being interviewed makes her feel like a turtle who longs to retreat into its shell: “I have always struggled with the limelight, except when I know it advances my work.” She’s adamant about communicating the department’s goals and challenges, and so she’s made her peace with my presence.

I start by asking her about Amherst. Lambrew says she wanted a liberal arts education and fell for the serene campus and countryside. She got in early, earned the worst grades of her life her first year and finds it ironic that, given her profession, she didn’t take a single political science class. She majored in English and especially loved reading Ralph Waldo Emerson in an American lit class. She enjoyed philosophy, fine arts and French courses and lived in the French House one semester. There was also a semester at McGill University in Montreal, where she worked on her French and took a course in medical history, which heightened her interest in health policy.

At Amherst, Lambrew loved to go on long runs (still a habit) and rowed for the women’s crew team. Sometimes she even ran to practice at the boathouse, rather than taking the crew bus. Randa Brandt ’89, Lambrew’s friend and crewmate, told me that in an eight-woman scull, the 7 and 8 seats are vital for setting a steady stroke for everyone to follow: “Jeanne was usually 7. She could keep a regular rowing rhythm, even during the pressure of a race or when exhausted from a long row.” As a metaphor for her career, you couldn’t do better.

Lambrew’s Amherst experience wasn’t all charmed: she was dismayed by the lingering sexism of the early coed years, found the party scene off-putting and was frustrated by the College’s lack of public health career infrastructure. “There was a pretty well-trodden path from Amherst to three tracks: Wall Street, law school or medical school,” she says. “And when I was interested in something else, I didn’t find a lot of help.” (The College has since bolstered its offerings with, among other initiatives, a public health alumni-in-residence program and the Five College Program in Culture, Health and Science. “There has been a major increase in interest in public health among Amherst students over the past decade,” says Richard Aronson ’69, health professions adviser and assistant dean of students.)

Lambrew once toyed with a career in journalism. She interned at Portland Monthly the summer before her sophomore year and consulted English professor Barry O’Connell about becoming a writer. Their conversation has stuck with her: “He said, ‘What do you want to write about?,’ but I didn’t have a good answer. He said, ‘Well, you go figure out what you want to write about before you decide you want to be a writer.’ Which I did. I started jumping into learning substantially about health care.” She has now edited, co-authored or contributed to five books, and published scores of articles on public health. She also wrote most of the White House website’s blogs about the Affordable Care Act.

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As president-elect, Barack Obama appointed Lambrew to the
new White House Office of Health Reform. “Jeanne Lambrew
has a depth and range of experience on health care that few
can match,” he once said.

Minutes after she told me this, she took a phone call about the several hundred asylum seekers, mostly from Congo and Angola, then being housed at the Portland Expo Building. Chicken pox cases had been reported, and she was coordinating with the Maine Center for Disease Control. Surprisingly, when she hung up, she tied that conversation back to ours about Amherst: “I learned from the faculty how words work, what they mean, how they can be strung together, and that remains incredibly important to me in my daily life. At the DHHS, we take communication very seriously. At the Portland arena, we had to communicate who was exposed, why there shouldn’t be panic, what people should do to make sure that they stay safe. Communication can be an actual intervention to keep people healthy.”

I ask her for a list of achievements of the Maine DHHS during her rookie year on the job. Key ACA protections for people with pre-existing conditions were codified into state law, she begins. A green light was given to tackle prescription drug costs, including starting a program to import safe and low-cost prescriptions from Canada. Philosophical and religious exemptions were eliminated from children’s vaccination requirements. State funding for abortion services was secured. Conversion therapy for LGBT people was banned, and gender-confirmation services are no longer excluded from Medicaid coverage. Initiatives have begun to explore long-term support for an aging population: Maine residents are, on average, the oldest of any state in the nation. And the DHHS has filled hundreds of positions left empty in the previous administration.

As we get closer to our destination, I fling her my last few questions.

Best job she ever had? “The best job has to be the one that makes the biggest difference. Right? So that would be my role in both HHS and the Obama White House, because every single day, we were making a difference. Although this current job as commissioner is rivaling it. Not in numeric scope—but because there’s so much meaningful work.”

Relationship status? “People assume you need to have a spouse or children to be fulfilled. I’ll just say I’ve been quite fulfilled without that.”

Books on her nightstand? Sarah Blake’s The Guest Book, about a family who summers in Maine, and Paul Doiron’s Maine game-warden mystery Trespasser.

Does she miss Washington? “To me, Washington was less of a place than an opportunity to act.”

Does she talk to fellow ACA veteran commissioners in other states? “Yes, we all work together very closely. Whenever things go badly, we all pick up the phone and call each other. It’s like a ‘commissioner support group.’ You know, in academia, you’re taught to be creative and innovative and unique and of course never plagiarize.
But in public policy, you should get the best practices, and you should plagiarize!”

What kinds of reactions is she getting around Maine? “What I love about Mainers is they’re direct. They’re giving me their list of complaints. They’re not tiptoeing around the concerns they have. They’re being respectful, but forthright, about the problems—and their skepticism that things can change quickly.”

Then we arrive in Bangor.

I’ve never met another commissioner,” says a child welfare specialist to Lambrew. “There is more forward momentum and transparency coming in this new administration than we have ever seen.” We’re touring Bangor’s DHHS headquarters, where the cubicles of some 220 employees are decorated with everything from Red Sox swag to job titles (incident data specialist, water inspector, casework supervisor). All day, Lambrew will hear this refrain about never having met a commissioner. As on her other listening tours (Bangor is one of 18 regional offices she visited in 2019), her mere presence is making an impact.

More employees file into a big, bland conference room. The questions, seemingly pent up for years, shoot forth. Lambrew is asked about Child Protective Services caseload volume, restoring a discontinued stipend for foster parents, reducing the call wait time (sometimes three hours!) to sign up for MaineCare. For that last one, Lambrew touts a deactivated credit-card call center in Wilton that has been revived as a MaineCare call center.

Why is it so hard to find qualified DHHS hires? “We can’t wait for a global solution,” says Lambrew. “But we are trying to tap into talent resources at the University of Maine to train this workforce.”

Someone laments the shortage of visiting nurses, and I think about Lambrew’s mother, needles at the ready. “If you could change one thing about hiring them, what would it be?” Lambrew asks the questioner. “Salary,” is the comeback. “It’s impossible to compete with regular nurse salaries.” Lambrew talks about pursuing other funding sources, and she mentions the new DHHS radio ads that try to recruit nurses to underserved areas. The questioner suggests that, if salary bumps are unrealistic, the state could offer to pay off the student loans of visiting nurses. Lambrew scribbles this down. Finally, an aide steps in to bring down the curtain. “Thank you all for what you do,” Lambrew tells the crowd, and there’s a round of applause.

At the Bangor Housing Authority meeting, the picture of health zooms out to include factors such as housing and transportation. On our car ride earlier, as we passed the exit for Etna, Lambrew had explained how a drafty home impacts your health—if you even have a home at all—and how you can’t stay healthy if you can’t get a ride to a doctor. Transportation challenges are a crushing issue in Maine, New England’s largest state by area and the most rural state in the country, with 61 percent of its population living in rural areas. It’s also New England’s poorest state, with abysmal public transportation options. “You can’t get there from here,” as the old Maine deadpan goes.

When Lambrew meets with the housing authority managers, she spells out how the DHHS has a federal grant to explore options for moving resources from Medicaid to support housing. As for transportation initiatives, she mentioned programs in Vermont and New Hampshire that give donated cars to local families who can’t afford to fix or buy their own.

She mentions a new position that will focus on, among other concerns, drug- exposed infants.

This long, information-dense day winds down at the Bangor Area Recovery Network (BARN), a boxy white building ornamented with a rising phoenix. Inside, there’s a kitchen where those in recovery are trained for restaurant jobs, and meeting rooms with whiteboards marked with inspirational phrases: “Loving Coercion,”  “Authentic Miracles.” The opioid crisis has hammered Maine so completely that mainstream organizations—local banks, the Chamber of Commerce—have dropped any stigma by association and openly given awards and money to BARN; you can see their plaques on the wall.

As Lambrew and her team meet with a dozen or so directors and clinicians, a small hive of volunteers work in the background. These are “affected others”: they have loved ones who are in or out of recovery, or who didn’t survive their disease.

“I want to hear what you all are proud of, what more can we do to help you and what are the gaps,” says Lambrew. One person says recovery centers are needed up in Lincoln, Dover and Millinocket. “On it, is all I can say,” responds Lambrew sympathetically, one of many “on its” she telegraphs today.

There are questions about training social workers specifically on substance abuse issues, calls for resources to identify underlying trauma and psychosis that addiction has obscured, requests for better data (“What we usually get is a crap-shoot, and I’m being polite,” says one person). Someone is frustrated that car dealerships, for insurance reasons, can’t hire those in recovery if they have an OUI violation, even if they’ve been sober for decades. Lambrew says she’ll look into the guidance on that.

The conversation shifts to ways to help children of addicted parents, a growing underclass in the state. Lambrew discusses a recently reconvened group that will target preschool-age concerns and expand training for child care providers to better identify and protect children at risk of abuse. She also mentions that there’s a new post for the state—a chief pediatrician, who will focus on, among other concerns, drug-exposed infants.

Then Bruce Campbell, a clinician and BARN board member, speaks: “To have you here is just an indicator that it’s a new day.”

Lambrew thanks him and the others, goes over to quietly talk with some of the affected others, and then heads back to Augusta with her team. In the weeks to come, she’ll follow up on what she’s heard today, and keep advocating for the people of Maine. That’s her job, after all. She’s trying every way she can to move the needle.

Katharine Whittemore is Amherst magazine’s senior writer.