Health care without MaineCare won’t work

Posted April 10, 2009, at 11:08 p.m.

As a nurse practitioner in Washington County, I see firsthand how vital MaineCare is to our communities, our economy and our families. As Maine faces the uncertainties of the global economic downturn, surely we can all agree that maintaining the health and well-being of our work force of today and tomorrow must remain a top priority. MaineCare, the state’s Medicaid program, is a fundamental component of achieving that goal.

The state has seen its unemployment rise to 8.8 percent, up from 5.6 a year ago in January. Some towns are being hit harder than others. For example, Millinocket’s unemployment rate has reached 15.6 percent and Washington County was at 13.3 percent as of January.

Suggesting that people just get jobs with insurance benefits is like telling a baseball team that all they need to do is hit the ball more. They’re trying. This state is losing its industrial paper base and replacing it with lower-paying jobs that have fewer benefits, and oftentimes no health insurance.

MaineCare offers us the ability to maintain a healthy work force. As taxpayers we will pay for this either as MaineCare or as uncompensated, expensive health care — bad debt and charity care in hospital emergency rooms instead of preventive care with a primary care provider. MaineCare is a major building block of Maine’s health care system. Funded with federal and state resources, it provides critical and necessary health care services to the elderly, people with disabilities, low-income families and adults. Without MaineCare, Maine’s health system could not function. It is our safety net, if we poke any more holes in the net, people will begin to fall through.

During the past four years, Maine has done a good job managing MaineCare’s costs — keeping them far below the national average. Compared with other New England states, Maine spends the least per enrollee ($7,568 versus an average of $10,009 in the other states), despite the fact that our state has a higher number of elderly and disabled people, whose care tends to be the most costly. Maine has also kept administrative costs for this program remarkably low (4.1 percent in fiscal year 2007) — significantly lower than the administrative costs of even private for-profit health insurers.

Too often, ideological opponents of MaineCare bend numbers to tell a story that simply is not true. They use data that are inaccurate or they drop important information that would help readers understand what the numbers are saying. And they make comparisons between Maine and other states that are not legitimate. Instead of comparing apples to apples, they’re comparing apples to antelopes.

The truth is that after meeting its obligations to provide the services that all Medicaid programs must, by federal law, known as mandatory services, MaineCare costs remain far below the national average of Medicaid programs.

What opponents to MaineCare don’t tell you is that their plan to achieve savings requires eliminating a broad range of health services that include optometry, psychologists, physical therapy, dental care, hearing disorders, respiratory care and primary case management, to name just a few.

Maine should be proud of the fact that it is above the national average in terms of the number of residents who have insurance; and MaineCare is an essential piece of the puzzle, providing medical coverage for 300,000 Maine people. In Washington County, one in three residents receives essential health care services thanks to MaineCare.

We can all agree that public dollars must be used in a responsible and efficient way. With approval of the Legislature, the state Department of Health and Human Services has made significant changes to MaineCare in order to continue its recent success in managing growth and containing costs. These include adjustments to the hospital reimbursement system, service utilization review for behavioral health services, care management for high-cost members with complex and-or chronic medical conditions and the implementation of measures to reduce excess use of out-of-state hospitals. From fiscal years 2004 to 2007, Medicaid grew at the rate of 13.4 percent nationwide, while in Maine, growth was 7.4 percent. From fiscal years 2006 to 2009, Maine’s growth dipped even more, to 5.2 percent.

Containing costs requires a measured approach, built on a careful understanding of how MaineCare fits into the structure of affordable quality health care. The health care system upon which every Mainer relies is at stake.

Anne Perry, D-Calais, represents District 31 in the Maine House. She is House chair of the Health and Human Services Committee.

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