BANGOR, Maine — Medicare payment rates in Maine are the second-lowest in the nation, reimbursing hospitals and physicians somewhere between 20 percent and 30 percent less, on average, than the cost of providing services.
For Rep. Mike Michaud, the opportunity to change that calculus came a little over a week ago when President Obama telephoned him to talk about his support for the Affordable Health Care for America Act, the U.S. House version of the sweeping national health reform effort in Congress. It was Friday, Nov. 13, the day before the House voted on the historic legislation.
“The president made it clear he was willing to work with me and Sen. [Olympia] Snowe on the Medicare issue as it relates to Maine,” Michaud said Monday, pointing out that Maine’s senior senator has many of the same concerns he does.
One possibility they discussed was increasing Maine’s reimbursement rate to match Boston’s, a measure that would boost hospital coffers here by more than $100 million a year, Michaud said. Another idea was to somehow dismiss Maine from its obligation to repay the federal government an annual $40 million prescription drug obligation related to the high number of low-income, elderly Mainers who qualify for both Medicare and Medicaid. A third scenario was to increase Medicaid payments to Maine’s primary care providers to come in line with Medicare rates instead of the approximately 40 percent less that Medicaid pays.
Armed with the assurance of Obama’s interest in helping to solve Maine’s Medicare and Medicaid dilemmas, Michaud overcame his several reservations about the House measure and added his vote to the Democratic majority, helping to narrowly pass the bill 220-215.
Michaud was at Penobscot Community Health Care in Bangor on Monday to accept a Profiles in Courage award from the National Association of Community Health Centers. The Rev. Robert Carlson, PCHC president, lauded Michaud’s support of national health care reform.
“He had reservations, but he voted in favor of it just to keep the conversation going so we can begin to sort through all these complex issues,” Carlson said, speaking to a small group of staff members at the Union Street health center. The national organization awarded similar recognition earlier this year to Snowe and Sen. Susan Collins for their support of Obama’s American Recovery and Reinvestment Act — two of only three Republicans to support the federal stimulus package.
The central goal of health care reform legislation in both the House and the Senate is to provide at least basic coverage to all Americans, an effort Carlson said will support the expansion of federally funded community health centers like PCHC.
The centers provide comprehensive care for enrollees in Medicaid, Medicare and private insurance policies, as well as a sliding-scale fee for people with no coverage. At its sites in Bangor, Brewer and Old Town, PCHC provides dental care, mental health services and medical care to nearly 50,000 area residents — “from psy-chiatry to podiatry and everything in between,” Carlson said.
Increasing the Medicare reimbursement rate for hospitals and doctors in private practice would not raise revenues at clinics like PCHC, said CEO Ken Schmidt.
“But I think it would be great if they could go to the Boston rate,” he said. Especially in underserved rural areas like most of Maine, he said, “it might encourage more private physicians to take care of Medicare patients and do it without losing money.”
The Senate version of the health reform bill, which will be debated on the floor next week, includes a Snowe-sponsored amendment that would lift a per-visit cap on Medicare payments to allow clinics like PCHC to be paid for the full cost of delivering their services, Schmidt said.
Assuming the Senate approves its own version of health reform legislation, it will be merged with the House version for final congressional approval and signing by the president.
Michaud has said his support for the House bill does not ensure he will vote for the final version.