May 25, 2018
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Fact versus fiction on fixing MaineCare

By Deborah Sanderson, Special to the BDN

In a recent BDN OpEd, state Rep. Mark Eves proposes to solve MaineCare’s financial problems by “better managing the costs of care.” I wish it were that simple.

Cost management should be a part of any welfare program. However, it will take more than that to get Maine out of a colossal fiscal mess that should have been addressed years ago. Unfortunately, the political party that ruled the state for decades refused to face the truth — MaineCare’s mushrooming growth was not sustainable. Now comes a reckoning.

This is not a matter of ideology. It is basic economics. Since 2000, MaineCare’s enrollment has grown by 78 percent while Maine’s population increased only 7 percent. Maine provides government health care for 35 percent more of its population than the national average.

If we were at the national norm, we would have 260,000 people on MaineCare, about where we were in 2004, and the budget would not be in crisis. Instead, enrollment in MaineCare and the related caseload has ballooned to 360,000 — more than a fourth of Maine’s population and twice as many people as students in public schools.

As explained in his March 26 column — “Coverage can remain, costs can be cut” — Rep. Eves says the solution does not lie in reducing enrollment. In fact, he calls that approach “morally wrong” and “unconscionable.” Democrats believe, he says, “the solution to the current shortfall is to maintain this important investment while better managing the cost of health care.”

I serve with Rep. Eves on the Health and Human Services Committee, which has jurisdiction over MaineCare, the state’s name for Medicaid. The committee has been immersed in the program for months due to its huge cost overruns. If “better cost management” alone could fix the problem, the whole Legislature would get behind that solution.

The most puzzling part of the column is where Mr. Eves asserts that MaineCare’s financial trouble started when Gov. LePage took office. As he writes, “His administration axed efforts that were under way to implement a comprehensive system of care management that would have saved the program tens of millions of dollars.” He continues, “The administration’s choice to end this initiative was part of a series of poor planning decisions and mismanagement that led us to the shortfall we are in today.”

That, as they say, is a doozy. No serious person believes that Gov. LePage would ax a strategy that could save “tens of millions of dollars.”

Maine’s previous approach for care management was simply containing costs by limiting the utilization of services. The LePage administration moved in a more progressive direction, linking cost containment and quality while focusing on proper use of services.

This approach may have altered the direction of the previous administration, but it focuses on those who are receiving benefits, holds providers accountable and has the potential to improve care and reduce costs.

To argue that MaineCare’s financial problems started with Gov. LePage is, frankly, preposterous. The program has been in financial distress for years, propped up by all manner of fiscal gimmicks and economic trickery to sustain the unsustainable. The explosive costs began to bite deep with the budget for 2004 and 2005.

The ruling Democrats began searching for revenue for that budget and those that followed.

They saved money by simply not paying hospitals for MaineCare services rendered. Fees and taxes were increased and, to get them, Gov. Baldacci hired dozens of “revenue enforcers.” They sold off the state liquor business and borrowed from the highway fund. They cut school funding and pushed expenses down to the local level. In 2008, they pushed provider payments out into the next fiscal year and forced furlough days on state employees.

Finally, when all possible revenue sources were exhausted, the magic “stimulus” money arrived from Washington. The Democrats wasted no time in pouring it into MaineCare — $162 million in 2009, $272 million in 2010 and $199 million in 2011. As you will recall, the “stimulus” was meant for “shovel-ready” projects to “jump-start” the economy. Instead, Maine sank $633.6 million into MaineCare.

Now the stimulus is gone and we find ourselves with a massive program and runaway costs. Denying the severity of this problem only postpones the inevitable. We must make these difficult decisions if we are going to preserve the integrity of this vital program for the poor.

This isn’t about “dismantling the safety net,” as Rep. Eves says. It is about strengthening it and restoring it to its original intent.

Rep. Deborah Sanderson, R-Chelsea, serves on the Legislature’s Health and Human Services and Criminal Justice and Public Safety committees.

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