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MaineCare facts more compelling than perceptions

Posted April 08, 2012, at 6:20 p.m.

MaineCare funding has been a lightning rod in current state budget discussions, causing sparks to fly between two recent BDN Op-Ed writers — Reps. Mark Eves, D-North Berwick, and Deborah Sanderson, R-Chelsea. In her March 14 Op-Ed, Rep. Sanderson constructed a “facts versus fiction” argument and I’d like to continue in that vein, countering some of what she claims are facts.

Rep. Sanderson: “Huge cost overruns” in MaineCare are due to “mushrooming growth” in covered populations.

Here are the facts: Let’s look at Department of Health and Human Services’ own posted figures on the Web, going back to 2006. Enrollment climbed a modest 2 percent per year during this period, a time when we experienced one of the deepest recessions in our lifetime; when the unemployment rate jumped up 75 percent, and thousands in Maine lost their jobs and health insurance.

But despite this growth, the total funding for the MaineCare program during this period was largely flat. In the six years between 2006 and 2011, MaineCare costs increased 8.9 percent at a time when medical care inflation “mushroomed” at double that rate.

Rep. Sanderson: Reducing enrollment in MaineCare will solve the program’s current fiscal problems.

Here are the facts: If one casts an actuarial eye toward MaineCare data, it’s hard to miss the striking fact that 5 percent of those covered account for 55 percent of MaineCare costs. This 5 percent is made up of the classic “required” populations covered by MaineCare — the elderly and disabled.

We still will need to pay for these high-cost, complicated patients even if other groups are eliminated through cuts. There is no solution in the governor’s plan for one of the most critical problems faced by the MaineCare program.

This point is not lost on other states — 37 of them have aggressive cost containment and care management programs in place. Maine is not one of them. The LePage administration scrapped a contract for a vigorous care management program dealing with several thousand MaineCare members for a much more limited voluntary program among hospitals to reduce emergency room use (working with about 750 patients). Promising efforts to contain costs have been reduced to a trickle.

Rep. Sanderson: MaineCare’s financial problems did not start “when Gov. LePage took office.”

Here are the facts: I agree. Nor did they begin with Democrats. The habit of “simply not paying hospitals for MaineCare services rendered” began in the Republican administration of Gov. John McKernan and continued in the independent administration of Gov. Angus King’s administration. It wasn’t until Democrat John Baldacci’s administration when payments finally started to flow to hospitals for these back debts.

Rep. Sanderson: To pay for those problems, Democrats sank “magic stimulus money … meant for shovel ready projects” into paying off MaineCare.

Here are the facts: This accusation has surfaced periodically in this legislative session, implying a dishonest use of the stimulus funds. In fact, the American Recovery and Reinvestment Act of 2009, or ARRA, included funds specifically designated only for use by state Medicaid programs, recognizing that in a recession, there is increased demand for Medicaid coverage at a time when states have fewer revenues to pay for it. There was no robbing of “shovel ready” funds. These dollars were used solely for their intended purpose.

Rep. Sanderson: MaineCare is simply “a welfare program.”

Here are the facts: MaineCare is a public health insurance program for the populations — elderly, disabled, mentally ill and poor — that the private insurance sector cannot or will not cover.

Moreover, MaineCare ought to be managed professionally, more like the private insurance sector, with experienced staff trained in such areas as insurance principles, actuarial science, claims management, information systems and cost containment strategies. Instead, we crank down on MaineCare staffing levels, nickel and dime the salaries of the specialists and technicians we need and “encourage” experienced staff to retire early. Why then are we surprised when we have computer system meltdowns (as in the Baldacci era) or major glitches in eligibility systems (as in the LePage era)?

When it comes to something as important as health care for people who are vulnerable and poor, it is important to get our facts right. It is also important that we find ways to talk with each other across whatever side of the aisles we sit to solve these problems together in order to best manage this vital health care resource.

Lisa Miller was a member of the Appropriations Committee in the 124th Legislature. She is a candidate for House District 52 (Chelsea, Somerville, Whitefield, part of Jefferson, Washington and Hibberts Gore).

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