Perhaps you are among the fortunate Mainers with health insurance, either through your employment, the Veterans Benefits Administration or Medicare. Even if you are insured, the debate about who will and will not be covered by MaineCare — Maine’s Medicaid program — will affect you.
The proposed elimination of MaineCare benefits for “childless adults” — nondisabled people ages 20-64 without dependent children — reverses a decade-long effort in Maine to expand coverage to a vulnerable population.
About 10 years ago, with strong bipartisan support, Maine sought and received a waiver from the Centers for Medicare and Medicaid Services to expand MaineCare to include childless adults. Part of a Bush administration initiative, the waiver program aimed to reduce the number of uninsured Americans.
The Maine Hospital Association, Maine Medical Association and members of the business community strongly supported increasing the income eligibility levels in MaineCare as a cost effective strategy to provide coverage to low income adults. As a result of the program, the number of uninsured in this low-income group dropped from 40 percent to 29 percent by 2008.
Plans to eliminate Medicaid coverage to save state dollars are shortsighted and will not end the health care needs of this population. The savings, an estimated $22 million, must be measured against the loss of $37 million federal matching dollars. Elimination of coverage shifts costs to you as a hidden tax on insurance premiums.
Here is how it happens: The uninsured poor and near poor have no access to preventive or primary care to stay well and attend to health problems early. By necessity they delay medical attention until they are forced to seek care through the most inefficient and expensive entry point for health care, the hospital emergency room.
For example, a person with undiagnosed and untreated high blood pressure may show up after having a stroke and will need very costly treatment. Hospitals are obligated to treat the uninsured and then pass on their increased charity care and bad debt to the commercial insurance market. The insurance companies then pass those increases on to the rest of us as higher premiums and reduced reimbursement to providers. We are all paying for the health care needs of the uninsured in the most expensive and least healthful way possible.
But more important than cost containment is enhanced survival. A recent study from Harvard Public Health, published in The New England Journal of Medicine, demonstrates that Medicaid expansion for childless adults saves lives.
Analyzing 10 years of data and nearly 200,000 people, researchers compared three states — New York, Arizona and Maine — that substantially expanded Medicaid eligibility since 2000 with three neighboring states that did not. The study showed a 6 percent drop in death rates in the expansion states compared with neighboring states (Maine was compared to New Hampshire), decreased rates of delayed care because of cost and increased rates of reported “excellent” or “very good” health.
In the five years before expansion, there were about 46,400 deaths per year among people ages 20-64 in the three states combined. In the five years after, there were 44,900. For every 176 additional adults covered by Medicaid, one death per year was prevented, the study found. In the other four states where coverage was not expanded, death rates went up.
Consistent with this, the Institute of Medicine estimated that health insurance reduces adult mortality by 25 percent. Similar results were found in Oregon, which expanded Medicaid coverage in 2008. In that state, randomly chosen recipients were compared with those who did not get coverage: Medicaid recipients were more likely to receive regular medical care, including preventive screenings and report better health. The data are clear: Coverage improves health.
Over the last decade, Maine has viewed access to health care as an important part of its investment strategy. As a result, our state has achieved the sixth lowest rate of uninsured in the country. Maine now joins 20 other states in offering Medicaid coverage to childless adults. Under the Affordable Care Act, low-income childless adults will be included as part of the Medicaid expansion in 2014.
Covering low income adults saves lives, reduces high-cost, facility-based care and ensures a healthy workforce. Expanding coverage is a benefit for all.
Barbara Shaw is a senior policy analyst at the Muskie School of Public Service at the University of Southern Maine. She is a member of the Maine Regional Network, part of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.
Beautifully said and reasonably presented. I couldn’t agree more – penny wise and pound foolish.
Hey why not, I pay for all my own expenses, health care or otherwise. I might as well go into the poor house and pay for everyone elses to. Those of us who have chosen to be productive members of society should be punished for working, it’s the new American way.
That is kind of the point here. Pay now, which you already have been, or pay later as an increase in your premiums. Oh and the Governor got rid of those pesky regulations to insurance companies. They no longer need to go through a review process to raise rates, so how do you think these honest, hard working, insurance companies are going to deal with all these unfunded ER visits? My guess: if they see a 10% increase from hospitals, they will get a 50% increase from those buying their coverage. After all its profits not people that matter, so says the Republican mantra.
The working poor are already punished for working. That is why we have this problem. Minimum wage jobs don’t offer health care, and don’t leave the money for people to buy it on their own.
That, of course, is the typical Tea Party perspective: never mind the big picture, just focus on what’s good for me. Except that the big picture will show that what’s good for all Americans is good for “me” too. Uninsured healthcare consumers are a huge economic drain and by far most either do or would work if given the opportunity. It is far less costly to subsidize their medical insurance than to have service providers and insurers jack up their rates to cover the costs involved.
Who said I was in the tea party? I’m just fed up with idea that my family has to suffer and pay for those that never had the will or desire to make something of themselves. I see it every day, maybe you don’t. The worst part is the riff-raff in this country is outbreeding the ones that are paying for it all by a large percentage.
As of 2006, the taxpayers pay Barbara Shaw $91,401 per year, including benefits. Her salary alone puts her in the top quintile of Maine families. Those without a cushy hack job care about the burdensome expense of government.
Who will pay for MaineCare?