June 23, 2018
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Why we should all care about MaineCare

Courtesy photo | BDN
Courtesy photo | BDN
Barbara Shaw is a senior policy analyst at the Muskie School of Public Service at the University of Southern Maine.
By Barbara Shaw, Special to the BDN

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.

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