AUGUSTA, Maine — The chief lobbyist for Maine’s doctors said Tuesday that his organization would support an expansion of Maine’s Medicaid program next year as part of the Affordable Care Act, the Obama administration’s landmark health care reform law.
Gordon Smith, executive vice president of the Maine Medical Association, told members of the Legislature’s budget-writing Appropriations Committee an expansion of the state’s Medicaid rolls would translate into more insured patients who seek medical care routinely rather than seeking care in more expensive hospital emergency rooms.
He also said a Medicaid expansion could support the creation of about 2,000 health care jobs.
“Every day [doctors] do see problems associated with people who have no insurance,” Smith told lawmakers. “The data is compelling, whether the studies are from Maine or the nation. We know the people who have Medicaid coverage are healthier. They are more likely to get medical care and are more likely to get it on a timely basis.”
Gov. Paul LePage has remained opposed to Maine’s participation in the national Medicaid expansion, which takes effect next year for states that decide to participate. LePage and members of his administration have continually said Maine already has a generous Medicaid program it can’t afford and the state can’t count on a promise from the federal government to stick to increased Medicaid funding rates.
Smith acknowledged the program’s fiscal troubles, but said doctors are encouraged by reforms underway in Maine’s Medicaid program to reduce the cost of providing care to the most expensive patients. Those reforms include shifting to an approach that reimburses health care providers for positive outcomes among patients rather than reimbursing them for the procedures they administer.
Much of that work will be supported by a $33 million federal grant Maine recently received along with five other states to foster state-level innovations.
Maine Medical Association’s support for the Medicaid expansion, Smith said, “is predicated on what we think will be a different Medicaid program than it was in the past.”
Another major medical lobbying organization in Maine, the Maine Hospital Association, hasn’t taken a public position yet on the Medicaid expansion.
Maine has the fourth-highest Medicaid coverage rate in the nation at 27 percent, and already covers a significant portion of residents who would be newly eligible for Medicaid coverage under the federal health care law. Maine covers parents who earn up to 133 percent of the federal poverty level and nearly 11,000 adults without children who earn up to 100 percent of the poverty level ($15,510 for a two-person household). The federal Medicaid expansion would make members of both groups eligible for coverage as long as they earn 133 percent of the poverty level or less.
Under the Medicaid expansion, the federal government promises to pay 100 percent of Medicaid costs for newly eligible residents for three years. That 100 percent funding level would gradually drop to 90 percent in 2020 and remain there.
Maine has fewer residents than most states for whom the state would qualify for 100 percent funding, but the federal government is promising to increase Medicaid match rates for states like Maine that have already expanded their Medicaid programs.
Maine expanded Medicaid coverage to childless adults in 2002. Medicaid enrollment in the state rose 78 percent between 2002 and 2011 to about 361,000 people, according to the Maine Department of Health and Human Services.
While the LePage administration has said Maine would essentially be penalized for expanding Medicaid early, a recent Kaiser Family Foundation analysis projects that Maine could be one of 10 states to see the amount of state funds it spends on Medicaid actually drop over the next decade — by $570 million, or 3.8 percent — while the federal share of Medicaid expenses would rise by $3.1 billion, or 11.4 percent.
The Kaiser analysis projects Maine’s Medicaid rolls will grow by 55,000 people over the next decade if the state expands the insurance program. Even if Maine doesn’t expand, the analysis predicts 10,000 more people who may currently be eligible but unenrolled will join. Part of that could be the result of the Affordable Care Act’s individual mandate, which requires everyone to obtain insurance coverage.
While the Maine Medical Association supports a Medicaid expansion, Smith said there are continual worries that the state doesn’t have enough doctors to serve a larger insured population.
“Maine will never have enough health care providers for the population we have,” he said. “It will be a challenge to provide care for these new people.”