The LePage administration may be trying to persuade the federal government to send a lot more money to the state to expand its Medicaid program under the federal Affordable Care Act, but don’t let the political ploy distract you from the issue at hand: Maine has a lot of work to do, and it will quickly run out of time.
Medicaid expansion should not be a partisan issue. Republican legislators and eight Republican governors across the country — people who opposed Obamacare — have analyzed the data and determined that it does not make financial or ethical sense to deny coverage for people who will be required to obtain health insurance under the act but won’t be able to afford it.
So far, the LePage administration has opposed Medicaid expansion without presenting a full analysis of the data. But the reputable Kaiser Family Foundation has looked into the numbers, and the details it presents are compelling. Also, the University of Southern Maine’s Muskie School of Public Service released a brief on the act this week. Its examination raises questions that the administration has so far not answered.
The first has to do with the very poor. The act requires states — regardless of whether they extend Medicaid eligibility — to have health care exchanges, where people can shop for insurance policies. People earning 100 to 400 percent of the federal poverty level will be eligible for federally funded tax credits to help them pay for the coverage.
But those with incomes less than 100 percent of the poverty level are not eligible for the credits. That could leave able-bodied adults, without children, with no coverage if Maine does not expand Medicaid eligibility to include them; Maine currently covers childless adults up to 100 percent of the poverty level, but its waiver to do so expires Dec. 31.
Does Maine want thousands of new people to be able to obtain health insurance except some of the very poor — especially when the law’s success depends on broad participation?
Second, starting in 2014, when people must be enrolled in a health insurance plan or else pay an assessment, more Maine residents are going to seek out Medicaid. These are people who are already eligible for Medicaid but have not enrolled. Kaiser predicts about 10,000 more people will join the rolls. If Maine does not agree to Medicaid expansion, it risks having to pick up the costs associated with this group.
Third, open enrollment for Maine’s health insurance exchange begins Oct. 1. John Martins, a spokesman for the Department of Health and Human Services, said the department is working with a consultant to assess its computer systems, recommend design changes and establish a work plan; the state is on pace, he said, to open the exchange.
The department, however, has experienced major computer system problems before, and the Legislature didn’t include funding in the most recent supplemental budget to upgrade the Medicaid billing system. Will the process be seamless when people start seeking coverage Oct. 1?
In her March 18 letter to the Obama administration, Maine DHHS Commissioner Mary Mayhew wrote that the federal government is penalizing the state for having broadened its Medicaid program more than a decade ago, when it decided to cover many residents who would otherwise have been considered newly eligible for Medicaid under the health care law. Because the federal government is offering less than 100 percent funding to cover that population, Mayhew said the rate would create “a dismal financial reality.”
Financial analyses so far, however, show just the opposite. While fewer Maine residents would qualify for 100 percent federal Medicaid funding, the federal government has promised to increase its share of costs for states like Maine that have already expanded Medicaid. That makes Maine one of only 10 states projected to actually experience a net savings from participating in Medicaid expansion.
In her letter, Mayhew asked the federal government to fund 100 percent of the state’s Medicaid costs for expansion for 10 years. While the request could be harmless, no one should expect the federal government to fulfill it. When it doesn’t, will the administration finally acknowledge the benefit expansion could bring, both in terms of dollars and health care for the poor?