May 22, 2018
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Expanding Maine Medicaid — a fact-finding mission

By Dr. Erik Steele

In the debate about whether to expand Maine Medicaid to cover 50,000 largely uninsured Mainers making less than $11,500-$15,000 annually, it’s worth comparing some of the rhetoric to some of the facts. The cool breeze of reality might blow away some of the smoke and reveal a path to compromise and better health care for 50,000 of our friends in need.

Rhetoric: Per Gov. Paul Lepage, getting Medicaid insurance from government encourages people not to get private health insurance on their own.

Fact: It’s the only way to get health insurance — and therefore the only way to get ongoing health care — for most of those 50,000 Mainers. The majority work for employers who do not provide insurance (less than half of Maine employers provide it), so would have to buy health insurance themselves. An insurance policy for a healthy adult in Maine is about $5,000 annually, $12,000 or more for a family of four. Those costs are prior to out-of-pocket expenses, which easily could add $1,000 to the annual health care bills for that family, and much more if anyone gets really sick.

Who can pay for rent, food, transportation, and other essentials, and still have $5,000 to spend on health insurance, on a $15,000 salary? I don’t know the exact answer, but bet it’s just about nobody. What couple making 130 percent of the federal poverty level — about $20,000 annually — can afford $10,000 for health insurance for both? I bet it’s the same answer.

That means for most of the 50,000 fellow Mainers who would be covered if Maine expanded Medicaid insurance coverage as recently proposed by the majority of the Maine Legislature, the choice is not between Maine Medicaid and private health insurance; it’s between Medicaid and no health insurance at all. For many of those friends of ours, that means a choice between working and making too much to get Medicaid insurance, or not working so you can afford to take care of your illnesses, or between health care and food, etc.

Fact: That’s not a real choice.

Rhetoric: Maine state government cannot afford to expand Medicaid.

Fact No. 1: The federal government (national taxpayers, a few of whom are you and I) will pay for Medicaid expansion for the next three years, and for 90 percent of Medicaid expansion after that, not Maine state government or taxpayers. The hit on Maine’s state budget will be small. In fact, the Kaiser Family Foundation estimates that Maine would gain almost $600 million in additional federal health care revenue by expanding Medicaid.

Fact No. 2: If the feds fail to follow through in three years on the commitment to help fund Medicaid expansion, the Republican-Democrat compromise bill passed by the Maine Legislature would allow the state to roll back the expansion. There’s a parachute on the proposal if Maine needs it.

Fact No. 3: In that three-year interval, Maine Medicaid could move to a fully managed insurance program that could substantially help reduce future costs of the program. A well-managed program would also help Maine hedge its bet against a federal failure to obey the new federal health care reform law that funds Medicaid expansion.

Rhetoric: Previous expansion of Maine Medicaid is a program that “has not worked.”

Fact: In one way, absolutely right. Maine Medicaid failed to pay the bills for its previous expansion because it failed to tightly manage its program. In another way, absolutely wrong. The result of previous Maine Medicaid expansion was tens of thousands of Mainers who got health care they would not have had otherwise because they would have been uninsured, and a state with one of the lowest rates of uninsurance in America. That is a success.

Fact: There’s a path forward for Maine. Expand health care access by funding Medicaid expansion primarily with federal dollars, develop a well-managed Medicaid program that is financially sustainable in Maine, and bail on the expansion if federal funding dries up in three years. Maine legislators should not fail to do that for Maine’s working poor just because most of them are not in that group; if they were, I bet they would be voting for the expansion in a heartbeat.

Erik Steele is the former chief medical officer of Eastern Maine Healthcare Systems. He recently accepted a new job at Summa Health System in Akron, Ohio.

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