CONTRIBUTORS

For children’s benefit, parents need continued Medicaid coverage

Pediatrician Dr. Terry Brenneman, right, examines patient Addison Davis, 11, at the Pediatric Partners practice in North Raleigh, North Carolina, November 1, 2012. Beside him is a tablet that he uses to enter data into an electronic medical records system. The change to electronic medical records that was mandated by Obamacare has received mixed reviews from doctors.
Chris Seward | MCT
Pediatrician Dr. Terry Brenneman, right, examines patient Addison Davis, 11, at the Pediatric Partners practice in North Raleigh, North Carolina, November 1, 2012. Beside him is a tablet that he uses to enter data into an electronic medical records system. The change to electronic medical records that was mandated by Obamacare has received mixed reviews from doctors.
Posted Nov. 18, 2013, at 10:43 a.m.
Last modified Nov. 19, 2013, at 9:09 a.m.

Thank you to Sen. Roger Katz, R-Augusta, and other thoughtful moderates for working doggedly to help Maine find a way to take the tremendous opportunity to accept the federal dollars already allocated and intended for Maine people to provide health care coverage for Maine’s many uninsured.

Katz raises issues worthy of honest policy discussion. But I ask less-than-moderate others to stop stigmatizing whole populations of people for political gain and to agree not to forfeit the health coverage of 69,500 Maine people and the more than $250 million in federal funds per year for Maine’s health care providers and the economy.

If enough lawmakers are able to reach agreement, Maine will receive 100 percent federal funding to cover about 55,000 adults with Medicaid from Jan. 1, 2014 (or as soon as enacted) through 2016, then ramping slowly down to 90 percent federal funding in 2020. Agreement would also prevent another 14,500 parents raising children at home with income between 100 percent and 138 percent of the poverty level ($19,530 and $25,951 for a family of three) who we now cover from being cut off Medicaid on Jan. 1. For this group, Maine would receive the regular matching rate of 61.5 percent federal dollars.

These parents are the group for whom Gov. Paul LePage wants a “better deal.” But the health reform law clearly states that only people newly eligible in January receive the 100 percent federal funding. We were already covering this group before health reform passed and will not be funded as if the state doesn’t already contribute to them. In this sense, we are being offered the same deal as every other state that was already covering parents at this level — including every other New England state except New Hampshire.

At the Maine Children’s Alliance, we are particularly worried about these 14,500 Maine parents raising children on the edge of the poverty line who are scheduled to be cut off Medicaid on Jan. 1. (Some may receive “transitional” Medicaid for four, six or 12 months following their termination).

Here is how it will work for them after they lose their Medicaid. Take a parent with two children earning slightly above the poverty level — $20,800 per year. Her children are covered by MaineCare, but she is scheduled to be cut off Jan. 1. If she is offered coverage at work that costs less than 9.5 percent of her income ($165 per month), she will not be eligible for a subsidy because employer coverage will be considered available to her. Because her income is below 138 percent of the poverty level (and Congress intended her to be eligible for Medicaid), she will be exempt from the mandate to sign up for coverage due to her hardship.

She will likely be uninsured because, in fact, the typical employee contribution to insurance (averaging about $92 per month) is simply not realistic for someone scraping by near the poverty level.

On the other hand, if she is not offered insurance from her employer, then she will be eligible for a subsidy to help her buy insurance on the new marketplace at healthcare.gov. She would pay about $34 per month for a “silver” plan on the marketplace — a plan that also allows her to obtain some assistance with deductibles and co-payments. But when life hovers around the poverty level, where heat, child care, transportation, food, light and housing are iffy on $1,733 per month anyway, even $34 per month is not a realistic expense. It would only be logical if she is already chronically ill and forced to pay health costs regardless. (Note that the premium adds the incentive to bring in to the marketplace only those low-income parents with chronic illnesses. This will affect the costs of everyone else on that plan.)

 

In short, whether offered coverage by her employer or through subsidies in the marketplace, the cost of health care for the parent would still cut into other very basic needs for a family living this close to the financial edge. We must be real about raising children on $10-per-hour wages.

These families are stressed. The struggle to survive takes a huge toll on children. When young children suffer unbuffered stresses from poverty, their early development can suffer, and they can struggle all their lives. And when they struggle, so does the rest of society. In our schools, special education costs. Our child welfare caseloads, our ill-equipped workforce and our health care costs. Our corrections costs. We must give these struggling parents and their children our support. These parents need the continued coverage of Medicaid.

Mary T. Henderson is a senior policy analyst with the Maine Children’s Alliance in Augusta.

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