AUGUSTA, Maine — Doctors with the Maine Medical Association on Thursday urged lawmakers in Augusta to work together to make Medicaid expansion the law of the land this year.
Their voices joined a growing chorus of statewide groups urging the Legislature to accept federal dollars related to expanding Medicaid, known as MaineCare in the state, to roughly 70,000 low-income Mainers.
It’s not just the usual liberal lobbying groups, either: Earlier this month, the Maine Hospital Association made its pro-expansion stance clear, and the Maine State Chamber of Commerce is also pushing a deal to tie Medicaid expansion to cost-saving measures within the program.
Republican leadership, including Gov. Paul LePage, are unequivocally opposed to the expansion. They point to a controversial study commissioned by DHHS that says expansion would cost $807 million over 10 years.
But the existence of back-door negotiations between Democratic leaders and a handful of moderate Republicans is, at this point, an open secret, and the Maine Medical Association wants to encourage that dialogue.
With the other nonpartisan groups involved, that could provide political cover for Republicans who want to buck party leadership.
“MMA and providers across Maine welcome these deliberations and hope an accord can be reached,” said Dr. Amy Madden, a family doctor and chairwoman of the group’s legislative committee, during a news conference Thursday at the State House.
The current version of Medicaid expansion being pushed by Democrats would expand the program for just three years — the length of time the federal government says it will cover 100 percent of the cost for newly eligible, low-income beneficiaries. It also allows the state to opt out of the program if the feds renege on their promise to pay, and includes a provision that would make Medicaid patients pay the highest co-payment allowed by federal law.
House Speaker Mark Eves, D-North Berwick, the lead sponsor of that bill, says it’s an effort to compromise by addressing fears voiced by Republicans last year that the program would be too costly. Republicans, however, point out that the bill is substantially the same as one rejected by lawmakers last year, and hardly counts as a new effort at bipartisan collaboration.
Madden and others with MMA said their support for expanding Medicaid is an extension of their desire as health care providers to help patients get the care they need. Many said that without access to Medicaid, many low-income people have only one source of health care: emergency rooms.
“As good a job as we do, I certainly wish fewer Mainers had to rely on the emergency room for their first, last and only source of services,” said Dr. Kenneth Christian, an ER doctor at Maine Coast Memorial Hospital in Ellsworth.
He said expanding Medicaid under the auspices of the Affordable Care Act — a move that would see the federal government pick up 100 percent of the tab for newly eligible beneficiaries for three years before tapering down to 90 percent after that — would be a “game changer.”
“Access to primary care saves lives,” Christian said.
Republicans have touted several scientific reports and studies that show Medicaid expansion would not decrease the use of the emergency department to treat nonemergencies.
One recent MIT/Harvard study showed that in Oregon, Medicaid expansion actually increased the use of the emergency rooms. A 2008 analysis by the Muskie School said “there was no discernable pattern associating high or low [emergency department] use” with insurance status.
The doctors with MMA said it makes perfect sense that expansion would result in an initial increase in emergency room use, but predicted it would decrease over time.
That’s because the newly insured don’t yet have a relationship with a primary care provider, and may not know when and how to contact one. So they at first turn to the one place they know to get service — the emergency room.
“There is going to be a certain amount of pent-up demand,” said Andrew MacLean, deputy executive vice president of MMA.
House Minority Leader Ken Fredette, R-Newport, said the fact that doctors, hospitals and businesses support expansion should not cause Republicans to waver in their opposition.
“Those are some powerful special interests who will profit from welfare expansion at the expense of Maine taxpayers, but the taxpayers don’t have any lobbyists and somebody has to look out for them,” he said in an email to the BDN.
Fredette also pointed out a recent Pan Atlantic SMS poll that indicated just less than half of Mainers oppose Medicaid expansion.
“Clearly welfare expansion has much more support among special interests than it does among Maine people,” he said.
Follow Mario Moretto on Twitter at @riocarmine.