In George Orwell’s dystopian novel “1984,” the Ministry of Truth is one of four departments responsible for running the government. It does the opposite of what its name suggests. It changes history to suit its message and broadcasts slogans like “Ignorance is strength” and “War is peace.” This is doublethink: Twist the facts, and dismiss any inconvenient truth.
The Maine Department of Health and Human Services is apparently employing the concept of doublethink as it continues its attack against Medicaid expansion, resorting to distortion of facts to serve an ideological purpose.
On Friday, the department, which has staunchly opposed expansion under Gov. Paul LePage, questioned the preliminary analysis of the nonpartisan Office of Fiscal and Program Review, which found expanding Maine’s health insurance program to 70,000 low-income people would cost the state $683,520 over three years.
DHHS Commissioner Mary Mayhew called the independent analysis “nonsense,” saying the office “clearly chose to ignore the facts,” and that “one must question the motivation of doing so and the integrity of the process.” When truth is not on your side, fight those who speak it.
The state costs are projected to be low because the federal government is obligated to pay 100 percent of the cost for newly eligible Medicaid recipients the first three years; the bill proposed by Sen. Roger Katz, R-Augusta, would roll out Medicaid expansion for only three years unless the Legislature voted to renew it. Considering three years of costs for benefits and personnel not covered by federal funds, the fiscal office projected expansion would save the state $3.4 million the first year and cost just under $290,000 in the second and $3.8 million in the third.
Yet DHHS says you shouldn’t believe the nonpartisan fiscal office. Rather, you should believe its partisan office. What’s more, you should believe that expansion would actually cost 123 times the amount the nonpartisan office says — $84 million by 2017 — based on suspect reasons, including per-recipient Medicaid costs that DHHS suddenly claims are nearly 80 percent higher than it has previously claimed those costs to be.
Never mind that the fiscal office’s analysis of a different Medicaid expansion bill last year was frequently used by Republicans making the case against expansion. The information is only true when it suits a purpose.
The rhetoric surrounding Medicaid expansion from the LePage administration has gone entirely Orwellian. Apparently, it is not “compassionate” for the state to accept federal funds to expand health coverage to about 70,000 low-income adults.
“We must show compassion for all Maine people,” LePage told Maine residents last month in his State of the State address. “We must protect our hard-working families from the higher insurance premiums and higher taxes that will result from further expansion.”
Compassion, evidently, is to leave some of Maine’s poorest residents without an affordable option for coverage that could improve their health, both physical and mental, and their financial position. And expansion, evidently, will cause higher health insurance premiums for everyone else when, in fact, it’s more likely to lead to premium reductions. In determining how much they expect to save by expanding Medicaid, a number of states have factored in lower health insurance costs for their state employees and retirees. With fewer uninsured people, these state analyses have determined, hospitals will have fewer unpaid costs from treating the uninsured to shift to those with insurance.
One principle of “Newspeak,” the official language of Orwell’s Oceania, is to remove any nuance from language. That’s exactly what LePage and Medicaid expansion opponents do by frequently characterizing the entire population that could benefit from an expanded Medicaid program as “able-bodied.” Why, after all, do the “able-bodied” deserve help from everyone else?
Characterizing the entire population in one way, of course, obscures the truth. No, the low-income adults who would benefit from Medicaid expansion aren’t classified as disabled in any official sense. But a homeless adult without children suffering from debilitating mental illness could be among those newly eligible for an expanded Medicaid program. Is “able-bodied” the most descriptive adjective for that person?
Indeed, a new report from the American Mental Health Counselors Association estimates 21,000 Maine adults who would qualify for extended Medicaid coverage are suffering from “serious mental health and substance use conditions.”
Yet to Mayhew, the adults who would qualify for expanded Medicaid are uniformly “able-bodied” and “70,000 adults who can work,” as she wrote last month in a Kennebec Journal OpEd.
As the fictional Ministry of Truth knew, manipulating information is power. Don’t let the LePage administration twist fiction into fact, ignorance into strength.