June 19, 2018
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BDN’s logic on Medicaid expansion ignores history

Jonathan McKane
By Jonathan McKane, Special to the BDN

Logic didn’t prevail, according to the Bangor Daily News editorial of April 12. In the BDN’s opinion, a logical conclusion to the 126th Legislature would have been a massive expansion of our MaineCare program.

But the BDN must have a different kind of logic — one that ignores history, facts and reasoned common sense.

For those of us who look at the whole picture — not just emotional anecdotes and false promises, the Maine Medicaid expansion issue really isn’t that complicated.

Essentially the question before the governor and the Maine Legislature was: Can the Maine people afford another massive welfare expansion?

The obvious and common sense answer is: No. Regardless of what promises are being made, Maine people, their children and grandchildren can’t afford to expand this welfare program any further than we already have.

Here’s why:

Maine’s Medicaid program, known here as MaineCare, is the third largest Medicaid program in the country measured as a percentage of the state’s population it enrolls.

It is our state’s largest single program, eating up one quarter of the biennial budget and starving all other programs, departments and spending (including programs for the most needy). It is the reason we have budget shortfalls every year and why we must resort to budget balancing gimmicks such as borrowing from the next fiscal year, borrowing from highway funds, bonding for what should be budgeted expenses and constantly raising taxes and fees. Ultimately, MaineCare is the reason our taxes are so high.

Our enormous MaineCare budget is the reason we can’t spend enough on our roads or on education, why there is never enough in the “rainy day fund” and why Maine accumulated so much debt. All of this puts a strain on Maine families, businesses and individuals and ultimately takes a heavy toll on our economy.

And yet even with this history of budget and economic misery due to our already expanded MaineCare program, we continue to hear the siren song of expanding this program once again, as though it were “logical.”

The promises are enticing and familiar — Maine’s uninsured rate will drop, there will be less charity care, fewer emergency room visits, and it will ultimately save the state money. And besides, most of it is paid for by the feds.

Sadly, this is not the reality. Our past MaineCare expansion and Medicaid expansions in other states have proven it.

Expanding Medicaid does not reduce the number of uninsured, it does not reduce charity care, and emergency room use actually goes up. In addition, a recent column in the Wall Street Journal shows that Medicaid coverage may be worse for participants than no coverage at all.

And Obamacare money from the feds does not begin to cover all the associated expenses. According to Department of Health and Human Services Commissioner Mary Mayhew, the predicted cost of this latest expansion would be astronomical — more than 800 million over the next 10 years. Add that figure to the estimate that by 2024 — even if we don’t expand again — we’re in line to spend a whopping 40 percent of all our state tax revenue on Medicaid — and you have a guaranteed recipe for economic catastrophe.

Proponents of welfare expansion have attacked the commissioner’s study saying it is politically motivated and inaccurate.

But Mayhew disagrees: “This department’s estimate of expansion costs is based on actual spending in previous years — not pretend savings assumptions as manufactured by the Legislature.”

Yes, we have a history with MaineCare — and it has been an expensive one.

The tax money to pay for the proposed expansion of MaineCare will have to come, directly or indirectly, from one, some or all of the following: higher income taxes, higher and or expanded sales taxes, and higher property taxes. And it would have to be siphoned off education funds, existing HHS programs, roads and bridges and all other Maine agencies and programs.

There are other hidden costs associated with the proposed expansion. MaineCare only pays about 70 percent of the cost of a medical procedure. That means the provider must figure out a way to make up the difference — usually through cost shifting. It is another reason why health care costs in Maine are higher than in other states. Expanding MaineCare will likely cut this reimbursement rate even further resulting in even more cost shifting.

It is important to remember that MaineCare is not health insurance, it is medical welfare. Participants in the program pay no premium, no co-pay and no deductible. That said, for some, it is anything but free — the Medicaid Estate Recovery Program could cost you your house and all your assets.

We will undoubtedly hear more of the too-good-to-be-true come-ons and twisted logic from MaineCare expansion proponents. Look at the facts. Look at the statistics. Look at Maine’s history. Ultimately, the decision to reject the deal will be obvious — it’s just common sense.

Jonathan McKane lives in Newcastle and served on the Maine Legislature’s Insurance and Financial Services Committee in the 122nd, 123rd and 125th legislatures.

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