May 20, 2018
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An ER doctor’s perspective: Steep price to pay for failing to expand Medicaid

Kevin Bennett | BDN
Kevin Bennett | BDN
Dr. Charles Pattavina stands amid the St. Joseph emergency department in Bangor in this December 2011 file photo.
By Dr. Charles Pattavina, Special to the BDN

I wish I could say I was surprised to note the latest news from our State House announcing that, once again, the two parties have failed to find common ground on the issue of accepting $750 million in federal funds over three years to provide health care coverage for 70,000 low-income Mainers.

Every day, our state sacrifices over $900,000 that could pay for needed health care. So, in contrast with the states that have accepted these funds, the health care for these Mainers continues to be paid for by you and me: Maine’s taxpayers and health insurance rate payers — even as most other states take proper advantage of the billions we have funded with our federal taxes.

Politics is the art of compromise. I shudder to think of where our state might be if compromise had eluded our forefathers. One hundred ninety-four years ago, Maine was admitted to statehood as part of the Missouri Compromise. Other landmark legislation resulting from acts of compromise include the Civil Rights Act and the Clean Air Act. In former Maine Sen. Olympia Snowe’s recent book, “Fighting for Common Ground,” she laments the failure of her colleagues to work together to solve problems. Supporting her concerns, a recent Pan Atlantic SMS Group poll showed 62 percent of Mainers wanting leaders willing to work with opponents even if that meant compromising on core values.

The work of the 126th Legislature and Gov. Paul LePage on MaineCare expansion is a classic example of ideology trumping common sense. If the $750 million was being offered for something other than health care — say, highways, bridges or navy ships — would there not be press conferences heralding the incoming funds? So why is federal money good for defense and infrastructure but greeted by some with disdain when used to help pay for health care?

LePage and the Republicans constantly use the term “able-bodied” when discussing those eligible. As an emergency physician, I wonder who they are talking about. Shift after shift, I see the sad results of uninsured patients waiting too long for care. Study after study demonstrates that better coverage, including primary care services, helps keep people well and decreases the cost of care when illness arrives. Like most of you, I am a taxpayer and would much rather have tax dollars used to provide proper comprehensive care for my neighbors. I do not want to see the taxpayers and the economy of Maine hurt, and I do not want my health insurance premiums to increase because of the cost of hospital care for chronic illnesses not managed well at home.

In a state as poor as ours, passing up $750 million set aside for Mainers’ health care coverage is simply unconscionable. The opportunity may still exist for Democrats, Republicans and LePage to find common ground. Compromises have been proposed, including some by reasonable Republicans, which address every concern raised by opponents, yet most Republican legislators march in lockstep and seem willing to hurt us, our state and our neighbors in order to oppose a working health care law that actually took many of its key provisions from Republican ideas.

Every other New England state has managed to get this done. Is this a time we want to be an outlier and leave 70,000 of our neighbors without health care coverage? And leave $750 million out of the Maine treasury?

MaineCare is not welfare, as no money is paid to enrollees. This is no more welfare than are the tax dollars paid for full-time health care coverage for our state legislators, who are considered part-time workers. Again, the health care for these 70,000 Mainers comes at your expense and mine when it could be paid for by the federal government.

Our legislators must go back to the drawing board. They should meet each other halfway.

This was done successfully in Iowa, Arkansas, Arizona, New Hampshire and many other conservative states. The highly respected and bipartisan Congressional Budget Office has just put the state cost of this program at a third less than what was previously circulated.Furthermore, recent studies in the well-respected publication “Health Affairs” indicate that, because of Maine’s failure to expand coverage, between 31 and 157 Mainers will die. This would be a very steep price to pay because of the failure to work together.

Dr. Charles Pattavina, M.D., is chief of the Department of Emergency Medicine at St. Joseph Hospital in Bangor.


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