April 24, 2018
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There’s a last chance for 70,000 to gain health coverage, and reasons against it don’t stand up

Troy R. Bennett | BDN
Troy R. Bennett | BDN
A woman holds a sign at a rally and lobby day organized by the Maine Peoples Alliance at the State House in Augusta on Jan. 8 around the issue of Medicaid expansion.


Republicans in the Maine Legislature have one last chance this year to deliver on health coverage for the state’s poorest residents.

On Thursday, when the House and Senate reconvene to take up a slew of vetoes from Gov. Paul LePage, lawmakers will have two veto letters before them nixing separate plans to expand Maine’s Medicaid program under the federal Affordable Care Act.

It’s long past time for lawmakers to take up the federal government on its offer to assume nearly all costs of expanding coverage to tens of thousands of Maine adults without children who are newly eligible for Medicaid under the federal health care law — if only Maine lawmakers agree to it.

We’re not naive enough to expect a dramatically different result on an issue that’s crossed these same legislators’ desks five times. But we’re not willing to let two more opportunities to insure 70,000 low-income Maine residents — so they can responsibly manage chronic conditions, access cost-saving treatments for addiction or visit a doctor without breaking the bank — pass by unnoticed.

One of the two pending Medicaid expansion proposals, from House Speaker Mark Eves, D-North Berwick, would use federal assistance so low-income childless adults could, starting in July 2015, purchase qualified private insurance coverage through Maine’s online health insurance exchange. (They would receive conventional Medicaid coverage until then.) The 15,000 parents who would qualify for expanded coverage would receive conventional Medicaid coverage.

The legislation is modeled after a bill passed in neighboring New Hampshire, which cleared a Republican-controlled Senate. The approach of using Medicaid expansion funds to buy private insurance was spearheaded in Arkansas under Democratic Gov. Mike Beebe and a Republican legislature.

The bill Eves has proposed isn’t perfect. Research has repeatedly found that health spending is higher overall with private insurance than with Medicaid. Other research has shown premiums and significant cost-sharing responsibilities have caused low-income enrollees to withdraw from health insurance coverage.

By relying on private insurance, Eves’ bill runs those risks. However, the bill leaves many details to be determined after it becomes law, meaning a deliberately designed, well thought-out program can mitigate those risks.

Predictably, LePage and his allies have latched onto yet another spurious argument to undermine support for yet another Medicaid expansion proposal meant to address Republican concerns about the expansion of a public health insurance program.

LePage declared in an April 17 news release that the Arkansas expansion model “is suffering enormous cost overruns into the millions of dollars,” and that state’s taxpayers will be responsible.

Indeed, Arkansas officials negotiated per-person budget caps with the federal government to secure approval for using Medicaid expansion funds to purchase private health insurance. And those costs have run ahead of projections in the first months of the program.

A paper cited by LePage, from the conservative Foundation for Government Accountability, claims spending could exceed negotiated projections by $6.6 million-$16.6 million this year if current trends persist.

But Arkansas taxpayers only are liable if Medicaid expansion’s costs exceed projections over a three-year term, giving Arkansas officials more than two-and-a-half years to rein in costs. One way they’re doing that is by restricting add-on benefits many private plans offered in the first year.

In addition, the terms of the deal Arkansas struck with the federal government grant the state flexibility to adjust those cost projections upward to more closely match actual costs.

While Medicaid expansion opponents continue to try to instill budget-busting fears in policymakers’ minds, a revised analysis from the Congressional Budget Office actually projects that, overall, states will assume a smaller share of the expansion’s costs than the office previously projected. They’ll end up spending 34 percent less between 2015 and 2024 than previously thought, according to the analysis.

As with past expansion attempts that have passed the Maine Legislature, the reasons against this expansion proposal wither away upon closer inspection. Meanwhile, the budgetary clock ticks down on a unique chance to provide life-changing health coverage to 70,000 people at minimal cost.


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