December 12, 2018
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Maine’s failure to expand Medicaid is costing us lives

Mario Moretto | BDN file
Mario Moretto | BDN file
Andrew MacLean, deputy executive vice president of the Maine Medical Association, voices his organization's support for Medicaid expansion at the State House Welcome Center in Augusta in 2014.

What avoidable causes of death endanger the people of Maine? Motor vehicle crashes killed 160 of us in 2016. Fires killed 20, and 16 people died in homicides. While these categories show a downward trend over the last decade, drug overdoses constitute an increasing threat. In Maine, drug overdoses claimed 376 lives last year. Can you imagine anything worse?

Yes. Lack of health insurance. A study from the Harvard School of Public Health published in the New England Journal of Medicine showed that when states expand Medicaid, for every additional 176 people enrolled, one fewer person dies per year. The converse of this is that for 176 individuals without coverage, every year witnesses one additional death. That allows us to calculate the effect of Gov. Paul LePage’s five vetoes of Medicaid expansion, passed by the Legislature with bipartisan support. Those vetoes, denying coverage to 70,000 Mainers, produced an additional 398 deaths per year.

Congratulations, governor. He has made himself a greater menace to Maine than heroin, prescription opioids, methamphetamine and cocaine combined.

For me, as a cardiac surgeon, this means more than numbers. I recall a patient who required an emergency coronary artery bypass. He came to my hospital from a smaller rural facility, and he had already suffered a massive heart attack. Because of the urgency of the situation, I didn’t have much time to talk to him before I took him to the operating room. Despite the irreversible damage that had already occurred to his heart, my team successfully got him through the procedure, preventing further injury. Afterward, as he made a slow recovery, I asked him how long he had chest pain before he came to the hospital.

“Two years,” he told me.

“Didn’t you know it was your heart?” I asked.

“Oh, I knew. I just knew I couldn’t afford this. When I lost my job at the mill, I lost my insurance, too. I was trying to wait until I got Medicare.”

He almost made it. He would have turned 65 in three months. Instead, he received less effective care, and it cost more money. Although he survived, he probably won’t live as long as if he had his operation two years earlier, or a year earlier. Even a month earlier. His is the human face of not having insurance and making Medicaid eligibility more restricted. Of course, I have no idea how many patients like him never make it to my hospital, or how many die before I can treat them.

Had Maine expanded Medicaid when it had the opportunity to do so in 2011, the state’s economy would have received an additional billion dollars, we would have an additional 3,000 high-paying jobs, and most important, at least 70,000 of our neighbors would have the affordable coverage and medical care they need. The cost to Maine? The federal government would assume 90 percent of the expense for the new enrollees, leaving Maine with only 10 percent. That’s quite a bargain, given that two-thirds of funding for current Medicaid patients comes from Washington and one-third from Maine. Maine would receive an additional $320 million per year once the expansion became fully implemented.

Our combined voices stopped the first attempt at passing the American Health Care Act — the proposed replacement for the Affordable Care Act. Yet, the American Health Care Act is rising like a zombie to threaten us again. This means that once again, we must urge our congressional representatives to resist any attempt to strip vital coverage from 24 million people. And we must continue urging our state legislators to resist the governor’s vicious budget proposal to remove another 20,000 from Medicaid rolls.

An additional 114 deaths per year? Not if we have anything to say about it.

Finally, in November, we must prepare to vote for the citizens’ initiative to expand Medicaid. Each of us can cast a veto-proof vote that will improve the health of our state, expand the economy, and create jobs. LePage might make Maine sick, but we have a cure for that.

Flavian Mark Lupinetti is a member of Maine Providers Standing Up for Health Care and a Copello Fellow of the National Physician Alliance.


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