June 23, 2018
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MaineCare is not welfare

By Steve Bien, Special to the BDN

There is no denying the economic difficulties that face our state, but it is a mistake to think that these difficulties should be solved at the expense of the vulnerable among us.

I am a family physician in western Maine and have had a community practice there for the past 30 years. Thirty percent of my patients are covered under the MaineCare program. While the governor talks about the supposed fraud and abuse of a program he regards as bloated and beyond our needs, I see a program that provides essential health care for working families and the children. These people are my neighbors and my patients.

While the governor lumps MaineCare under welfare spending, it is no such thing. MaineCare is a health care program for low-income Mainers. Twenty-five percent of MaineCare enrollees work, 42 percent are children and 28 percent of enrollees are disabled individuals and seniors. Deprived of their insurance, their health will no doubt decline, unattended problems will become more severe and costs will be kicked down the road, not avoided.

MaineCare has a broad range of benefits which are not obvious when talked about as welfare. First and foremost it is an effective health care program. By expanding MaineCare availability a few years ago Maine now has a markedly lower number of uninsured residents compared to other states.

In a broad range of studies, the level of insurance in a population is a key measure of that population’s overall health. This is why Maine scores highly, eighth in the U.S. in overall health rankings. This high rate of insurance also means fewer uninsured patients turn up at emergency rooms for expensive care that is not reimbursable. When that happens hospitals must eat those costs, which results in costs that must then be passed on to the rest of us.

Because budgeted MaineCare dollars are matched by federal dollars, every Maine dollar spent brings in $3 in federal funds. This is an engine in our economy, helping to fund the one in four Maine jobs that are in health care. At a time that the governor is promising to be a job creator, he would instead cut off a vital cash stream, ensuring the loss of an estimated 4,000 jobs from the contraction of health employment that would result.

MaineCare spending is not out of control. In recent years, MaineCare costs have actually risen more slowly than the national Medicaid average and far slower than the cost inflation of commercial insurance carriers. Nor is fraud a culprit. The rate of fraud in MaineCare is low both in absolute terms and in comparison to other states.

Instead, the current crisis has been brought on by the administration’s failure to adequately account for all of the Department of Health and Human Services’ obligations in last year’s budget. Simultaneously, the governor has called for $190 million in tax cuts, which chiefly benefit the wealthiest taxpayers. The way out of this mess is not going to come from taking an axe to an essential, effective and well-run state program.

At this point the whole budget needs to be reevaluated and priorities, including tax breaks, need to be reconsidered.

Not that there is nothing to change. All aspects of health care are plagued by the waste of unnecessary tests, procedures and treatment. But instead of broadly cutting beneficiaries and services, Maine should study models of reform such as the Kaiser Permanente system, which is a national leader in cost containment and effective coverage.

By using MaineCare to pilot reforms, the state system could be a leader for the change we need to see while continuing to serve its residents. This far more promising choice, already used successfully in several states, would allow us to move together as a state rather than put the health of so many Mainers in jeopardy.

Steven Bien is a physician who lives in Jay.

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