Irrational GOP threatens Medicaid expansion

Posted June 12, 2013, at 10 p.m.

Once again, Maine Republican lawmakers have shown they will withhold health care coverage from this state’s poorest residents to spite federal health reform. The arguments that members of the Maine House made Wednesday in opposition to Medicaid expansion were appalling.

It won’t matter that 97 representatives voted to support a Medicaid expansion compromise measure on Wednesday, while 51 were opposed. The House needs four more votes to override an anticipated veto from Gov. Paul LePage. Apparently just enough members are listening to the ill-informed rhetoric of their House colleagues.

Rep. Richard Malaby, R-Hancock, spoke on the House floor of how increasing Medicaid eligibility under the Affordable Care Act would be “expanding a program I feel is broken.” There’s no doubt Maine’s Medicaid program for the poor and disabled, MaineCare, can deliver services more efficiently. Lawmakers have the power to suggest and approve changes, and improvements don’t have to happen separate from expansion.

Rep. Michael Nadeau, R-Fort Kent, meanwhile, argued that the state should not expand Medicaid when as many as 3,100 people remain on a waitlist for services. “My constituents are going to say, ‘We’ve neglected this group of people,’” he said.

Of course Medicaid expansion and taking care of people with developmental disabilities on the waitlist are not mutually exclusive options. To be clear, the people on the list already have health care. They are waiting for services to help them be as independent as possible in their homes, work and communities. Using them as an excuse to not provide health care to others is a cruel diversionary tactic.

Rep. Ken Fredette, R-Newport, the House minority leader, used an unfortunate analogy to convey a point about the cost of expansion — and later apologized. He said the Medicaid expansion debate reminded him of the relationship guide, “Men are from Mars, Women are from Venus.”

“Now my brain, being a man’s brain, sort of thinks differently because I say, ‘Well, it’s not, if it’s free, is it really free?’ because I say, in my brain, ‘There’s a cost to this.’”

The federal government would cover 100 percent of the costs of newly eligible individuals for three years and then slowly drop down to 90 percent. Even though the reputable Kaiser Family Foundation has estimated Maine would be one of 10 states likely to save money on Medicaid over the next decade if it expands, people have said it doesn’t matter because federal spending comes from taxpayer dollars, too.

Aside from the fact that Maine receives more dollars than it sends to the federal government, the point of expansion is to not only improve health but actually reduce health care costs — a benefit to everyone. A study by the Rand Corporation, a nonpartisan research institution, analyzed the effect of 14 states opting out of expansion.

“We estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion,” the study found. “We conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.”

As if that’s not enough, Maine learned Wednesday it will get $21.2 million from the Affordable Care Act to help seniors and people with disabilities get long-term care in their home, rather than institutions. Is it OK for Maine to accept these dollars, offered through the federal health care reform law, but not others?

Even more ludicrously, a few ill-informed House members find themselves trying to argue against a bill amended by a fellow Republican. The compromise measure crafted by Assistant Senate Republican Leader Roger Katz of Augusta would allow expansion but have Maine withdraw after three years — during which time the federal government pays 100 percent of the costs — unless the Legislature decides later it wants to continue the program.

The Affordable Care Act will bring coverage to low- and moderate-income individuals and families whether Maine votes to expand or not. Medicaid expansion is for those near and below the poverty line. It makes no sense to tell those individuals that people who earn more than they do should get help to pay for insurance, but they, because they are the poorest, are on their own. It’s becoming embarrassing for lawmakers to continue to oppose expansion.

https://bangordailynews.com/2013/06/12/opinion/editorials/irrational-gop-threatens-medicaid-expansion/ printed on April 17, 2014