Medicaid researcher: LePage missed point of study he used to oppose expansion

Posted Sept. 18, 2013, at 6:14 a.m.
Last modified Sept. 18, 2013, at 2:02 p.m.

AUGUSTA, Maine — One of the two researchers who wrote a study cited Monday by Gov. Paul LePage as new grounds to oppose Medicaid expansion took issue Tuesday night with the governor’s contention that increasing access to eligibility would lead to a “sharp increase” in the number of smokers and heavy drinkers on the program.

“We did find that individuals newly eligible for Medicaid under the Affordable Care Act are more likely than current Medicaid beneficiaries to smoke (49 percent vs 33 percent) and to have heavy alcohol use (17 percent vs 10 percent),” Dr. Matthew Davis wrote in an email to the Bangor Daily News. “However, these findings illustrate that this is not about a ‘sharp increase’: there are already clinically concerning levels of smoking and heavy drinking among people who currently benefit from Medicaid. As a primary care physician, I would say that Medicaid expansion under the Affordable Care Act has the potential to bring more people in for medical care who could really benefit from having insurance coverage and having their health needs addressed.”

Davis collaborated with Dr. Tammy Chang on the study, which was published in a recent edition of the Annals of Family Medicine. Their research focused on who would receive health insurance through Medicaid if every state accepts the federal government’s eligibility expansion offer next year.

The study analyzed information found in a survey by the Centers for Disease Control and Prevention. LePage focused on its findings that higher percentages of young men, smokers and heavy drinkers would qualify for publicly funded health care if all states accepted the federal government’s proposal for expanded Medicaid eligibility

In addition to projecting increased percentages of smokers and heavy drinkers, as LePage highlighted, the study showed that the average age of Medicaid recipients under the ACA expansion would go from 39 to 36 and there would be an increase in the number of male recipients from 33 percent to 49 percent of total enrollees.

The same study estimated that the number of obese people on Medicaid would drop from 43 percent to 35 percent and the number diagnosed with clinical depression would drop from 22 percent to 16 percent.

“This study illustrates why we oppose a very costly Medicaid expansion,” LePage said in a release issued Monday. “This expansion of welfare would provide services to a younger population, while depleting scarce resources that are critical to care for those who desperately need assistance. We must ensure our neediest Mainers, the elderly and disabled, are put at the front of the line.”

Davis disagreed.

“Seniors and the disabled remain at the front of the line in Maine and in the United States, through the Medicare program and its connection to Medicaid for poor and low-income seniors, and those who have disabling conditions,” he wrote in the email to the BDN. “It is important for readers to know that the Affordable Care Act does not undermine or unravel the safety net for seniors and the disabled that has existed for the last several generations. Instead, the Affordable Care Act attempts to extend the types of benefits that Medicaid offers to a broader set of individuals who are currently uninsured.”

Davis and Chang also note that expanding coverage to younger, healthier individuals could limit anticipated cost growth associated with broadening eligibility and, importantly, allow physicians to steer patients toward healthier lifestyles or programs that could intervene before smoking and drinking take too heavy a toll on their health.

“While our research indicates that they appear less immediately ‘needy’ in terms of their health status, our study also suggests that they are likely to benefit from better access to health care,” Davis wrote. “After all, if as a country we can help our neighbors deal with unhealthy habits such as smoking and heavy alcohol use, we have a chance to reduce the health care costs of tomorrow when those individuals reach the age when they become eligible for Medicare.”

Expanding the state’s Medicaid program would provide coverage for about 50,000 adults without children in Maine who earn up to 133 percent of the federal poverty level, or $20,628 for a two-person household. The expansion would also prevent about 25,000 parents and childless adults from losing their Medicaid coverage on Jan. 1, 2014.

Davis is a University of Michigan Medical School associate professor who specializes in pediatrics, communicable diseases and internal medicine. He also is an associate professor of public policy at the Gerald R. Ford School of Public Policy.

He said the key conclusion of his and Chang’s research is that “people likely to be eligible for expanded Medicaid under the Affordable Care Act have distinct characteristics than people currently on Medicaid across the United States. In other words, the Affordable Care Act is not about just growing the Medicaid program in its current form. Instead, the Affordable Care Act is likely to provide health coverage through Medicaid to many people who have not traditionally been reached by the program.”

Adrienne Bennett, spokeswoman for LePage, said Wednesday by phone that the governor recognized the study advocated for Medicaid expansion.

“We were using this as a resource,” she said. “We know the authors were intending it to support the other position. We certainly weren’t insinuating that the study had any weight in terms of substantiating our decisions. The governor was simply pointing out who would be receiving taxpayer-funded benefits.”

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