June 21, 2018
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Medicaid expansion: A ‘no brainer’ for Mainers

By Robert Allen and Noah Nesin, Special to the BDN

This month our Legislature is revisiting the question of Medicaid expansion.

When the Affordable Care Act was passed by Congress in 2010, the law required all states to expand Medicaid to cover low-income people ages 21-64. (These are people with incomes below 139 percent of the federal poverty level, or up to $15,856 for a single person.)

Those low-income individuals under 21 are already covered by Medicaid (MaineCare, as it’s known in Maine) and almost everyone over 65 is covered by Medicare. Because of this requirement in the law, the Affordable Care Act Health Insurance Marketplaces were not set up to deal with this group. Congress and President Barack Obama reasonably believed that providing 100 percent federal funding for the first three years of Medicaid expansion (gradually dropping to 90 percent funding thereafter) would be an adequate enticement for states to expand this vital health insurance coverage for some of our most needy families.

Unfortunately, when the Supreme Court made Medicaid expansion optional, politicians in a number of states opposed to the Affordable Care Act — including here in Maine — defied common sense and thwarted attempts to extend health coverage to those who can least afford it. The result is a gaping hole in Maine’s safety net that leaves some without health coverage and others footing the bill for care when the uninsured need it.

Last year, our Legislature passed a bipartisan MaineCare expansion bill, which Gov. Paul LePage then vetoed. When the Legislature fell a handful of votes short of overriding that veto 75,000 Mainers were left with no coverage.

In other words, a huge hole has been created in Maine’s safety net to ensure humane treatment of all of our residents regardless of income. Many of these 75,000 people will seek care in hospital emergency rooms. Hospitals in Maine, after all, do not turn people away for inability to pay, but ER visits are expensive, and unnecessary testing and avoidable hospital admissions may follow.

Who pays for these costs? You do. Why? Because when hospitals provide free care they are forced to raise their rates for everyone else who does have coverage. This results in higher premiums for businesses and individuals and, as many have experienced, insurance plans with higher deductibles. But when Maine people have health coverage, the costs for everyone will ultimately go down.

Although legislators are properly concerned with cost, if MaineCare is expanded Maine will receive $250 million a year from the federal government.

Some argue that covering more of Maine’s poor with MaineCare will result in unnecessary ER visits by the newly insured. While this may occur early in the process of expanding coverage, once people have access to a primary care medical home, the rates of ER use and avoidable hospitalizations should drop. That has been the experience in Massachusetts, where a similar law has been in place for several years. And we know from studies that people who get regular preventive care and proper management of chronic diseases have better health outcomes at lower costs.

Fortunately, thanks to leadership from Maine Quality Counts, the Maine Primary Care Association, the Maine Health Management Coalition, and the Department of Health and Human Services, Maine has a strong network of patient-centered medical homes, and these practices provide comprehensive primary care as well as behavioral health services. Some, such as Penobscot Community Health Care in the Bangor area, provide evening and weekend hours and walk-in care. In our case, this has resulted in decreased rates of ER use by our patients.

Finally, let us not forget that Medicaid expansion would bring into Maine $250 million in federal funds a year and approximately 3,000 jobs in health care and related areas.

So talk to your legislator today and encourage him or her to expand MaineCare to provide your fellow Mainers the same access to health care that is already available to those of us who are fortunate enough to have health insurance.

Mainers care about their neighbors and their communities. Medicaid expansion is consistent with those values, and it will result in better care, lower costs and improved access for all.

Dr. Robert Allen is executive medical director and Dr. Noah Nesin is chief quality officer of Penobscot Community Health Care.

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