June 18, 2018
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Medicaid expansion disaster has a clear alternative

Contributed photo | BDN
Contributed photo | BDN
Alex Willette, R-Mapleton, is assistant Republican leader in the Maine House.
By Alexander Willette, Special to the BDN

An alternative to Medicaid expansion is staring us directly in the face.

There is a debate raging in Maine over whether to sign state government up to help foot the bill for the largest-ever expansion of medical welfare in the state’s history. As part of Obamacare, the proposal would add 70,000 to 100,000 able-bodied adults to the Medicaid rolls at a cost to the state of $800 million over the next decade. There are currently 1.8 working Mainers for every Medicaid recipient. With expansion, there would be 1.3.

Maine has expanded medical welfare coverage repeatedly over the years, creating a massive hospital debt, annual budget shortfalls, and leading to tax increases and funding cuts to other state programs. This paper even referred to Medicaid shortfalls as ” a tradition in the Maine State House.”

The latest Medicaid-induced budget shortfall — this time $119 million or more — recently hit the news on the same day that Democrats were advocating the expansion of the very program that caused it.

Not only have past expansions of the broken welfare program cut a swath of fiscal disaster through Maine’s economy and budget, but they have grossly under-delivered on their promises.

Proponents, then and now, have said Maine hospitals would be burdened with less “charity care.” Charity care has nearly tripled since the last expansion.

They said fewer people would rely on expensive emergency room care. Multiple studies show that ER usage actually increases with Medicaid enrollment, by as much as 40 percent.

Perhaps the most devastating cost of expanding medical welfare to tens of thousands of able-bodied adults has been the neglect of those whom Medicaid was originally intended to help: The elderly and severely disabled. There are 3,100 Mainers with severe disabilities on waitlists for home care and our nursing homes are underfunded by some $30 million per year.

These needy Mainers should have been taken care of all along, but politicians cared more about throwing more people on the dole than taking care of the needy few. Now they want to do it again, and if they succeed, Maine’s elderly and disabled will likely never be prioritized in the state budget.

There is something severely wrong with that.

If Medicaid expansion under the Obamacare law is not a viable option, some say, then what is the alternative to get coverage to the low-income, able-bodied adults who are currently without it?

Republicans want to see everybody insured against catastrophic illnesses that all too often lead to bankruptcy and devolving health problems. That’s why we reformed Maine’s broken health insurance regulatory framework in 2011, leading to 70 percent rate decreases for individual policies and dramatically lower premiums for small businesses.

Taken as a whole, Obamacare is a major burden on the middle class and small businesses that will cause great damage to our economy and health care system. One redeeming quality of it, however, is that there is an alternative to Medicaid expansion built into the law that keeps the Obamacare virus contained within the federal government.

Turns out, roughly half of the people who would be eligible for expanded Medicaid at great cost to the state are already eligible for heavily subsidized private health insurance on the exchange.

These are plans that cost just $4-10 per week for low-income people who otherwise would have been eligible for expanded Medicaid. The plans cover preventive care and 94 percent of total costs.

The other half of these able-bodied adults would be eligible if they earned more than $220 per week. That’s 30 hours per week at minimum wage. For once, there’s an incentive to work in our welfare system!

And let’s remember who the Medicaid expansion population is. They’re all able-bodied and they’re all 19-64 years old. About 60 percent of those who received Medicaid during the last expansion more than a decade ago were under the age of 45, 60 percent were male, and 75 percent were single.

Our state’s welfare system can’t be all things to all people, and at some point, those who can provide for themselves, must. There is already a path to near-free coverage for low-income, able-bodied adults, and that makes it extremely difficult to ask Maine taxpayers to pay for another welfare expansion. Welfare should not be a goal; it should be a last resort.

It’s especially difficult to look the 3,100 neediest Mainers who are languishing on waitlists in the eyes and tell them that an able-bodied young adult has cut them in line.

One fiscally conservative citizen who spoke at Medicaid expansion’s public hearing equated the measure to the definition of insanity. Maine keeps doing the same thing over and over again, expecting different results. Let’s do something different this time.

Rep. Alexander Willette of Mapleton is the Assistant Republican Leader in the Maine House of Representatives.


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