June 21, 2018
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This Medicaid expansion episode has come to a close — and logic didn’t prevail

Kevin Bennett | BDN
Kevin Bennett | BDN
Governor Paul LePage gives an interview with a Canadian TV station prior to offering opening remarks at the Maine Tourism Conference at the Cross Insurance Center in Bangor on Wednesday, March 19.


As the Maine Senate returned to a familiar debate Friday about expanding Medicaid coverage to more than 70,000 low-income residents, state Sen. Emily Cain said the 35-member body had a chance to “celebrate April 2014 as the best month for health care ever in Maine.”

On Wednesday, lawmakers from both parties on the budget-writing Appropriations Committee had agreed to a budget-balancing plan that includes funds to shrink the size of state waitlists of people with intellectual disabilities awaiting state services.

The plan also provided funding to boost payments to Maine nursing homes, which have long been underpaid by MaineCare, the state’s Medicaid program.

Lawmakers, however, didn’t complete the trifecta. The Senate came up two votes short of overriding Gov. Paul LePage’s damaging veto of a bill to expand Medicaid coverage to thousands of low-income parents and adults without children.

The Medicaid expansion plan that lawmakers voted on was itself something worth celebrating. It was a deliberate effort by Republican Sens. Roger Katz and Tom Saviello to craft a bill that included something for both sides of the aisle and that did something important for the state.

It expanded Medicaid. It included measures to control costs in an often unwieldy MaineCare program. The expansion it proposed wasn’t permanent, allowing Maine to end expanded coverage the moment federal funding for those newly eligible for coverage dropped below 100 percent.

The bill proposed a deliberate course of action to design the most effective managed care program possible for MaineCare. And it laid out a similarly deliberate course of action to address the high costs of serving Maine residents with intellectual disabilities.

The reasons for rejecting the expansion just don’t add up.

“The fiscal savings promised by Medicaid expansion and managed care are merely mirages,” LePage wrote in his veto message. “Proponents of the bill tout ‘free’ federal money and unspecified state ‘savings’ with no backup for these claims.”

Review all that has been said about Medicaid expansion in recent months — in Maine and across the country. The only references you’ll find to “free” money from the federal government come from opponents of the expansion putting words in proponents’ mouths.

Of course, the infusion of federal funds Maine could expect to see from expanding Medicaid is not “free.” And that’s precisely a reason why rejecting the expansion is foolish.

Medicaid coverage is expanding to low-income residents in more than half the states as a result of the Affordable Care Act and state policymakers who acted sensibly. As a result, about 2.6 million low-income people are gaining health care coverage.

People in Maine — and every state — are paying for it. Hospitals, in particular, are paying for it. The tax hikes and hospital payment cuts that fund the Affordable Care Act affect every state. The difference in states that aren’t expanding Medicaid is, they’re sharing in the pain without realizing the gain.

But that bit of logic doesn’t matter to LePage. Even if there’s a gain — beyond providing coverage to thousands who need it — there’s no way it can last, apparently. “It is shortsighted to think federal funds will always be available, especially after watching the federal deficit climb and witnessing continual delays and changes from Washington,” his veto message continued.

No one can predict the future, but history can inform it. And there’s no historical precedent for the federal government to reduce state Medicaid funding rates. In fact, federal match rates over time have increased in the aggregate as expansions of the program have permanently raised rates for specific groups of people. During the most recent recession, the federal government temporarily raised rates.

And when the federal government needs to trim Medicaid spending, it hasn’t touched reimbursement rates because governors have demanded the cuts come from elsewhere.

Plus, according to the Urban Institute, the costs of expanding Medicaid represent 1.7 percent of all Medicaid spending by the federal government. To predict that future federal spending cuts will come from that tiny sliver of a $300 billion program, and to use that as a reason to reject expansion, just doesn’t compute.

For now, the Senate’s vote to uphold LePage’s Medicaid expansion veto closes an especially disappointing episode in Maine politics. The bigger disappointment, though, is the thousands of Maine residents who could have had access to health care but will go without due to reasons that don’t hold water.


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