May 23, 2018
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What a Medicaid expansion would have meant for Maine’s poor adults

Courtesy of the George Washington University
Courtesy of the George Washington University
Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy at the Milken Institute School of Public Health at the George Washington University in Washington, D.C.
By Sara Rosenbaum, Special to the BDN

A May 19 BDN OpEd by Maine House Republican Leader Ken Fredette congratulates opponents of Maine’s Medicaid expansion for a job well done. One can become quite jaded about the news in today’s slash-and-burn political environment. But it is still jarring when a leading elected official charged with protecting the well-being of a state’s population trumpets his party’s success in pushing more than 24,000 of the state’s poorest residents into a health coverage gap, with all of the terrible consequences that can follow.

His self-congratulatory essay over barring coverage for tens of thousands of low-income residents came only days after publication of a major study that examined the impact of Massachusetts’ Medicaid expansion and that offers the strongest findings yet regarding Medicaid’s role in reducing mortality among low-income adults.

I write as someone who has worked to improve Medicaid over the course of my career. I also write as a resident of Virginia, which Fredette invoked as another state in which reform is faltering, largely because of our own version of this deeply disturbing pattern of conduct by elected leaders who appear determined to prevent life-saving improvements in health care for the poor. We are a bigger state; in our case, the coverage gap would approach 200,000 residents. But the human toll of saying “no” to Medicaid is the same, regardless of the number of people whose lives and health are on the line.

The words used by Fredette, like those of Virginia’s Medicaid opponents, are meant to conjure up every negative image that political consultants can dream up. Each phrase is carefully chosen to achieve that special “dog whistle” effect — sending coded messages without having to come right out and smear real people.

For its opponents, Medicaid is not the nation’s largest public health insurance program; instead, it is “welfare” for “able-bodied” “young men” — words that demean and stigmatize Medicaid and the thousands of hardworking people who stand to benefit from its help. But the characterization of Medicaid as “welfare” hits not only those people who would have gained from its coverage but also those who currently receive assistance, including, ironically, the very people with disabilities about whom Fredette professes such concern.

The effort to conjure up distasteful imagery through the use of the “m” word — men — is remarkable. Who knew that providing men with affordable health care was shameful? Expanding Medicaid to help men, in Fredette’s world, is a reason to kill the expansion rather than a step toward ensuring healthy husbands and fathers. Do we imagine that Fredette and others opposed to Medicaid expansion because it might help men ever would expose their own families to the risk of having a father, a husband or an adult son without the means to secure necessary health care?

Another common tactic in Medicaid opposition politics is the false choice. Fredette attempts to invoke the need for long-term care reform as a reason not to insure poor adults. Somehow 26 other states and the District of Columbia — all of which struggle with the immense challenge of making Medicaid work for their most disabled and vulnerable residents — have managed to pursue long-term care improvements and Medicaid expansion for low-income adults. By contrast, Maine has chosen to leave more than $2.2 billion on the table even though it is eminently possible to both expand coverage for the poor and work to improve long-term care.

And then there is the misrepresentation. Fredette claims that the Medicaid expansion is unnecessary and that the “vast majority” of people who need coverage can buy it on the exchange “for just a few dollars a month.” This cavalier assertion is meaningless for the 24,390 people who, according to the Kaiser Family Foundation, are too poor to qualify for subsidies. Eligibility for premium subsidies in Maine does not begin until household income reaches the federal poverty threshold ($19,780 for a family of 3 in 2014). These more than 24,000 people will be turned away simply because their incomes will not meet the exchange threshold. They will be left with nothing.

I hope that both Virginia and Maine will come to their senses; people’s lives literally are on the line. More importantly, I hope that we can move past the tragic situation in which we increasingly find ourselves — one in which senior, elected lawmakers literally take pride in causing this much harm to their own state residents.

Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy at the Milken Institute School of Public Health at the George Washington University in Washington, D.C.


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