September 23, 2017
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Medicaid is insurance

Mario Moretto | BDN
Mario Moretto | BDN
Andrew MacLean, deputy executive vice president of the Maine Medical Association, voices his organization's support for Medicaid expansion in a 2014 photo.

Here’s how the federal government describes Medicaid: “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.”

The Maine Department of Health and Human Services lists MaineCare, the state’s version of Medicaid, under the heading of Insurance in a list of DHHS programs. It goes on to define MaineCare as: free or low-cost health insurance for families with children and pregnant women. Under the listing of questions about the program is this query: Who is eligible for this insurance?

Insurance companies, hospitals and medical providers treat Medicaid as insurance. Schools, camps and sports programs recognize Medicaid, or MaineCare, as insurance on the forms parents are required to fill out.

Yet, last week, a group of Maine Republicans, including former party Chairman Rick Bennett, set out to convince the public, and Secretary of State Matt Dunlap, that Medicaid is not insurance. It is welfare, they argued.

Gov. Paul LePage joined in, threatening last week to sue Dunlap if the word “insurance” stays in the ballot question. The Medicaid expansion question, Question 2 on the Nov. 7 ballot, is currently proposed to read: “Do you want Maine to provide health insurance through Medicaid for qualified adults under age 65 with incomes at or below 138% of the federal poverty line (which is now about $16,000 for a single person and $22,000 for a family of two)?” The Secretary of State’s Office accepted public comments on the ballot question wording through Friday.

LePage and the GOP are not confused about what Medicaid is. They just need what they believe is a winning campaign strategy to defeat an expansion of Medicaid at the ballot box. Rather than convince voters that extending health insurance to more people is a bad idea, GOP leadership decided to fall back on the welfare argument, which has helped them win other elections. It is much easier to convince voters not to extend benefits to their friends and neighbors when they think they are getting welfare than it is to convince these same voters to deny health care to these same friends and neighbors. Health coverage will save lives and money. Welfare, the GOP thinking goes, gives people something they don’t deserve.

This is a cynical political move meant, first, to try to convince Dunlap to remove the word “insurance” from the ballot question, which he should not do. Failing that, we expect the GOP to mount an opposition campaign based on the idea that health insurance for the poor is welfare.

It is not.

Most fundamentally, people who are covered by Medicaid don’t receive any of the money. Instead, when they are treated at a doctor’s office or stay in a hospital, the medical provider bills Medicaid (or MaineCare) for the services. Payments are made directly to the provider, as is the case with any other insurance carrier.

Beyond all of this, extending health insurance to thousands of Maine residents who don’t currently have it is the right thing to do. The Maine Legislature has repeatedly approved expanding Medicaid to accomplish this. LePage has vetoed an expansion five times.

Stymied by LePage and Republicans lawmakers who have voted to uphold his vetoes, advocates for Medicaid expansion gathered signatures last year to put the question directly to Maine voters.

Thirty-one states have expanded Medicaid under a provision of the Affordable Care Act to offer health insurance coverage to poor residents who weren’t eligible for Medicaid. In states that have expanded Medicaid, the number of people without health insurance has dropped, resulting in better access to medical care for these newly eligible people. When people can see a doctor more regularly, their health often improves and their medical care is less expensive in the long term. The additional investments in health care have created new jobs and spurred economic growth in expansion states. Maine was expected to gain $1.2 billion in federal funds over the next two years under legislation that died in the Legislature last year.

This is not welfare, this is a common sense way to ensure that more Mainers have access to health care, which benefits all of us.

 


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