Critics of Medicaid expansion, Question 2 on the November ballot, have ignored the success of past expansions in Maine as well as the success of recent expansions in other states. I find these columns disheartening and disingenuous. So, as Paul Harvey used to say, “Let me tell you the rest of the story” on past expansions.
The critics ignore the fact that Maine’s earlier expansions succeeded in reducing uninsured rates for people under age 65 and improved access to health care during one of the worst economic downturns in the country. They want people to believe improved access to health care somehow caused everything from hospital debt to state budget deficits. None talk about the health care crisis Maine and the nation faced at that time.
People were losing jobs and access to employer based health coverage. Medical and health insurance costs were out of control. Charitable care grew. The economy tanked.
All this occurred because the state expanded health care coverage to the poor… Really? I think not.
Yes, more people requested coverage through Medicaid than expected because they no longer had access to health insurance through work and had health conditions that required treatment. Additionally, coverage on the individual market was simply unaffordable.
Expensive emergency room care increased as that became the “normal” way for people who couldn’t afford coverage to be treated. Opponents don’t mention studies commissioned by our own Department of Health and Human Services showing people enrolled in Medicaid had improved access to preventive care, exceeding national benchmarks, and other care, including diabetes testing, at a rate higher than the national average. Improving access to preventative health care helps keep people out of the emergency room and saves money.
The governor often mentions how proud he is that we paid off the hospital debt. I too am proud to have been part of this effort. Once again, expansion opponents mislead readers about factors that caused the debt and falsely indicate we are headed to this same deficit if we expand now.
Opponents don’t mention that the hospital payment and reimbursement system was flawed in the early 2000s nor that the payment system was modified to prevent this large debt from occurring again. They don’t mention the Maine Hospital Association continues to support Medicaid expansion or that hospitals in expansion states are benefiting from improved operating margins and decreases in charity care. Rural hospitals need this expansion to reduce charitable care and survive into the future. Hospitals will benefit, and that is why they support Medicaid expansion today.
Some fail to acknowledge the huge economic benefit of expanding Medicaid, pointing instead to the cost of implementing the program, which is quite modest compared to the return on investment. The Legislature’s nonpartisan fiscal office estimates expansion will cost about $50 million annually, substantially lower than what some critics forecast.
I would be less than truthful if I said expansion would not cost the state money. But for most every dollar spent on health care the state, we will see a $9 return. I’d make that investment any day.
Franklin County, for example, would see an influx of $18 million in new federal funding, with $2.6 million in badly needed resources for our hospital. We are already paying for expansion through the Affordable Care Act, which taxes certain medical services, and through reduced Medicare payments to our doctors, which shifts costs to hospitals. This “money” is supporting other states’ health care expansion — we should bring those funds back to Maine.
Finally, opponents ignore how expansion states are benefiting. They don’t tell you 31 states have expanded their Medicaid programs and none have changed their minds. Interestingly, the majority of expansion states are run by Republicans, including Vice President Mike Pence’s home state, Indiana. Expansion was put in place under his watch as governor, and Indiana has continued the expansion.
Medicaid expansion is critical for Maine, which is struggling economically. It will be good for people who will qualify, most of whom work but in low-paying jobs that don’t offer coverage. It will help our rural hospitals and community health centers stay afloat. It is a sound business decision.
As Paul Harvey said, “now you know the rest of the story.”
Tom Saviello is serving his fourth term in the Maine Senate. He is the Senate chair of the Environment and Natural Resources Committee and also serves on the Agriculture, Conservation and Forestry Committee.
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