December 18, 2017
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Why Maine should expand Medicaid

By Erika Lynn-Green and Howard P. Forman, Special to the BDN
Troy R. Bennett | BDN
Troy R. Bennett | BDN
A woman holds a sign at a rally and lobby day organized by the Maine Peoples Alliance at the State House in Augusta around the issue of Medicaid expansion, Jan. 8, 2014.

Mainers will vote on Nov. 7 on whether to expand Medicaid, Question 2 on the ballot. The referendum would bypass a gubernatorial veto and extend the state’s Medicaid program, known as MaineCare, to qualified adults under 65 with incomes at or below 138 percent of the federal poverty line ($42,435 per year for a family of four), as in the 31 states that have expanded Medicaid under the Affordable Care Act.

Maine has unique challenges as the most rural state in the country. With the specific needs of rural communities and as a relatively low-income state, not taking the additional Medicaid funding clearly hurts Mainers and their health. Medicaid expansion has been shown to have a disproportionately positive effect in rural communities, with the uninsured rate in small and rural towns decreasing 11 percentage points since the Affordable Care Act took effect.

Arguments against Medicaid expansion have relied on unfavorable comparisons to the 2002 expansion in Maine, which was funded by a cigarette tax increase and by tapping into federal Medicaid payments to hospitals that provide care to a significantly higher share of low-income patients. No such burdens exist for the current Medicaid expansion. Opponents also argue that Maine’s insured rate did not change after 2002, but this time overwhelming evidence from Medicaid expansion states shows a decrease in the uninsured rate.

The Maine Department of Health and Human Services has also claimed that Medicaid expansion would not help Maine’s “most vulnerable citizens,” the elderly and children, but rather “only” expand coverage to “ able-bodied, 21-64 year old adults.” First of all, this claim contradicts evidence that Medicaid-expanded states showed a decrease in uninsured children in rural areas by 3 percentage points, which translates to thousands of children helped nationally. There is no reason Maine would not see a similar trend.

Second, everyone benefits from insurance, regardless of vulnerability. Medicaid expansion would benefit everyone: the uninsured, the underinsured, those with Medicare, and those with private insurance, because the expansion ensures the solvency of health care providers. Doctors, nurses and hospitals already provide care to the uninsured and underinsured, and everyone benefits when this coverage is compensated. The Maine Hospital Association strongly supports expansion and has expressed frustration over the gap.

Third, times have changed since 2002. The opioid crisis affects everyone, even and especially “able-bodied” young adults, and continues to get worse. On average in 2016, someone died every single day of opioid abuse in Maine, which was more than twice 2002’s death count. Only five states had a higher opioid-related death rate per capita. Medicaid expansion would cover an estimated 800,000 uninsured Mainers, many of whom are affected by opioid use. More than 75 percent of Mainers who died of opioid-related causes were adults between the ages of 24 and 55, certainly qualifying as a “vulnerable population.” “The services we’re talking about here are essential. If not this plan, then what?” said Jeff Austin, a representative of the Maine Hospital Association talking about opioid addiction.

The Medicaid expansion has significantly impacted the opioid crisis in states that implemented it. Nationally, Medicaid covers 30 percent of nonelderly adults with opioid addiction, making it a crucial tool in fighting the worsening epidemic. Opioid addiction is a long and hard fight, requiring a great deal of support. Uninsured hospitalizations related to behavioral health, including opioid use, decreased dramatically in Medicaid-expansion states. Medicaid covers medications that help with addiction recovery, such as methadone, buprenorphine and naltrexone, as well as naloxone, which reverses potentially deadly opioid overdoses. Not having insurance for hospitalizations or much-needed medication can devastate a family’s finances and health, especially when fighting addiction.

Expanding Medicaid will help stabilize markets for all Mainers, as it has done in other states. In fact, the Medicaid expansion has worked especially well in rural states like Maine. Maine’s health care providers also deserve compensation for the care they currently provide for free to low-income patients. Everyone benefits: from doctors and nurses who can keep doing their essential work to the Mainers who count on compassionate, quality care, regardless of income. Mainers should vote to expand MaineCare on Nov. 7.

Erika Lynn-Green is a graduating senior in Yale College. Howard P. Forman is a professor and physician at Yale University and Yale-New Haven Hospital.

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