July 19, 2018
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Maine has spoken on Medicaid expansion. It’s time to honor the result.

George Danby | BDN
George Danby | BDN
By Steve Bien, Special to the BDN
Updated:

The people of Maine have clearly spoken on Medicaid expansion. The question now is whether the Legislature will act in our behalf or play politics with the result.

Medicaid expansion passed by an overwhelming 60-40 margin, but already the governor and his followers in the Legislature are working hard to throw sand in the works. They are trying to convince us that getting $500 million in federal money annually is not worth the state chipping in $50 million. Much as he was willing to stiff job training centers because it did not sit well with his ideology, the governor seems committed again to put political dogma over public benefit.

The immediate beneficiaries of Medicaid expansion will be the approximately 70,000 Mainers with incomes between 101 percent to 138 percent of the federal poverty level. Those winners are not hard to identify, but the rest of us also have serious skin in this game. An inconvenient truth is that Maine’s health care system has been in a state of decline over the past several years.

[Chellie Pingree: LePage can’t veto Medicaid expansion this time]

Serious warning signs are not hard to find: First and foremost is the dire financial straits of Maine’s hospitals, especially smaller, rural hospitals on which many rural communities depend. Maine hospitals are in trouble because they are footing the bill for so much uncompensated care. Five of seven of the state’s health care systems lost money last year; 19 of our 36 hospitals are in the red; and our 23 rural hospitals are in serious financial trouble.

To stanch the red ink, many of those hospitals have cut services like obstetrics, pediatrics, or emergency room and intensive care unit staffing. Others, like Franklin Memorial Hospital in Farmington, have given up their independence to become part of larger health systems. Faced with rising costs and declining populations, Calais Regional Hospital closed its obstetrics unit in May, Penobscot Valley Hospital in Lincoln closed its unit in 2014, and Blue Hill Memorial in 2009.

Cutbacks in services like these are severe enough, but if this situation continues, some hospitals in the state will close, and the closure of a hospital can be a death knell for a town. All of these forces combine to drive the next concern: the rising infant mortality rate.

The infant mortality rate is widely regarded as one of the most important measures of a community’s health. This is because it reflects so many community features such as insurance coverage and availability of care, quality of care, maternal nutrition, general maternal health, and child health in the first year. In the early 1990s, Maine had the lowest infant mortality rate in the U.S.; now we have fallen to 31st. Many factors contribute here, including maternal health and nutrition, child and family poverty, and general adult health.

Not all of this improves with health insurance, but some of it certainly does. If the health of the adult population is in decline, as it has been in the rural counties like mine, the infant mortality rate goes up, and it has.

[Maine’s voters say they want to help low-income residents. LePage still won’t budge.]

Finally, there is the the tidal wave of Maine’s opioid epidemic. With more than one Mainer dying a day from an opioid overdose, there are few treatment resources, and the number needing but unable to get treatment continues to rise.

In Maine, about 8 percent of babies are born with a drug withdrawal syndrome, and nearly 10 percent of our 18- to 25-year-olds are in need of addiction treatment. While 15,000 Mainers are in treatment for substance-use disorder, the number in need of treatment is probably much higher.

Opioid-related problems are an increasing percentage of emergency room visits and hospital admissions, yet hospitals are forced to eat these costs, draining vital resources from other areas. We have no hope of catching up to this problem without expanding access to health insurance and treatment.

The governor and some in the Legislature are throwing up roadblocks to implementation of Medicaid expansion as fast as they can think of them. But they have no answers to these problems. Implementation will not solve all of these problems, but expanding access to those 70,000 Mainers would be a major and essential first step.

Having vetoed five bills to expand Medicaid, it is no surprise the governor, who consistently puts ideology over public need and health, promises to do all he can to stop this, too. Will the Legislature carry his water or ours?

Steve Bien is a family physician in Farmington.

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