The expansion of MaineCare remains unresolved, unyielding and unfunded.
Widening the opening to admit another 70,000 to 80,000 recipients of Maine’s version of Medicaid is one of the most contentious battles in Augusta. Proponents of expanding eligibility and inviting more applicants to our MaineCare program are butting heads with Governor LePage, who insists that any expansion — if there is to be one — be properly funded lest Maine endure the budgetary train wreck other states have experienced in the wake of a poorly thought out Medicaid expansion.
Under previous Governor John Baldacci, Maine’s Dirigo Health program — the precursor to MaineCare — consumed 30 percent of the state’s budget and still ended up owing the state’s hospitals over $500 million in reimbursements when LePage took office.
Nevertheless, in 2017 Mainers voted to expand Medicaid eligibility for 70,000 to 80,000 more applicants. Proponents convinced the state’s voters that Medicaid expansion would be good for Maine. LePage and the state Department of Health and Human Services pushed back, demanding that the Legislature provide adequate funding for implementation before pulling the trigger on expansion. Yes, the federal government (still our tax dollars) funds 90 percent of the expansion initially, but the federal support decreases in subsequent years.
LePage has submitted eligibility waiver requests to the federal government, seeking work requirements for applicants younger than 64 and an asset test instead of the simple income-only measurement for applicants. He also is pushing for revocation of the retroactive eligibility component championed by expansion advocates. All but the asset test waiver have been approved by the feds in several other states as the ballooning costs of Medicaid expansion have rocked state budgets in almost all of the other 32 states that have participated in this Affordable Care Act program.
Missing from the expansion process are the steps necessary to ensure that Medicaid costs containment and reimbursement levels match, or, at least come close to matching, so budget numbers can be real. What good does it do to expand eligibility for 70,000 more people if doctors and hospitals don’t want to see these patients because their reimbursement levels for services provided are a fraction of both their cost and otherwise normal charges?
And where are the steps to encourage healthy lifestyles? Most private insurance plans supported by employers provide smoking cessation programs, healthy eating and exercise guidelines, as well as preventive medical care for all participants. Current Medicaid programs do not. Not only do food stamp programs fail to encourage healthy eating, they make it difficult for farmers markets to accept food stamps. These situations call for examination and change. MaineCare recipients need to be part of improved health programs as well as cost containment efforts.
There are larger issues associated with America’s health care delivery, not the least of which is cost. Prices for procedures should be readily available so we can make sound consumer decisions. Must we wait for Amazon to alter the landscape with medicines and processes so that health care becomes more consumer-friendly?
Providing medical coverage for all citizens is a noble cause. Exercising control and restraint on the state’s budget also is a worthy effort.