April 3, 2013

Maine Medicaid debate: Cost vs. benefits

Backers and skeptics make their cases on a bill seeking to have Maine cover more people under Obamacare.

By Steve Mistler smistler@pressherald.com
Staff Writer

AUGUSTA – Supporters of a bill to increase publicly funded health care coverage for thousands of low-income Mainers called it a historic opportunity and a moral and economic imperative.

click image to enlarge

Speaker of the House Mark Eves, D-North Berwick, introduces L.D. 1066, "An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding," on Tuesday April 2, 2013 before the Health and Human Services Committee in the Cross Building in Augusta.

Staff photo by Joe Phelan

But opponents and skeptics said lawmakers need only look at the federal government's fiscal problems to know that it is pitching a deal that is too good to be true.

Those were the prevailing arguments Tuesday over L.D. 1066, a bill to make Maine a participant in the Medicaid expansion offered in the federal Affordable Care Act, also known as Obamacare.

The public hearing, one of at least 24 of its kind held in state houses across the country this year, unfolded before the Legislature's Health and Human Services Committee. It further framed the upcoming legislative discussion over a proposal that would provide health care coverage for an additional 55,000 to 69,000 people, according to two studies.

Maine currently has about 130,000 uninsured residents, according to health care groups.

Democrats, doctors, nurses and advocates for veterans and the poor said increasing coverage would reduce Maine insurance costs and yield better long-term health outcomes through preventative care and reduced use of emergency rooms.

Senate President Justin Alfond, D-Portland, and House Speaker Mark Eves, D-North Berwick, both said expansion is a historic opportunity. House Republican leader Kenneth Fredette, of Newport, said lawmakers should proceed cautiously.

"If history has taught us anything, it is that the federal government hasn't always kept its promises," Fredette said.

Supporters' economic argument was buttressed by a recent and key participant in the expansion debate: Maine hospitals. On Tuesday, hospital representatives said expansion would reduce the amount of charity care -- health care that patients either can't or won't pay for -- that they currently provide.

Katie Fullam Harris, the lobbyist for MaineHealth, the group representing Maine Medical Center and 16 other Maine hospitals, said that continuing to provide free care could result in the closure of hospitals or higher insurance premiums.

"We respectfully submit that neither of these alternatives is in the public's interest," Harris said.

Hospitals have been instrumental in states that have chosen to increase Medicaid eligibility, particularly those with Republican governors. The Maine Hospital Association has taken a measured approach to expansion. It did not express outright support until last week.

The association's announcement followed a reaffirmed commitment by the Democratic-led Legislature to work with Gov. Paul LePage on a plan to pay hospitals more than $480 million in outstanding Medicaid reimbursements.

Hospital support for increasing Medicaid eligibility also coincides with the governor's recent receptiveness to explore participation in expansion under Obamacare. LePage has often railed against the federal health care law, calling it a "denigration" of the country's health care system.

The LePage administration is still skeptical.

Part of the expansion would cover "able-bodied" Maine parents who earn up to 133 percent of the federal poverty level -- just over $15,800 a year for an individual, or $26,951 for a family of three. The government says the states will be reimbursed 100 percent of the cost of their coverage for three years, then 90 percent after that.

But on Tuesday, LePage's health commissioner told lawmakers that Maine's decision to increase Medicaid eligibility in 2003 means it wouldn't get the same deal as other states that didn't.

Department of Health and Human Services Commissioner Mary Mayhew said that for about 41,000 parents who were part of the 2003 expansion, the federal government would maintain its current reimbursement rate of 61.5 percent. The remaining cost is paid by the state, amounting to $57.6 million in the next two-year state budget, and that cost won't decrease if the state joins the latest expansion, she said.

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