AUGUSTA — A band of health care providers speaking on behalf of the Maine Medical Association urged lawmakers Thursday to reach a bipartisan compromise to expand the state's Medicaid program to cover a larger group of low-income residents.
Doctors and a nurse practitioner speaking during a news conference at the State House said they favor expanding access to health care because it would save lives and money.
Kenneth Christian, an emergency room physician at Maine Coast Memorial Hospital in Ellsworth, said too many Mainers depend on emergency rooms for their medical care.
"When the ill or injured show up at our doors, they get access to the attention and the care they deserve," Christian said. "But as good of a job as we do serving the public, I certainly wish that far fewer Mainers needed to rely on emergency rooms as their first, last and only access to health care services."
Expanding Medicaid would eventually see those individuals flowing into less costly and more efficient primary care practices, Christian said.
Others in the group, including Rhonda Selvin, a nurse practitioner and the associate medical director of Maine Quality Counts, said expanding access to health care could in the long run save money, but more important, it would save lives.
Selvin outlined a list of pilot programs designed to redirect low-income people to primary care practices. But many still seek medical care in emergency rooms, which often leads to duplication of effort or expensive diagnostic tests that may not be necessary.
"Having a CT scan one week and another CT scan the next week doesn't save costs," Selvin said. "And when we don't have providers that have access to this information, these types of patterns will continue. Primary care is the essential place where we need to develop both the communication and the service and the care for our patients, and without access none of these programs will follow through because they hinge on the fact that all of our patients have primary care."
Other speakers said they agreed with Maine lawmakers who support an expansion of MaineCare, but they wanted it to include reforms to help contain costs and create a culture of personal responsibility.
Phil Caper, a doctor with Maine Health Care, said he supported provisions in the bill before the Legislature's Health and Human Services Committee, including co-payments for those receiving Medicaid.
Caper and others in the group said emergency room visits likely would increase in the first few years of an expansion but would decline as people were filtered to primary care practices.
Asked what they would consider a deal-breaker on Medicaid expansion, Andrew MacLean, deputy executive vice president and general counsel for the MMA, said, "There is little we would categorically rule off the table. "
MacLean said the MMA was more skeptical about the concept of managed care.
"In respect to managed care, we would say the devil is in the details," MacLean said. "We are waiting to see more specificity in what might be in a managed-care proposal."
The Health and Human Services Committee on Wednesday tabled LD 1578, the bill that expands Medicaid eligibility in Maine, while they negotiated on various amendments to the measure that might bring in enough conservative votes to pass it.
Republican Gov. Paul LePage has remained firmly opposed to an expansion, saying it would cost Maine taxpayers too much with little improvement to health outcomes. LePage twice successfully vetoed bills in 2013 that would have expanded Medicaid.
In his weekly radio address, LePage said hardworking Mainers would have to foot the bill for expanded Medicaid coverage.
"Welfare expansion will cost $800 million over the next decade, and Maine taxpayers would have to start paying millions immediately," he said.
According to the Affordable Care Act, the first three years of the expansion would be covered 100 percent by the federal government. After that, it would cover 90 percent of the cost.
Dr. Marguerite Pennoyer, an allergist and immunologist, said LePage's own rags-to-riches story may have turned out very different if he had been afflicted with a serious medical condition or illness as a young person.
"Health is fundamental, a prerequisite for anyone seeking to live a productive and independent life," Pennoyer said. "Expanding access to health care is the surest thing we can do to position people for advancement and to help end the cycle of dependency that grips so many."
She detailed LePage's life story of escaping poverty, seeking a higher education, becoming a successful businessman and eventually ascending to the highest office in state government.
"Now imagine a young man from Lewiston who is full of great potential but is afflicted with a chronic but treatable condition like asthma," Pennoyer said. "There are no rags-to-riches story for those who are debilitated by a curable disease. One cannot pick oneself up by the bootstraps when bedridden by a chronic but treatable illness."