AUGUSTA — Officials within the Maine Department of Health and Human Services appear to be working behind the scenes to change the public and political discussion about an expansion of Medicaid.
Email messages, published by the Portland Press Herald, after they were inadvertently sent to the newspaper, suggest DHHS officials may be trying to downplay the controversial Alexander Group study of the state's welfare programs.
The messages sent between Feb. 11 and 14 also suggest a strategy to highlight how much other state departments are being cut in order to sustain the state's existing Medicaid program, MaineCare.
It's a theme that Gov. Paul LePage also emphasized last week when he suggested state agencies were being "cannibalized" by the state's Medicaid costs.
“Because Maine already expanded welfare a decade ago, Medicaid is now cannibalizing funding from all other state agencies,” LePage said in a prepared statement Feb. 13. “That means the state cannot fully pay its 55 percent share of local education costs. It cannot hire more Maine State Troopers or repair National Guard facilities. The state cannot adequately promote fishing and hunting programs or conduct research on our fisheries. It cannot expand job-training opportunities or properly fund programs for environmental emergencies. Everything the State of Maine does is adversely impacted by Medicaid spending. Now liberals want to expand welfare again.”
On Monday, Democratic lawmakers shot back, noting it was income tax cuts passed under a Republican majority in 2011 and signed into law by LePage that were the source of the state's current budget woes.
"This new rhetoric is a clear public relations ploy," Jodi Quintero, the communications director for House Democrats wrote in a memo sent to media Monday. "What’s really cannibalized the state budget is Gov. LePage’s tax cuts for the wealthy."
The emails released Monday also show "Communications Directors" around the state have been instructed to send in guest editorials to Maine newspapers highlighting what is being cut as a result of Medicaid costs.
"We are succeeding on all fronts on getting the expansion message out and the focus on the AG report has died down," DHHS Communications Director John Martins wrote in one message to Commissioner Mary Mayhew, DHHS Deputy Finance Director Sam Adolphsen and the department's Legislative Liaison Nick Adolphsen.
Martins also notes a memo from one of the Alexander Group's analysts, Erik Randolph. That memo apparently defends the group's work but DHHS officials appear to be weighing when they would make it public.
Martins also references a draft news release about the memo noting, "I've drafted the attached release, which is pretty 'weedy' and has some strong quotes in it that may need to be tempered."
In another message, Martins asks for "quotable and reliable" sources on the topic of how many people in Maine would be eligible for a federal subsidy for health insurance, were they to buy it on the federal exchange. Republicans have argued Maine does not need to add 70,000 new people to the Medicaid roles because many of them (those earning above 100 percent of the federal poverty level) would be eligible for a subsidy on the exchange.
It's unclear still how many people that may be but it's a talking point along with the projected cost of the expansion the administration appears intent to tout.
"If we want to message around the subsidies and the $800 million, we can do a release, if we have the data that shows the numbers of those eligible for subsidies and keep the focus squarely on expansion," Martins writes.
The exchange of emails includes a brief response from Mayhew, who notes one of the attachments, "looks good."
The messages also shed some light on how much of the messaging sent out by LePage's cabinet members is first sent through his office for approval.
In one message, Sam Adolphsen asks about the timing of the release and whether they should wait until the "next attack" on the Alexander Group report.
Sam Adolphsen also asks, "Do we need permission from the Gov.'s office, or can this just go?"
Martins writes back, "We will definitely pass this by the Governor's Office before moving forward."
In September 2013, the Rhode Island-based Alexander Group was hired under a $925,000 no-bid contract to do a five-part analysis of the state's welfare program.
The first part of that study, which suggested expanding MaineCare, the state's low-income health care program that's largely paid for with federal Medicaid funds, would cost state taxpayers $800 million over the next 10 years.
The report and the Alexander Group's CEO, Gary Alexander, have been roundly criticized by supporters of an expansion while Democratic lawmakers have crafted a bill to nullify the contract with the Alexander Group.
So far the company has been paid about $184,000 for its work.
DHHS and LePage have been reluctant to release communications about the study and even failed to release the first installment of the report, which tackled the Medicaid problem, until after LePage read it.
Despite Freedom of Access Act requests by the Sun Journal and other newspapers, the first installment of the report delivered to the state on Dec. 16, 2013 — 15 days past the contractual due date — was not made public until Jan. 10, and only after Maine's Attorney General sent LePage a letter urging him to follow state law and release the report.
DHHS also determined it would charge $255 to provide copies of communications about the report that were passed between LePage's office, DHHS and the Alexander Group from Dec. 1, 2013, to Jan. 20, 2014. The Sun Journal sought access to those communications on Jan. 20.
Martins also said it would take the department at least two months to assemble the data.
Hank Fenton, a deputy counsel for LePage's office, estimated the cost of processing the same request at $135. Fenton wrote the "non-binding" time estimate for getting the documents together would be March 28.
A request by the Sun Journal that the fees be waived because the release of the information would be in the public interest was denied by DHHS and the governor's office.
In her message to State House reporters Monday, Quintero also highlighted several key facts Democrats want to emphasize about a Medicaid expansion in Maine including:
* 43 percent of the 2011 income tax breaks go to the top 10 percent of income earners, while the average income tax reduction for 200,000 households earning less than $20,400 in 2013 is $17.
* For the top 1 percent of Maine income earners, or 6,700 households, the average tax break is $2,810.
* Maine’s spending on Medicaid, per recipient, is the lowest in New England and the state ranks 26th nationally.