AUGUSTA — The projected — and hotly disputed — $220 million shortfall at the Maine Department of Health and Human Services has produced confusing rhetoric and statistics from Gov. Paul LePage and state officials.
At the heart of the debate is an ideological divide between Republicans and Democrats over the scope of the state's Medicaid program.
Republicans have long opposed the expansion of Medicaid — sometimes derided as "welfare" — because they view it as inefficient, government-run health care funded by taxpayers. Democrats, meanwhile, believe Medicaid is a manageable option to provide health care to people who may not be able to buy private insurance.
Keeping those divergent viewpoints in mind may be helpful in deciphering the rhetoric that is sure to increase as Augusta lawmakers continue debating the DHHS shortfall.
LePage has repeatedly argued that MaineCare, the state's Medicaid program, is unsustainable thanks to a nearly 80 percent enrollment increase over the past decade. The statistic, repeated Tuesday by House Speaker Robert Nutting, R-Oakland, was first released in a report by the Maine Heritage Policy Center, a conservative advocacy group that wields considerable influence among the Maine GOP.
While progressive groups question the validity of the MHPC figure, MaineCare caseloads have increased since 2002. Advocates for the poor and elderly link the recent increase to the recession.
The overall increase has been due to the expansion of programmatic offerings in MaineCare, such as health care coverage for childless adults.
The programmatic expansion was overseen by Democrats, who controlled the Blaine House and the Legislature from 2002 to 2010. It has allowed LePage to blame the current shortfall on Democrats.
But according to the LePage administration's own analysis, increased enrollment in MaineCare comprises only about 5 percent of the shortfall for the current fiscal year — about $6.5 million of the $120 million gap.
Also, according to the administration's analysis, the current shortfall was largely driven by a variety of budgeting miscalculations it made last year.
For example, DHHS officials significantly under-budgeted for the state's private, nonmedical institutions. It also didn't sufficiently account for the loss of federal stimulus funds or increased Medicaid premiums by the federal government.
According to DHHS, the biggest driver in this year's shortfall — $29.9 million — is the result of a new claims system that caused benefit payments that should have been settled last year to be paid this year.
That LePage and some other Republicans repeatedly linked the budget gap to increased MaineCare enrollment irks Democrats, who believe it's rhetoric designed to further a narrative that people are moving to Maine to the state to obtain health care.
"There will be a shortfall; we know that," said Rep. Peggy Rotundo, D-Lewiston. "We need to know what the issues are. We can’t be dealing with fiction."
She added, "There’s this myth that this problem has been created by people flocking to the system. That’s not what these figures show us."
Democrats also take issue with LePage's claim that the state has spent more than it can afford on MaineCare. The MaineCare expansion that began in 2002 initially required additional state funding: about $1 billion, according to LePage.
However, according to DHHS, the funding for the program has been largely flat since 2006. The state budgeted $2.24 billion for MaineCare in 2006 compared to the $2.26 billion budgeted for the current biennium. The slight increase was buoyed by an influx of federal funding in the stimulus act.
All statistics and an analysis of the shortfall are available on the DHHS website, but have been largely absent from the public debate.
Democrats wonder if the administration's budgeting calculations were designed to create a crisis that would allow the governor to advance what could be painful policies for thousands of Mainers.
"A skeptic would say that this was thought out; this was created," said Rep. Mark Eves, D-South Berwick. "They want a shortfall, no matter what, so they can carry out their agenda. This is a good way to do it."
Democrats have also argued that LePage's policies would leave 65,000 Mainers without health care and leave many residents out in the cold.
However, Republicans believe there are less expensive ways, other than Medicaid, to help disadvantaged residents. Some, like the governor, believe the GOP's recent overhaul of the state's insurance laws will make private, low-cost health insurance more affordable and accessible.
Others simply are philosophically opposed to Medicaid expansion. In a written statement, LePage on Wednesday described MaineCare as a "taxpayer-funded, government-run health care (welfare) program."
The GOP, in Maine and nationally, is also fearful of the Medicaid expansion called for in the federal health care law. The joint state-federal program is expected to expand with the implementation of the Affordable Care Act in 2014.
Some of the programs that LePage has proposed cutting would be reinstated upon the adoption of the ACA, which will add 16 million people in 2014.
The federal government will pay for full costs associated with the increased coverage for the first three years. However, by 2020, the bulk of the funding responsibility will fall back to the states.