Lee Myles: Moral, fiscal imperatives to expand MaineCare

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A society is measured in part by how it treats its most vulnerable: its oldest citizens, its poor, and its people on the margin.

Our state’s MaineCare (Medicaid) program, despite multiple challenges, has made sure that Maine’s most economically vulnerable have access to the same basic health services afforded those who have health insurance coverage. These basic health services include immunizations for children less than two years of age, routine care for persons with chronic conditions, screenings and preventive exams to ensure health problems get diagnosed early, and emergency care when all else fails.

It has not been a perfect system, and only covers part of the cost of providing those services. But it has been, and continues to be, a critical safety net for those most in need.

Much has been published about the potential cost of expanding this program. Maine’s spending per Medicaid (MaineCare) recipient has been the lowest in New England, and 26th nationally. With that said, we need to work closer with the state to reduce the total cost of the program and, in particular, better manage the cost of the top 5 percent of MaineCare recipients who currently consume more than 50 percent of the Maine Care budget. In this regard, efforts by the Department of Health and Human Services are already underway.

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The fact remains that individuals and families that do not have access to basic health care negatively impact all of us, whether that be lost productivity for employers, or high health care costs when preventive health services were not timely. It is far better, and less expensive, to treat diabetes before it leads to medical complications or surgery; far better to screen for the lump before it turns to cancer; and far more effective to treat the cough before it becomes pneumonia.

When individuals do not seek care due to lack of basic health insurance coverage, the cost is not saved, but only deferred.

Members of our community who are at high health risk touch us all — at work, at home, in our volunteer activities, or through our insurance premiums. In this, and other states, Medicaid, or our MaineCare, is the safety net to protect those who cannot afford the offerings of the new health exchange or marketplace or the traditional insurance products.

As a health system committed to serving all in our community, we believe there are moral and fiscal imperatives to expand the MaineCare system because it will allow thousands of our friends, neighbors and relatives to obtain the care they need.

Expanding MaineCare is an opportunity for us, as a community, to do what is right for each other to develop a healthier community. The Affordable Care Act envisioned that states would expand their coverage for residents with additional funding from the federal government.

Our state is at an important crossroad and seems to have taken the position that we can’t count on the federal government in the future, and that the program will simply be too expensive going forward.

Those are valid concerns, but do not outweigh the daily reality of sick families seeking care from providers.

Health care policy must protect life and human dignity; expanding MaineCare in this state does that.

Businesses, health care providers, hospitals, insurance companies and private individuals have voiced their support for this direction.

At the same time, we need to commit our efforts to redesigning a MaineCare program that creates incentives for patients to see providers for preventive care and also seek care in lower cost settings for non-emergent needs.

Key to the future success of the MaineCare program will be reduced enrollment through better job creation, more participants on the health exchange and healthier communities.

With that said, shared responsibility and accountability of MaineCare recipients for their use of resources and personal health awareness will make the ultimate difference as to whether the MaineCare program continues as it was intended — to be a safety net for those most in need.

The more we all take greater responsibility for our own health, the more likely that current resources can be better utilized for other vitally important community needs.

We respectfully ask the Maine Legislature to consider the diverse range of voices that support expansion and pass meaningful legislation this session. St. Mary’s is committed to working with the Legislature, the governor, providers and everyone interested in the care and well-being of our community to make this a good decision.

In that regard, we will continue to be an unwavering champion for those most in need.

Lee Myles is president and CEO of St. Mary’s Health System in Lewiston.

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