Medicaid expansion needs to happen

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The people of Maine spoke loudly and clearly this past November. The Citizens’ Initiative to expand MaineCare passed by a wide margin and is now the law of the land. However, the deadlines to enact this law are rapidly approaching, and it is time to inquire if the governor and the Department of Health and Human Services are ready to submit a plan to the federal government by the April 3 deadline which outlines the expansion plan.

Keeping this deadline will allow for a smooth transition for expansion to occur by July 2.

It is estimated that 70,000 additional adults, who are currently uninsured, will be covered under the expansion. For those individuals, that means getting medical care that is desperately needed. As a physician, I see these patients every day in my office. The care they currently get is either not covered by any insurance, which means they will be on the hook for paying, or they receive uncompensated (free) care through the hospital, the cost of which the hospital must write off. Neither of these situations is sustainable.

The expansion of Medicaid in Maine, however, does a lot more good than just enabling 70,000 Mainers to have health insurance that they previously did not have. Several studies of states that have expanded Medicaid have demonstrated the benefits for the state as a whole. A recent study in the journal Health Affairs (January, 2018) demonstrated that hospitals in states which expanded Medicaid were 84 percent less likely to close than in states that did not expand Medicaid. When rural hospitals were compared, the change was even more marked. Conversely, unemployment dramatically increased in rural areas (such as the majority of the state of Maine) where hospital closures occurred.

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Another recent publication by Dr. Elizabeth Kilbreth, of the Muskie School of Public Service at the University of Southern Maine, estimates that Maine will see an increase of 6,000 jobs, 4,000 of which are in the health care field with Medicaid expansion. Furthermore, states that have expanded Medicaid have seen a decrease in their premiums on insurance plans on the marketplace, which is certainly something that Mainers who have ObamaCare could use.

Paying for the expansion will not fall to Mainers alone. The federal government will initially cover 93.5 percent of the cost, and then 90 percent by 2021 (and it would stay at 90 percent after that). The nonpartisan Legislative Office of Fiscal and Program Review estimates that Maine will spend approximately $55 million dollars on the expansion in the first year, with the federal government spending an additional $525 million in Maine. In other words, for every $1 that Maine puts into expansion, the federal government puts $9 back into the state. And Maine’s budget is in good shape; there is currently a budget surplus to fund expansion. It is time Maine takes these resources and put them back into the economy with a nearly 900 percent return on investment by the federal government.

Maine’s people need the expansion, which is law under the citizens’ initiative, to occur — not only for the uninsured but also for Maine’s hospitals and the state’s economy.

It is time for the voters to speak out again — to call upon lawmakers in Augusta to push hard to meet the April 3 deadline to enact Medicaid expansion.

Elizabeth Rothe is a board-certified family medicine and sports medicine physician, practicing at Central Maine Family Medicine Residency as a faculty member and for nine years at Central Maine Sports Medicine in Lewiston. She is a member of Maine Providers Standing Up For Healthcare and is a life-long Mainer.

Elizabeth Rothe

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