Gov. Paul LePage, as all governors before him, is duty-bound to manage state spending and duty-bound to promote Mainers’ common well-being.
The pending crisis to resolve the $220 million debt in the Department of Health and Human Services’ budget pits these duties against one another, and a solution is as imperative as it will be painful.
Most importantly, a solution must be reached quickly.
The Legislature has two months — until April 1 — to resolve the DHHS debt. That’s not an unreasonable date, but we need a solution more quickly.
The DHHS crisis is not a surprise. It has been pounding toward us for years. We’ve not done enough to confront it and it’s unlikely the work will be completed without a deadline. If that were possible, the work would already be done and — clearly — it is not.
Part of the debt solution before the Appropriations Committee includes trimming thousands of people from MaineCare. Unfortunately, taking low-income people off those spending rolls would not eliminate their need for health care. They would stream into hospital emergency departments, unable to pay, and the cost of that care would shift to hospitals, and shift again to businesses and patients fortunate enough to have private health insurance.
Talk about pain.
For the mentally ill who do not choose to seek emergency treatment, there is a very real likelihood they would commit crimes — petty and serious — and be housed in our jails.
No matter how we twist this crisis, we are going to pay for health care for the poor and disabled, and it makes sense to responsibly manage that care in the most efficient, least expensive way possible.
Maine doesn’t have a strong history of doing so.
One pattern driving health care costs is that too many MaineCare patients seek higher-priced health care than necessary, choosing a visit to an emergency room over an appointment at a physician’s practice.
That’s because, although DHHS provides funding, it has not consistently provided advice about what kind of care to seek in specific circumstances. As with the food stamp program, the state provides money but not tips on shopping or eating responsibly.
Why would and how could this agency expect its clients to best manage the public’s money without a little education?
That has to end, and DHHS Commissioner Mary Mayhew has pledged it will, as the agency develops management programs to better educate welfare recipients and more thoroughly track spending.
It’s a plan that makes good sense going forward and demonstrates a commitment to control spending, but it’s nowhere near an immediate solution to the crisis.
Gov. LePage’s proposal to strike entire categories of welfare clients from MaineCare rolls is no solution, either.
Some clients should go, and Maine should push MaineCare eligibility levels closer to federal guidelines, but even if those things are done with utmost care, we won’t come close to filling the $220 million debt gap in two months’ time.
It’s not a popular idea, but if we are treating Maine people for illnesses that are caused by smoking, over-eating and over-imbibing, it makes sense to tax the products that contribute to these illnesses at a level that might recoup some of the resulting health care costs.
Raise the tax on cigarettes at least equal to other New England states. Raise taxes on booze. On sugary drinks. And, yes, on Twinkies and snack cakes of all kinds.
These products are not basic necessities of life, so there can be no social duty to subsidize their purchase or control their cost. More important, when they are over-consumed, we know these products contribute to much of this state’s staggering health care costs in the form of cardiovascular disease, diabetes and cancer.
How much tax is too much?
How much disease is too much?
The Legislature must act fast to swing the DHHS budget into shape without compromising our collective duty to Mainers’ common welfare.
Taxing cigs and cakes is a much better immediate solution than withholding health care from a single eligible soul.
The opinions expressed in this column reflect the views of the ownership and editorial board.