AUGUSTA – Some services for the mentally ill, unlimited patient visits to rural doctors and gastric bypass surgeries were among the health services on the table Thursday as the public weighed in on Gov. John Baldacci’s plan to cut Medicaid spending by $22 million to help balance the state budget.

The cuts, which will take effect Jan. 20 and require no legislative approval, would:

• Reduce the level of some services, such as rationing the number of rural doctor visits to 10 a year.

• Ax a few medical procedures, such as ear wax removal, gastric bypass surgery and penile implants.

• Cut fees paid to drug stores, doctors, hospitals and other providers.

• Raise co-payments for prescription drugs for the elderly and those with disability needing rides to appointments.

Dr. Roy Miller, who practices in Coopers Mills and Augusta, testified that rationing the number of annual visits that Medicaid patients can make to rural doctor offices is one of the stupidest proposals he has ever heard about.

“I just can’t get over it,” said Miller. Limiting visits to 10 a year would mean the elderly or patients with diabetes would need to be hospitalized more, which would increase costs. “It doesn’t make sense.”

Dr. Michelle Toder of Bangor said she “takes great offense” at the suggestion that gastric bypass surgery is an elective that taxpayers should no longer pay for. Her patients are morbidly obese to the point that diet and exercise doesn’t help. “These people are dying” because of their weight. With the surgery, their health dramatically improves, which reduces their medical costs.

Diane Bechard, president of Maine’s National Alliance for the Mentally Ill, said more cuts to services for the mentally ill would mean more people would bounce from living on the streets to mental hospitals to jails.

Saying it’s unfair to subject Maine’s poorest and sickest to less care and high co-payments, a new coalition of health-care providers and users calling itself “Maine Can Do Better” called on Baldacci to withdraw the proposed cuts.

The governor should fill the $109 million budget gap by taxing advertising, said Betsy Sweet, spokeswoman for the coalition.

“Maine has over 200 tax exemptions – goods or services not subject to sales taxes,” including advertising. “How do you like all the commercials on TV? Wal-Mart, drug companies, McDonalds, you know, the ones you hate,” Sweet said.

Removing that one exemption would bring in $31 million, enough to cover the cuts Baldacci is proposing to the MaineCare program, Sweet said.

“That’s not an option,” governor’s spokesman Lee Umphrey said Thursday. “The governor doesn’t want to go there. He wants everyone to work together to manage care and costs.”

Sweet said the cuts would be “devastating” to individuals and programs that provide services. “In the past two years in mental health alone we’ve suffered $90 million in cuts, and in Maine Care and mental retardation there is no more to give without doing grave harm to our people.”

The cuts include a $2.5 million reduction to the Drugs to the Elderly program, which means many seniors would have a higher co-pay or pay 30 percent of their drug costs instead of 20. That’s unacceptable, said John Carr of the Maine Council of Senior Citizens, adding he fears that seniors would not be able to afford to fill their prescriptions.

Speaking to reporters Wednesday, Trish Riley, director of the Governor’s Office of Health Policy and Finance, acknowledged that the cuts are painful, but that the administration must be responsible to taxpayers.

“We have $109 million we have to recapture between now and June.” Of that amount, less than one-fourth is being cut in health care, she said.

Riled noted the governor did not reduce eligibility requirements, which would have removed some people from state health care coverage, but instead tried to reduce costs. “We’ve tried to mitigate the pain and share the burden,” she said.

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