Gov. Baldacci is faced with another set of uncomfortable choices. The state is facing a budget shortfall of $109 million that must be addressed before June.

He can’t raise taxes. There’s no doubt that work needs to be done on the state’s tax structure. There are too many exemptions, some areas face too-high property taxes, and the highest rate for the income tax kicks in too low. But filling a budget gap with a new tax shouldn’t be an option in our difficult economy. Changes in taxation should be considered in the context of reforming the entire system, not one isolated case at a time.

That leaves cuts in spending.

There’s plenty of pain that has to be spread around, and MaineCare, the state’s Medicaid program, will be hard hit. The governor’s plan looks to save $22 million in the program and can go into effect Jan. 20 without the Legislature’s OK.

At a hearing last week, advocacy groups, pharmacists, doctors and patients called on the governor to leave the state’s poorest and sickest alone.

We agree that balancing the state’s budget on the backs of the poor is harsh. One critic called on the richest nation in the world to do better. We couldn’t agree more. The richest nation should do more. But Maine is far from the richest state. That leaves difficult choices.

With a few exceptions, we believe the governor’s cuts to Medicaid strike a reasonable balance.

The plan would reduce the dispensing fee that pharmacists serving Medicaid patients receive from $3.35 per prescription to $2. This does not include the reimbursement rate for the actual drug. Pharmacies will suffer, and Rite Aid, which has 80 stores in the state, has threatened to close some of them. Pharmacies are squeezed between declining government reimbursements and drug company pricing, but we believe the reduction is in line and necessary. The Medicaid drug market in Maine generates $300 million in sales and accounts for more than 1.7 million prescriptions a year. We believe that market will continue to be met.

The governor’s plan also eliminates coverage for some surgical procedures. Gastric bypass, which for some people is hardly elective, would no longer be covered. Neither would penile implants, newborn circumcision or acne surgery, to name just a few. No doubt, this will create a hardship for the 4,000 or so Mainers who are affected.

Co-payments for prescription drugs will go up for some. But the state’s poorest residents are already protected by federal law, which says Medicaid patients can’t be forced to make co-pays.

The governor also seeks to ration the number of rural doctor visits to 10 a year. This goes too far. A person in serious need should not have to check the calendar to see if they can go to the doctor. This move will lead to increased hospital stays and emergency room visits, which are more costly than doctor visits.

As tough as these are, it could have been worse. States around the country are cutting Medicaid by making it more difficult to qualify for services. Maine isn’t changing eligibility requirements. That’s noteworthy.

Every agency in the government is being cut. There’s $109 million worth of pain to go around and plenty of tough choices. The ax doesn’t stop with MaineCare.
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