Congress is looking to cut $10 billion from Medicaid in the next five years.

As Medicaid (known in Maine as MaineCare) celebrates its 40th anniversary this weekend, efforts are under way in Washington, D.C., to undo key components of the program that have helped make it so successful. Fortunately, two leaders from Maine will play important roles in determining Medicaid’s future: Sen. Olympia Snowe and former Gov. Angus King. Mainers are looking to these and other policymakers to help keep Medicaid strong and effective.

MaineCare’s accomplishments are impressive. It provides primary and preventive health care to more than 250,000 Mainers, including low-income children and their parents, seniors and people with disabilities. Every day, our neighbors, friends and family members receive help through MaineCare – from comprehensive primary care at community health centers, to community-based mental health treatment that helps them stay employed, to supportive living through residential facilities or home health care.

The result? A healthier state.

For example, Maine has the lowest infant mortality rate in the entire nation, according to new findings by Kids Count (a foundation-sponsored initiative to track the status of children in the United States). MaineCare contributes to this positive health outcome by providing prenatal care to low-income pregnant women.

In addition, MaineCare responds to slow economic times by helping many Mainers who otherwise would become uninsured. Between 2000 and 2003, when many workers lost their jobs and health insurance for those with jobs became less affordable, MaineCare filled the gap. Employer-based coverage for Maine’s children dropped by about 11 percent during that period, but MaineCare coverage increased by 12 percent. Similarly, MaineCare enrollment among adults increased during those years to offset the decline in employer-based coverage for adults.

MaineCare also provides coverage to people who couldn’t obtain adequate health coverage at any price, such as those with chronic and disabling conditions. Private health insurance doesn’t cover long-term care or assistance for people with disabilities, for example, and neither does Medicare. MaineCare handles many of these vital services. In fact, MaineCare provides three-quarters of the care in Maine’s nursing homes.

By providing coverage to those who are too poor or too ill to obtain private coverage, MaineCare reduces Maine’s total health care costs. When people without insurance head to the emergency room for medical help, their treatment costs are passed on to those who pay for hospital services (such as private insurance companies), who, in turn, pass the cost on to their customers through higher premiums. On the other hand, the presence of MaineCare cuts this cost shift because of its reimbursement for their health care services, thereby restoring some balance to the marketplace.

Moreover, numerous studies have shown that coverage leads to earlier interventions and use of preventive services. The care that MaineCare beneficiaries receive, including preventive care and chronic disease management, can help make them healthier and more productive, while also reducing their need for health services over the long term. A recent U.S. Department of Health and Human Services study confirmed that among all insurance coverage sources, the presence of Medicaid coverage had the biggest impact on the reduction of individuals’ utilization of the emergency room. In conjunction with this, health centers’ aggressive case management among those with Medicaid saved the state $4 for every $1 invested.

For rural areas, MaineCare is beneficial in yet another way. More than one-quarter of the people who come to Maine’s federally qualified health centers are enrolled in MaineCare. Often, these community health centers are the only source of health care in the local area, and they depend on reimbursements from MaineCare to stay in business. Without MaineCare, many rural Mainers – whether or not they are enrolled in MaineCare – would have less access to health care.

Now, though, MaineCare – and Medicaid as a whole – is in trouble. Congress is looking to cut $10 billion from Medicaid in the next five years. To help produce these savings, the National Governors Association has recommended weakening key federal Medicaid rules, such as allowing states to cut back on the services that states must provide Medicaid beneficiaries – especially children – and to charge poor people much more for health care. The unintended consequences of this unraveling of the safety net would be higher health care costs and worsening rates of disease among those who most depend on this lifeline.

Sen. Snowe, a strong supporter of Medicaid over the years, sits on the Senate Finance Committee, which oversees Medicaid. Also, former Gov. King has been appointed vice-chairman of a presidential commission created to come up with ways to cut Medicaid. They and other leaders responsible for charting Medicaid’s future have a tough task in front of them. Still, it is critical that they remain committed to maintaining the standards and structure that have made Medicaid’s first 40 years so successful.

Kevin Lewis is the executive director of the Maine Primary Care Association, which seeks to strengthen the safety net and improve access to primary care among the medically underserved and uninsured.

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