In this election horse race, the Maine Hospital Association has plunked down its last $2 and is hoping for the best. Whether the landmark settlement to repay millions from Medicaid succeeds will be determined by candidates, and voters, during this taut homestretch toward Election Day.

Next to the campaigns, the MHA has the most to lose, or gain, from the gubernatorial race and the Taxpayer Bill of Rights referendum. Last week, the MHA and the Baldacci administration agreed on a schedule to pay $551 million in Medicaid reimbursement owed to state hospitals.

The agreement calls for $330 million in outstanding Medicaid – or MaineCare – debt accrued since October 2003 to be paid by 2011, while $221 million in current Medicaid underpayments are funded to proper margins in the short term. According to Stephen Michaud, president of the hospital association, the deal stops the bleeding now, and clears the debt tomorrow.

It’s the best accord hospitals could have hoped for. Gov. John Baldacci and the MHA are adversaries, starting with Dirigo Health through the April 2005 expansion of Medicaid. The MHA’s efforts to freeze Medicaid enrollment at that time failed against political will.

And so debt swelled, especially for rural hospitals disproportionately dependent on Medicaid reimbursements. With about 270,000 enrollees, MaineCare serves a full fifth of Mainers.

Enrollment is a problem, but reimbursement is the crisis. Without repayment – or at least a signed agreement to repay – Michaud said some Maine hospitals would drown in red ink. Yet once announced, the settlement was decried as an “October Surprise” to boost Baldacci’s campaign.

“The fact that the governor waited until the last month of his term to address this important issue demonstrates his lack of fiscal leadership,” said Sen. Chandler Woodcock, the Republican candidate for governor, in response. “If paying the hospitals back were a real priority for the current administration, they would have addressed it long before now, a month prior to the election.”

Woodcock might be correct, but criticism of Baldacci should be weighed against the MHA’s guile. The election, said Michaud, was the leverage used to force Baldacci’s hand. Little love is lost between them, so it’s unlikely the MHA would support the governor now, in his time of need.

There were more pressing reasons for the settlement. “At least it pays the bills,” Michaud said.

But it hasn’t. Not yet. A regime change, or TABOR’s enactment, could find this agreement torn up like a losing stub. Sen. Peggy Rotundo of Lewiston, chairwoman of the Legislature’s appropriations committee, told the Bangor Daily News that passage of TABOR would make honoring the settlement “more difficult.”

“If TABOR passes or not, the debt is still there,” Michaud said.

Scuttling this settlement cannot happen. Maine’s hospitals have waited years for reimbursement, and only through the MHA’s tireless politicking has this resolution been struck. The state must honor this agreement, regardless of governor or TABOR, because hospitals are out of options, but not patients.