MaineCare is performing as the best low-income health care program in New England

Health care reform is on just about everybody’s agenda right now – legislators, health care providers, insurance companies, public health advocates, businesses and individuals alike. As one of the biggest issues facing Maine, and the country, health care is a complex issue that is unfortunately politicized, criticized and often simplified into a stand-off between access and affordability.

Central to health care reform is MaineCare, the state program that delivers Medicaid services to low-income individuals. Of all the components of health care reform, MaineCare is often attacked hardest – especially by conservative groups – and becomes commonly misunderstood by the general public.

Fortunately, a recent national report offers in-depth analysis, instead of unsubstantiated value judgments, which reveals that while MaineCare has room for improvement, it’s quite effective compared to other state Medicaid programs.

The report – released by the Public Citizen, a national nonprofit public interest group – reviewed the effectiveness of all 50 states in providing Medicaid services; MaineCare ranked 13th-best in the nation. The report based its rankings on four components: scope of services, quality of care, eligibility and provider reimbursements.

Maine received its best mark in scope of services at seventh in the nation, the best in New England. We ranked tenth in the nation for quality of care. We can build on these top marks by bolstering services that promote wellness and prevention, a proven method for improving health and therefore lowering health care costs.

MaineCare ranked 18th in eligibility, which should give pause to critics claiming standards to qualify are unreasonably low; the ranking is moderate, especially given Maine’s comparatively low income levels. A common misperception about MaineCare is it’s a handout to the unemployed, and is a disincentive for a strong work ethic.

In fact, more than 54,000 Mainers covered by MaineCare are in the work force, and becoming increasingly eligible to transition off of MaineCare. The program also fills gaps left by employers who drop health care coverage for employees.

Children benefit most from MaineCare, making up nearly 40 percent of all MaineCare enrollees. And more than 25 percent of MaineCare beneficiaries are citizens with disabilities and seniors. MaineCare is renowned for the quality nursing home care it covers.

A closer look at the people who use MaineCare dispels the perception the program is a hand out. Rather, it is a hand up for low-income workers, critical assistance for seniors and disabled, and a safeguard for children.

The state’s only low ranking is in provider reimbursements, at 38th. This is an aspect of MaineCare policymakers are taking seriously, because we recognize quality service is intrinsically linked to quality providers. Gov. John Baldacci has included $9 million in his proposed budget to increase provider payments. And the Legislature’s Appropriations Committee projects we can save $5 million in health care expenditures by providing managed care for individuals with mental illnesses, so their care focuses on quality, not quantity.

We could likely realize further savings by pursuing managed care for all MaineCare recipients. Most important, we must realize it is much more affordable to pay for health care proactively instead of reactively, because promoting wellness reduces demand for expensive, high-level services.

Through these efforts and more, we will create a payment program fair to both providers and taxpayers and ensure we provide the right care at the right price.

While this report acknowledges Maine still has hurdles to clear to reach quality, affordable health care for all, it shows we’re headed in the right direction. Maine has the lowest rate of uninsured low-income people of any state, thanks to MaineCare, which is instrumental in helping every Mainer obtain affordable health care coverage.

The findings of this report speak to the importance of keeping an open mind in reforming health care. It illustrates affordability doesn’t need to come at the expense of access to quality health care.

As Maine comes to understand increased access to quality health care services – especially those that promote wellness and prevention – may lower the cost of health care, we can begin to clear the political obstacles that force health care to be a privilege and make it a right for all.

Rep. Margaret Craven, D-Lewiston, is serving her third consecutive term in the House of Representatives. E-mail her at [email protected].