The insurance program must expand when the economy retracts.
More and more people are losing their jobs in Maine and across the country — and with it their employer-provided health insurance.
Thankfully, some of these households, primarily those with children, are able to fall back on MaineCare — Maine’s Medicaid program — to protect them from the terrible consequence of job loss. Whether it is an unemployed mill worker with diabetes or a chronically ill child of a retail clerk who was laid off from a bankrupt big-box store, few would argue that they should be left uninsured.
Not only would the human cost be too high, but so would the economic cost — a cost that we cannot afford as we try to steer toward economic recovery. Without MaineCare, many more would arrive in the emergency room, unable to pay. Hospitals that currently receive MaineCare reimbursement would receive no reimbursement at all. The costs would be shifted to private insurance. Businesses and their employees — already struggling with spiraling premiums in a tough economy — will bear the burden.
Thus, of all times in history, this is not a time for policymakers to succumb to the position suggested in a recent Sun Journal editorial (May 3, 2009) that MaineCare should manage its budget troubles by cutting the coverage it provides or limiting access to those who “need it most.” Aren’t we coming to consensus as a nation that everyone needs coverage and that those who cannot afford it must have access to needed care?
MaineCare plays a special role in our health care system. When unemployment rises, it’s MaineCare’s job to pick up the unemployed and their children. It is the only health care insurer that must expand when the economy contracts. That’s why the federal government has increased its share of the cost for MaineCare, now paying $3 out of every $4 in program costs through the end of 2010 and bringing over $400 million into our health care system and our economy at time when it is greatly needed.
It is also MaineCare’s job to take on the responsibility of insuring some very high-cost populations that our employer-based insurance system was never designed to cover — low-income seniors and people with disabilities. According to the Kaiser Family Foundation, while these populations make up only 25 percent of our MaineCare enrollment they are almost 60 percent of the program’s cost.
MaineCare picks up the cost of long-term care that is not covered by Medicare and supports nearly three out of four nursing home residents in the state. This is a huge task in Maine, with the third highest percent of people over 65 in the country and the sixth-highest rate of adults reporting a disability.
It is no wonder that in this recession, MaineCare’s budget is especially strained. We all agree that MaineCare must be able to pay its bills and operate in an efficient manner. In this conversation, what has already been done in cost control must not be ignored. According to the most recent data from the Kaiser Family Foundation, Maine did a better job than all but two other states in controlling its annual growth in Medicaid spending between 2004 and 2007. While we must increase our long-standing efforts to care for seniors and people with disabilities in their homes, instead of in more expensive residential care facilities, we do a better job of providing this care at less cost than New Hampshire and most other New England states.
Relatively new care management strategies are beginning to reduce the cost of caring for people with chronic illness such as heart disease and improving the health status of MaineCare members, as well. None of these strategies alone is a quick fix to its immediate budget problems, but they are essential to making MaineCare — and the rest of our health care system — truly sustainable.
MaineCare’s budget difficulties must be understood in light of the entire health care system. It is subject to the same increasing costs as the rest of the health system. Reducing MaineCare’s rolls would shift costs, but would not reduce them. Those left uninsured would still have health care needs. Rather, to control MaineCare’s costs, we must control health care costs generally.
We are making progress at a state level and, fortunately, at the national level the call for health care reform is getting louder every day.

Mary Henderson is an attorney specializing in health care policy, and is currently studying to become an occupational therapist. She lives in Wales.