Nuggets from the notebook while wondering if some of Gov. Paul LePage’s proposed cuts in MaineCare will be well received by the federal government …

Last week, the governor told reporters he was confident that the state could pressure the federal government to release the state from a provision in the federal health care law that prevents states from cutting certain Medicaid services.

LePage has said the Legislature would have to pass his $220 million in cuts at Maine’s Department of Health and Human Services before the state can apply for an exemption from the Affordable Care Act provision known as Maintenance of Effort.

Some states have applied for the MOE waiver, but to date the federal Department of Health and Human Services has not granted one.

That and other factors have left some wondering why LePage is so confident that Maine will obtain a waiver. The administration claims that legislative action may compel the federal DHHS to grant the exemption.

The administration has also cited a temporary waiver the state previously received last year.

But a Sept. 2 letter from U.S. Secretary of Health and Human Services Kathleen Sebelius to U.S. Rep. Chellie Pingree, D-Maine, raises additional questions about the likelihood that Maine could obtain what the federal government has thus far refused to grant to any other state.

In the letter, Sebelius reassures Pingree that last year’s waiver was temporary. Sebelius also notes that she was pleased the governor’s biennial budget didn’t include the MaineCare cuts he originally proposed.

Several of those cuts are now a significant part of LePage’s DHHS budget plan.

There’s also a political component.

Republican governors, including LePage, have been railing against the MOE since the 2010 elections swept several GOP governors into power. Their argument, coordinated through the Republican Governors Association, is that the ACA ties states’ hands and forces them to keep unsustainable Medicaid programs.

Earlier this year, 33 governors and governors-elect, including LePage, sent a letter to Sebelius requesting more latitude with the MOE.

“The effect of the federal requirements is unconscionable,” the letter said. “The federal requirements force governors to cut other critical state programs, such as education, in order to fund a ‘one-size-fits-all’ approach to Medicaid. Again, we ask you to lift the MOE requirements so that states may make difficult budget decisions in ways that reflect the needs of their residents.”

Democrats have countered that the RGA attack on the MOE is an extension of Republicans’ attempt to dismantle the federal health care law.

Michaud: No budget, no pay

U.S. Rep. Mike Michaud, D-Maine, is cosponsoring a bill that would halt lawmakers’ pay if they don’t pass budget bills on time.

According to a release from his communications office, Michaud’s “No Budget, No Pay Act” says that if Congress doesn’t pass its budget and all its appropriations bills by Oct. 1 every year, then Congress doesn’t get paid.

The bill apparently excludes the possibility of retroactive pay.

“It’s sad that this bill is even needed, but Congress shouldn’t get paid if they can’t do their work,” Michaud said in a news release. “In this era of dysfunction in our nation’s capitol, this bill would at least put pressure on Congress to accomplish its most basic responsibilities.”

According to Michaud, Congress has passed its appropriations bills on time only four times over the last 36 years. This year it failed to pass its spending bills on time for the 15th straight year.

Insurance overhaul analysis released

An independent group has just released an analysis of the health insurance law recently passed by the Legislature.

Republicans said the law would lower premiums in the individual market, a contention confirmed by the report.

Democrats said the law would jack up rates for rural and elderly Mainers, as well as some small businesses. The report confirmed that, too.

The report predicts lower premiums for 80 percent of the individual market.

It also predicts significant rate changes in the small-group market.

The analysis said the majority of groups will experience less than a 5 percent impact during the first 15 months of the new law. It said 7 percent of small-group members will experience premiums that are more than 10 percent higher than what they would have experienced in the absence of PL 90, the new law.

The study also noted that self-insured product offerings could deteriorate the small-group and large-group (51 to 100 employees) market risk pools.

smistler@sunjournal.com

Copy the Story Link