The impasse of Medicaid expansion

It seems that state legislators are so enamored with party politics that they have stopped considering what the people want and what is best for Maine. The current argument over expansion of Medicaid is just one of the issues they are bickering over and use as a rallying cry for the faithful on either side. Perhaps it is time for the voting public to step in with a compromise solution that allows for coverage at affordable cost.

Here is my understanding of the past, present and future related to the expansion issue.

First, the history — in 2013, Gov. Paul LePage proposed a bill, later unanimously approved by the Legislature to pay Maine’s hospitals $490 million in outstanding claims past due but unpaid under previous administrations. Of that, $306 million came from the federal government and $183 million came from the state in the form of a new, 10-year liquor contract.

Keep in mind, much of that debt was created by a Medicaid program that was spending much more than the state could pay for due, in part, to previous Medicaid expansion. From 2002 to 2010 the Medicaid population grew by 78 percent while Maine’s general population grew by only seven percent. By 2010, Medicaid eligibility was almost 35 percent higher than the national average. At one point, the numbers included around 361,000 lives covered. The LePage administration has reduced eligibility by making changes, such as removing childless, able-bodied people aged 19 and 20 from eligibility.

They say those who do not understand history are doomed to repeat it — and that would seem to be the argument made by the current administration. But expansion of Medicaid would lead to unfunded care unless the remaining working individuals are taxed even further. The argument is that there are already waiting lists of people not being covered and ignored under expansion, as well as unfunded laws passed but waiting in Appropriations for the money to fund them. (In full disclosure, my employer supports two such bills that will die if not funded this session).

Those in favor of expansion simply point to other countries offering health care to all, or have a rallying cry of people dying without insurance. They also say that because a majority of voters passed a law for expansion, the state has no choice but to do so. But implementation is the responsibility of the Legislature and, thus, there is an impasse.

So how does Maine get to what the electorate may have approved? I have spoken with my state Senator Nate Libby1 about a compromise solution that has three adjustments to full expansion to make it viable.

First, limit coverage to those whose employer either does not offer coverage or whose coverage through their employer would cost more than a percentage threshold of their wages. If the employer can provide coverage without providing a significant hardship to the employee, than that should be the first option. Keep in mind that many of the new enrollees are working at low wage jobs or working part time. Legislators should look at allowing enrollment for dependents when coverage for the employee only is an affordable option.

Second, modify the program to remove some of the non-medical provisions of full Mainecare. Items such as social services, transportation and other issues should not be provided to those who might have more options available to them. In addition, copays should be raised to a level that is still affordable yet saves some money to the program. Moving from a $2 copay for those with no income to a $10 copay for those with limited income is not going to prevent getting good care when needed.

Lastly, after making those changes, the entire expansion could be paid for with the money that could be raised by taxes paid under the new recreational marijuana sales. Use that new revenue to fund the program and not allow legislators to use it on their various pet projects.

Maine should stop trying to be like other places that suffer from high taxation to pay for health care coverage. Both sides need to stop the rhetoric and come up with a solution that requires them to give in a bit for the good of the Mainer who is struggling and needs help.

Stop saying “no” and, instead, say “what if …”

Robert Reed currently serves as chairperson of the Lewiston Finance Committee and a former city councilor. He is the executive director of the Maine Chiropractic Association, chairman of the Looking Ahead Clubhouse Advisory Board in Lewiston and volunteers with local Scouting programs. He lives in Lewiston.