BY JOE LAWLOR

Portland Press Herald

Maine has an especially difficult task trying to control the rapidly rising cost of health care, as it ranks fifth among the states for per-capita health care costs, according to 2009 federal statistics.

“We are a very rural state, we are the oldest state in the nation, and older people have higher per-capita health care costs. And we don’t have a lot of competition in our health care markets,” said Mitchell Stein, public policy director for Maine-based Consumers for Affordable Health Care.

Maine’s health care costs averaged $8,521 per person in 2009, the most recent year for which statistics are available from the Centers for Medicare and Medicaid Services.

Some states, including Maine, are devising models to control health care costs that ultimately will determine whether President Barack Obama’s Affordable Care Act can make good on its name.

Millions of people soon will gain eligibility for health insurance under the federal law, adding pressure on the system. States, insurers and medical groups are experimenting with various programs to contain costs without undermining care.

The Affordable Care Act is expected to extend coverage to many of the roughly 50 million Americans who now lack insurance by expanding Medicaid, the state-federal health care program for low-income people, and requiring most others to buy insurance or pay fines.

Maine received $33 million in federal money for a three-year “state innovation” grant to cut down on red tape and improve efficiency and service in Medicare, Medicaid and the private health care market.

The grant aims to reduce waiting room times, improve access to primary care and urgent care centers, and better coordinate doctors, patients and insurance companies, according to the Maine Department of Health and Human Services’ website.

The grant, which runs from 2013 to 2015, also will help the state devise payment models to increase incentives for doctors to spend more time with patients.

While the innovation grant will help, Stein said, working at cross purposes is the state’s failure to approve Medicaid expansion.

While Democrats pushed for covering more people with an expanded Medicaid program, Gov. Paul LePage — like many Republican governors who oppose the Affordable Care Act — vetoed attempts this year to do so. The federal government would have paid for 100 percent of the expansion for the first three years, and 90 percent in subsequent years.

The Affordable Care Act was passed in 2010 with the assumption that states would expand Medicaid. But the U.S. Supreme Court ruled in 2012 that states could opt out of the Medicaid expansion, and Maine decided to forego expansion.

Stein said if the state had expanded Medicaid, more low-income residents would have had health insurance and utilized more cost-effective medical care, such as primary care, compared to costly emergency room visits.

He said the state faces hard-to-change challenges — such as its age and rural character — that will make reducing health care costs difficult.

“In some areas of Maine, there is no competition at all in the health markets,” Stein said.

Meanwhile, the lack of major urban centers in Maine also exacerbates per capita health care costs, Stein said. While many states have large swaths of open land with few people, they also contain cities with much higher populations than Maine’s cities, Stein said. The competition within the health care industry in the big cities works to keep a lid on costs in those states, Stein said.