People serving in divided government have two choices: They can do nothing, or they can compromise and get things done.
We have seen the do-nothing approach from Washington. This week, we will find out what kind of government we have in Augusta.
The issue, again, is whether to accept federal funds to expand Medicaid under the Affordable Care Act, providing health insurance to as many as 70,000 Mainers through 2016. Last year, a similar bill came within two votes in the House of passing over Gov. Paul LePage’s veto, but if a few more Republicans decide to buck the governor and their legislative leaders, the outcome could be different this time.
If that doesn’t happen, Maine will be stuck with a system that puts health insurance out of reach for many of the working poor and shifts cost for emergency care onto those who can pay. Critics of the current Medicaid program — known as MaineCare here — should be concerned that failing to accept federal support now puts more pressure on insurance premiums while doing nothing to lower costs.
What’s new is that Democrats and Republicans are working on a compromise that would accept the federal funds for a limited time. Now lawmakers will have to decide if they are happy with the status quo, or if they want to do something that would cover more low-income workers, control costs through more preventative care and pump million of federal dollars into the state’s economy.
NOT A BOONDOGGLE
The governor, House Republican Leader Ken Fredette of Newport and other critics of MaineCare expansion deride the idea as a boondoggle that would dump money into a system that already is spiraling through out-of-control growth.
They could not be more wrong. It’s failing to expand MaineCare that would be fiscally irresponsible.
At $2.1 billion, the MaineCare budget is huge, but more than half of it is federal money. If Maine agrees to expand under the Affordable Care Act, 100 percent of the new coverage would be paid by the federal government through 2016, and at no less than 90 percent after that. That is projected to equal $388 million over the next three years.
If the federal government offered to pay 90 percent of a road, sewer or port improvement project, the vote to accept it would probably be unanimous. But the politics of health care and social services has created controversy where it doesn’t belong.
Federal MaineCare money would go to doctors, clinics and hospitals in compensation for services. These providers are major employers in the state, and the money they pay in salaries, rent and equipment sustain and stimulate the economy in many communities. If this argument sounds familiar, its because it was the one the governor made last year for using the proceeds of the state liquor sales to pay off the debt the state owed to hospitals.
It applies even more aptly today, because the Affordable Care Act is funded in part by reduction in Medicare reimbursements to hospitals. If Maine refuses to expand MaineCare, Maine hospitals would lose income from one federal program without benefiting from expansion in another.
The Mainers who would be covered under the expansion are mostly nondisabled and childless adults who earn between $5,000 and $15,000 per year as fishermen, loggers, home health care workers, day-care providers and in other jobs that don’t offer health insurance. Giving them a way to pay for preventative care and treatment for chronic conditions such as asthma and diabetes actually would slow the rate of growth in health care spending. Refusing the federal aid would not make it less expensive to care for them when they get too sick to work and become eligible under the current guidelines.
UNINSURED MAINERS GET SICK
The nonpartisan Kaiser Commission on Medicaid and the Uninsured projects that states that do not expand Medicaid will see their spending on the program increase at a faster rate than those that do accept the federal funds. That’s because expanded Medicaid will increase the federal responsibility in other areas such as community mental health treatment, saving the states money.
As Maine Hospital Association President Steven R. Michaud wrote in a recent column in the Portland Press Herald, denying insurance to low-income Mainers does not make their problems go away. “The Legislature is not voting on whether to expand Maine’s population by 70,00 people. These people are here. They get sick now. They require care today,” he wrote. The question is how to pay for it.
Now it is up to the Legislature to answer that question.
Republican lawmakers may not have voted for the Affordable Care Act, but that’s not what’s on the table now. Instead, there is a compromise bill that puts the state in a position to receive the fullest benefit from the federal program.
They have a choice: Show their disapproval for the federal policy, or make the best deal for Maine. We hope they don’t miss this opportunity to govern.