The proposal by Gov. Paul LePage to eliminate health care coverage for extremely poor adults is shortsighted, and will result in a significant shift of costs to our communities and hospitals. More importantly, it will lead to increased suffering and shorter lives.

Under current law, Maine offers limited MaineCare coverage to about 18,000 poor adults without children. There are another 16,000 people who are on a waiting list who are eligible but don’t receive services.

To get care, they have to have income of less than $11,000 per year, leaving no doubt that they are unable to pay for health insurance on their own.

Despite the political mythology to the contrary, they are often sick and face significant health care challenges that limit their ability to function.

Along with University of Maine Professor Sandra Butler, I helped to compile the qualitative research for a report by Maine Equal Justice Partners that look at this program and the people it helps.

After reviewing the statistics, it’s clear that without proper and timely access to health care, they are in serious trouble. Sixty percent of them are 35 years old or older.

Of those who have sought medical attention, 47 percent have been diagnosed with a disease or cancer, 24 percent have been diagnosed with a mental disorder and 11 percent were treated for injury or poisoning.

By and large, they are not healthy people. They need consistent medical attention to manage their conditions.

As part of our research, I reviewed a sub-sample of actual MaineCare cases and used my experience as a doctor to try to predict what would happen to these people if they lost access to health care.

The prognosis is not good.

In one case I reviewed, a woman in her 50s, “Debbie,” has lung disease, which causes her to feel out of breath most of the time. She also suffers from high cholesterol, depression and gastro-esophageal reflux disease. Her medications cost more than $250 per month, which is a substantial portion of her income.

Without her medication and regular treatments, Debbie will be a frequent patient in the emergency room. Her condition will likely deteriorate and her shortness of breath will worsen.

Shortness of breath is terrifying and emotionally draining, which is likely to make her depression worse. If she loses coverage, Debbie could be facing hospitalization.

In another case, Carol suffered a heart attack in her early 30s. Now in her mid-40s, she is diabetic, has high cholesterol and struggles with depression. But she also balances a job and being a full-time caregiver for her elderly mother who has had a stroke.

MaineCare allows Carol to make regular visits to a primary care physician and helps with her medications. She needs ongoing care to prevent disability and serious health consequences. Her medical management is crucial to preventing further disability. Without it, she will have more rapidly progressive cardiovascular disease and could also suffer from complications from diabetes, including kidney failure. As her health declines, she will be less able to work and to care for her mother.

Whether we’re talking about mental health issues, heart disease or drug addiction and substance abuse, regular, well-managed care is the most cost effective approach. Frequent emergency room visits and hospitalizations cost Maine citizens more — and ultimately may cost their lives. Uninsured adults with common chronic conditions, such as diabetes, heart disease and asthma, suffer a significant gap in medical care. If they don’t have the money or access to insurance, they don’t get the care they need. They get sicker, they can’t work and they have a higher risk of mortality.

Eliminating health insurance for this population won’t make their health care needs go away. Instead, it will make it much more difficult for many people to regain their health, maintain employment or return to the workforce.

Policy makers face many hard decisions, but before they decide to eliminate this program they should understand the implications.

For many, such a decision would mean that their lives will be shorter; that they won’t be able to work or care for their families; and that they will rely on the most uneven and expensive means to get care, but only when it becomes an emergency.

Many low-income adults will pay a terrible price for such a policy decision.

Dr. Laurel Coleman is an attending physician in geriatrics at Maine Medical Center. She is board certified in internal medicine, geriatrics and hospice/palliative care.


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