Gov. Paul LePage takes pride in his business expertise. His decision to restrict access to Medicaid coverage, however, demonstrates how little he understands his responsibility as the chief executive officer of the state.

His claim of fiscal prudence merely shifts costs from one budget center to others without regard to the total costs for the entire health care environment of the state.

LePage is fundamentally naïve because he assumes that the cost of providing health insurance and the cost of providing health care are related, and that Mainers will save money by not providing Medicaid insurance coverage.

Most people who are uninsured eventually will be injured or become ill. Since we rarely allow people to die on the streets, most will get medical care. Generally, they will be far sicker and require more resources provided by health systems than they would have been with regular care.

Those resources don’t materialize out of the air. Hospitals and providers provide the care without compensation. To offset the financial losses, they negotiate with governments for grants provided by tax dollars, raise charity dollars and increase their bills to paying patients and insurance companies. And of course, insurance companies pass the cost of higher bills to the customers by charging higher premiums.

As the state’s CEO, LePage should recognize that investing in Medicaid is prudent management because it helps avoid unnecessary cost by preventive maintenance. His comprehensive view of health care delivery in the state should support wellness and fiscal balance and not unnecessarily shift the cost of care to other agencies, entities or providers. Doing so creates an inefficient health-care market burdened with avoidable excess costs borne by all Mainers. It is shortsighted leadership. It is bad government. I hope the legislature can help him see the light.

Steve Entman


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