As long as he’s been in office, Gov. Paul LePage has been fighting a war on health care for the poor, slashing MaineCare rolls and repeatedly refusing to expand publicly funded coverage for the uninsured.

The cuts have forced Mainers in need to turn to hospitals for care, but now these institutions are in the LePage administration’s cross hairs. Department of Health and Human Services officials are advocating MaineCare reimbursement cuts that could further shred the safety net and leave poor Mainers out in the cold.

LePage’s proposed DHHS budget calls for reducing the rate at which it reimburses hospitals for services to MaineCare recipients. Primary care, mental health and substance abuse treatment and other outpatient services are most threatened.

Maine’s hospitals already are pressed to cover costs. Their annual charity care expenses have shot up over the past four years from $33 million to $44 million, as tens of thousands of Mainers have lost MaineCare benefits. The state’s decision not to accept federal funds to expand MaineCare eligibility has aggravated the situation.

Another financial challenge: Unlike their peers in private practice, primary care doctors who work for hospitals must accept MaineCare recipients. Because MaineCare reimburses at a lower rate than private insurance, hospitals make less of a profit from seeing publicly funded patients.

Further cuts in reimbursement rates may drive hospitals to reduce staffing and cut back primary care and behavioral health services for low-income patients. And given that at least 80 percent of Maine’s primary care physicians are employed by hospitals, it might be difficult for a MaineCare recipient to find another primary care provider.

Supporters of reimbursement rate cuts say their priority is to eliminate the waiting list for residential care for needy senior citizens and developmentally disabled adults. The waiting lists were invoked repeatedly by opponents of expanding MaineCare eligibility, and this argument is no more believable now.

The governor and his allies are offering a false choice: Reduce hospital reimbursements, or provide services to the elderly and disabled. There are other options, such as reviewing tax breaks for large corporations and abolishing those that don’t create jobs. Lawmakers also should look skeptically at the governor’s proposal to eliminate the state income tax.

What they shouldn’t do is pass as presented a proposed DHHS budget that helps one group of vulnerable Mainers only at the expense of those who are just as much in need.


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