4 min read

We all need to know exactly what happened in the U.S. House of Representatives the night of May 21.

Based on false ideas that the safety nets of our society must be “reformed” and rid of their “fraud, waste and abuse,” and that diverting huge amounts of our nation’s wealth from the poor and middle class to the very wealthy, through tax cuts, will invigorate the economy, the Republicans very narrowly passed a budget bill that will seriously hurt Mainers and people throughout the country. The bill now goes to the Senate.

The claims of Medicaid (MaineCare) fraud are, themselves, fraudulent. Repeated studies have found that while there is fraud in Medicaid, it is largely by dishonest care providers and corrupt businesses — not by patients or families somehow cheating and enriching themselves at the public’s expense, or “able-bodied” people choosing to cheat rather than to work.

Those of us practicing medicine in Maine see many people on Medicaid, and these are disabled, poor and often very young. The largest age group of those on Medicaid in Maine, 28% of the total, are ages 0-18. They also include those on the Affordable Care Act, or Obamacare — usually working but not able to get insurance through their jobs.

To understand the calls for MaineCare reform, I contacted the office of Maine House Minority Leader, Rep. Billy Bob Faulkingham, and asked for information about such fraud. I did not receive a reply.

It’s remarkable that one of the loudest voices about Medicaid fraud is Sen. Rick Scott of Florida. Scott was the president of Columbia/HCA, the country’s largest for-profit health care company, when it was found guilty of fraudulently billing Medicaid and Medicare, guilty of 14 felonies and fined $1.7 billion.

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Scott was forced to resign by the board of directors, but he left with a golden parachute of $9.8 million and stock worth $350 million. He’s one of the wealthiest members of Congress and one who will benefit from the tax cuts that the safety net cuts are intended to support. He is indeed an expert on Medicaid fraud!

Despite claims not to touch Medicaid, Medicare and Social Security, the Republicans’ bill cuts safety nets through indirect ways. We know that by increasing the burden of maintaining Medicaid eligibility, the number with insurance will decrease. Even in the world of commercial insurance, there has been interest in decreasing the burden of periodic re-enrollment as a way for people to continue health insurance more consistently, without gaps — which leads to better health and lower medical costs. Increasing red tape and other barriers is a devious way to decrease the numbers on Medicaid. Another twist on the idea of Medicaid fraud?

The nonpartisan Congressional Budget Office estimates that the proposed changes to Medicaid will lead to 7.6 million Americans losing Medicaid. Since most of these will not be able to obtain other insurance, the number of uninsured will soar — many becoming more ill and requiring more medical costs.

The Medicaid changes will “save” $625 billion over the next decade, shifting wealth to allow tax cuts to the wealthy.  More uninsured people — including more children — means that more will progress to more advanced disease and will cost all of us more. Treatable illnesses will go untreated. More clinics and hospitals will close. People will die of treatable illnesses.

My pediatric and child and adolescent psychiatric colleagues and I anticipate that access to mental health care for the young will deteriorate — when we already have a “youth mental health crisis.” Our voices will not change the priorities of the current administration, but we can speak up about the consequences of bad government decisions. The Maine Chapter of the American Academy of Pediatrics and the Maine Council of Child and Adolescent Psychiatry are developing a process to monitor and make known the consequences of these assaults on access to health care.

We will monitor data on the number of young people with mental health crises being sent to hospital EDs, being managed by law enforcement, or requiring foster care because of the difficulty of finding mental health and substance abuse treatment for their parents. We will track the burden on primary care offices in managing these needs, and we will hold focus groups of health care providers and parents regarding the services that are needed but not available. We will report what we learn to the public, to health care policy leaders, and to political leaders.

Our goal is to make the effects on Mainers visible and known, not obfuscated until they appear in future statistics. We all need to know what is happening, and who is responsible, so that we can rebuild when sanity and genuine — not fraudulent — governance returns.

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