December 23, 2013

Will study facilitate MaineCare compromise?

Described as controversial yet innovative, a contractor hired by Gov. LePage may be the key to Medicaid expansion in Maine.

By Joe Lawlor
Staff Writer

The roots of a compromise to extend Medicaid health insurance coverage to 70,000 Mainers might emerge from a study being conducted by a controversial Rhode Island contractor hired this fall by Gov. Paul LePage.

Whether State House Democrats and LePage desire to forge such a compromise is unknown and uncertain, as the two sides have warred over Medicaid expansion for more than a year.

LePage and Democrats in the Legislature signaled in October that they could be open to such a compromise, but since then partisan attacks over Medicaid and other issues have escalated, including over the hiring of Rhode Island contractor Gary Alexander, founder of The Alexander Group.

But while controversies have recently followed Alexander, he is also known in some circles as an innovative reformer of government programs.

Could that reputation lead to a “grand bargain” over MaineCare, Maine’s Medicaid program, granting health insurance to an additional 70,000 uninsured residents? Or will recent controversies involving Alexander in Pennsylvania and partisan bickering over the way he was awarded a $925,000 no-bid contract in Maine sink any such chance of compromise?

Alexander supported alternative ways to expand Medicaid in Arkansas, and in Rhode Island, he was known as a competent, well-liked reformer, a University of Rhode Island political science professor said. In Rhode Island, Alexander was instrumental in that state’s obtaining a global Medicaid waiver, which has saved the state about $23 million per year, according to an independent study of the waiver’s impact.

The waiver gives the state more flexibility to design its own Medicaid programs, wringing efficiencies out of the system and making tax dollars stretch further without cutting services.

“He was regarded very highly in Rhode Island,” said Maureen Coakley, a political science professor at the University of Rhode Island. She said the Medicaid waiver, approved in 2009, sailed through the state legislature and was supported by both parties. “It was known as a progressive, innovative program. It wasn’t controversial at all.”

Alexander did not respond to requests to comment for this story.

Alexander, in a $220,000 study for the Arkansas state government, recommended a compromise alternative to Medicaid expansion, although a plan to do so was already in the works. The federal government approved the Arkansas plan this fall.

While Maine has hired Alexander to work on a comprehensive study of state programs that serve low-income residents, part of his task will be to look at how other states have handled Medicaid expansion, including alternative methods like plans approved in Arkansas and Iowa. Half of the states have approved Medicaid expansion or alternative methods.

Medicaid expansion is a key part of President Obama’s Affordable Care Act, but many Republican governors, including LePage, have rebuffed attempts to expand Medicaid, claiming that federal funding will dwindle in future years. Medicaid is a federal program administered by the states, and the U.S. Supreme Court in 2012 ruled that states could opt out of Medicaid expansion. About half of the states turned down the expansion, although some are devising these complicated workarounds.

Alexander also headed up the Pennsylvania Department of Public Welfare for two years before controversies resulted in his ouster in February – such as his charging taxpayers for commuting from Rhode Island to Pennsylvania. Austerity measures that Alexander advocated in Pennsylvania, including cuts to food stamps, public assistance and Medicaid, also stirred controversy.

Pennsylvania last week proposed an alternative to Medicaid expansion, although Alexander was not directly involved in that plan because he had left before it was drawn up, Pennsylvania state officials told the Press Herald.

In October, LePage praised Pennsylvania Gov. Tom Corbett, as well as Arkansas and Iowa, in written remarks, for discovering inventive ways to increase health coverage without expanding Medicaid. LePage also credited Obama for being flexible with states that are looking at alternative models.

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