Monday, April 21, 2014
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Gov. Paul LePage
The federal investment would save Mainers money because needy residents would no longer have to get charity care in hospital emergency rooms, she said. That care is often funded through higher premiums for those with private insurance.
The charity care argument could play a significant role in LePage's and lawmakers' decision-making, particularly if it's made by the Maine Hospital Association, the trade group representing the state's hospitals.
Data published by the American Hospital Association shows that uncompensated care – health care costs that hospitals absorb because people can't or won't pay – soared from a total of less than $5 billion to nearly $40 billion from 1980 to 2010.
A recent report by the Portland Press Herald showed that uncompensated care by Maine hospitals has doubled over the last five years, from $94 million to $194 million.
Jeffrey Austin, a spokesman for the Maine Hospital Association, said uncompensated care is a "significant burden, but it's just not fever-pitch like it is in states" with restrictive Medicaid eligibility.
Austin said increased Medicaid eligibility would decrease costs for uncompensated care, but hospitals often end up paying for expanded Medicaid programming through reduced federal reimbursements.
"It's great to have more people covered ... but the feds have to get the money for that somewhere, so they're cutting money for hospital payments," said Austin. He said payments to Maine hospitals have been reduced by $900 million over the past 10 years.
Still, Austin said, the association could advocate for the expansion.
White House Chief of Staff Jack Lew, in a recent interview on ABC's "This Week," said he is confident that most states will increase Medicaid eligibility.
"For those few that are slow to come in, they're going to have to answer to people why they're turning this down and why they're letting people go without coverage," Lew said.
But some states are pushing back on that argument. They say the federal government will pay administrative costs, but states will absorb the additional technological and administrative expense of the expansion.
State Sen. Richard Rosen, R-Bucksport, said Maine lawmakers should be skeptical of the expansion.
"The budget gyrations that we've been through since 2008 are a good example of how unpredictable it can be when you start with what appears to be a partnership (with the federal government) and are later left with requirements of being locked into a program," he said.
Rosen said that if Medicaid is going to grow, states should have flexibility to spend the money. His comment echoes GOP support for block grant Medicaid funding, an idea that Democrats fiercely oppose.
Other political factors also cloud the prospect of Medicaid expansion in Maine. Among them: a nationally coordinated effort by Republicans to end Obama's law and his presidency.
Staff Writer John Richardson contributed to this report.
State House Writer Steve Mistler can be contacted at 791-6345 or at: email@example.com