April 11, 2013

Maine Voices: Federal money to expand MaineCare comes with high costs

Anyone who thinks this deal is ‘free’ hasn’t looked at the numbers, or how to serve the most needy.

By HEATHER SIROCKI Special to the Press Herald

SCARBOROUGH — In 2011, as a freshly minted state representative, I was selected to serve on the Health and Human Services Committee, an assignment that provided a deep education on the ongoing problems with our Medicaid system – MaineCare.

This session, I’m back on the same committee, where we are debating the expansion of MaineCare, this time with “free” money from the federal government as part of the so-called Obamacare.

Editorial writers around the state are calling for Maine to take advantage of this federal “windfall” or risk losing out on the bonanza. But the devil, as usual, is in the details.

Consider the existing MaineCare landscape.

Beyond question, we are struggling to meet our current obligations. We owe our hospitals almost $500 million for MaineCare services going back as far as 2009. That’s shameful.

More than 1,000 severely physically and cognitively disabled individuals are still on waiting lists for MaineCare. These are individuals who, by any standard, are deemed very vulnerable; many have to use wheelchairs. Some of them have been waiting more than four years. Again, that is shameful.

We have already expanded MaineCare to the point of unsustainability. These programs were designed to serve as safety nets for the most needy. But now, due to federal regulations, Maine is unable to prioritize our limited resources. We are forced to allow the able-bodied to be served, while those languishing on waiting lists continue to wait. Yes, shameful.

Previous Legislatures made promises that we are now finding difficult to keep. As the federal matching money steadily declines, Maine is stuck holding the bag – an empty bag.

With a projected $313 million Department of Health and Human Services budget hole over the next two years, how do we balance the budget? By digging a deeper hole? Or by continuing the hard work we started two years ago of prioritizing our limited resources to rebuild our safety net for the neediest among us?

In January 2011, when I was sworn in, the 125th Legislature was handed a $1.2 billion budget deficit. We soon discovered that Maine’s waiting lists were long. But, with determination, we were able to remove 300 people from the lists.

The current biennial budget proposes to serve another 85 of these high-need individuals – limited progress, but certainly a huge improvement for the individuals who are now getting help.

Before we all jump to further expand our MaineCare population, let’s take a step back and crunch some numbers, because nothing is free.

To begin with, Maine will need to hire 93 new employees to administer the expanded program at an annual cost of $7 million. After the first three “free” years, the cheapest cost estimate for the newly enrolled 50,000 Mainers will be $45 million, plus the $7 million administration cost – every year.

Additionally, there are two more groups that would be swept in with the expansion at much lower matching rates. The total expansion cost for the first fiscal year (2014-2015) is $101 million. By the 2018-2019 fiscal year, the cost jumps to $134 million.

There is nothing “free” about this deal.

Moreover, the portion of the money that is “free” is coming from the same federal government that is now employing an across-the-board spending freeze known as sequestration.

Our spending remains so astounding that the country is borrowing around $3 billion a day, more than $2 million per minute. If this doesn’t alarm you, I don’t know what will.

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