Friday, December 6, 2013
Good news for Gov. LePage: The Supreme Court's 5-4 vote to uphold the constitutionality of the Affordable Care Act will not mean the end of the republic as we know it.
Even though LePage declared Thursday that "Washington, D.C. now has the power to dictate how we, as Americans, live our lives … and is infringing upon the individual choices that we, as Americans, have in pursuing our own American dream," he can still enjoy a Fourth of July barbecue Wednesday and maybe even take in some fireworks.
Despite what the governor says, America is still free.
What the court's decision should do is motivate states like Maine to get off the sidelines and start dealing with the sweeping reform law instead of sitting back and hoping that it will be wiped out by some judicial magic. Maine and the other 25 states that went to court rather than get to work should now be focused on implementing the Affordable Care Act, which is already helping thousands of state residents pay for their treatment and will help thousands more, as more elements of it come into effect.
That, unfortunately, is not how the LePage administration wants to play it. Rather than focus on implementing the law in ways that would make the most sense for Maine, Commissioner of Health and Human Services Mary Mahew issued a statement Friday saying the state's official position will be pretending that we can still wait and run out the clock.
"The language of (the) Supreme Court decision affirms that Medicaid expansion cannot be mandated and that states have the flexibility to manage their Medicaid program without risking the loss of existing matching federal funds," Mahew wrote. That's administration-speak for continuing to cut people off the MaineCare rolls, shifting more costs to hospitals, municipalities and people who pay private insurance premiums, and trying to call it reform.
A more constructive approach would be to take advantage of the structures built into the ACA to improve health care affordability as well as access.
Increasing the population of insured Mainers is important, but is not the entire solution. Providing insurance that people can't afford won't make Maine people healthier, or boost our economy.
Maine should now move ahead and set up its own health insurance exchange to facilitate competition between companies. (This session the Republican-controlled Legislature chose to take no action and accept a cookie-cutter federal exchange instead of designing its own.)
The state also should look at the promising payment reform trials now under way to see if there are elements that can be replicated. Organizations that are paid by the patient and not by the procedure have an incentive to keep people healthy and avoid unnecessary medical costs. Programs that prevent medical errors and infections reduce costs by improving care and should be at the center of the state's cost-cutting strategy instead of relentless attempts to take away people's coverage.
The next election will affect how Maine's government accepts this challenge, but like the court ruling, it will not be the final word. Regardless of the result in November, legislators will work for years designing how the state's programs will fit in the national framework, and all three branches of government will likely be involved in shaping the final outcome.
The court's ruling did not take away our freedom, no matter what Gov. LePage fears. Instead it gave state government an opportunity to make the law work in a way that makes sense for Maine, and state leaders should make the most of it.