November 21, 2013

Our View: MaineCare study won’t tell much we don’t know

A $1 million review of state programs is more likely to delay real action than facilitate it.

The Alexander Group’s report on Maine’s social service system isn’t due until May 15, but there’s not much mystery to what it will contain.

Gary Alexander, the firm’s principal partner, has a long track record as an ideological warrior in the fight to cut social service budgets, first as state welfare director in Rhode Island and Pennsylvania, and more recently as a consultant, completing a similar study to the one Maine has ordered for the state of Arkansas.

In every state, his prescription has been the same: eliminate coverage and services, beef up fraud investigations and ask the federal government for relief from Medicaid rules.

Since that more or less describes the LePage administration’s agenda since taking office, it’s hard to see why the taxpayers should have to shell out $925,000 to hear the same thing from someone else.

The administration lumps all social programs together and calls them “welfare,” making it sound as if tax money is being used to pay people not to work. The real picture is more complicated.

The annual DHHS budget is $3.4 billion, but most of it, $2.4 billion in state and federal funds, pays for the Medicaid program, known here as MaineCare. In 2010, 72 percent of MaineCare recipients were either elderly, disabled or children. The remaining 28 percent were adults, many of whom have jobs.

Cutting their health insurance won’t make most MaineCare clients more independent. It will just make them sicker. The state has already made it harder for Mainers to get coverage under MaineCare, particularly for parents of eligible children and childless adults, which the governor says will preserve the programs for the “truly needy.” But relatively little of the MaineCare budget is spent on the population he wants to cut.

According to a study by the Muskie School of Public Service, adults make up 28 percent of the program’s roster but account for only 10 percent of the costs. People with disabilities make up 20 percent of the program enrollees but account for 49 percent of the cost.

Cutting non-disabled adults from the program might be good politics, but it doesn’t do much to lower costs and creates expenses elsewhere in the health care system when the uninsured put off getting care.

A better approach would start with accepting federal funds to cover as many as 70,000 Mainers under Medicaid, which is the right thing to do and would save the state money.

More people with insurance would mean fewer cost shifts and better preventive care.

Then payment reforms that address the real cost drivers in the system should be expanded. They include programs where providers are paid for keeping people healthy, not just treating them when they are sick. Public health programs that focus on healthy lifestyles that prevent illness should also be part of the plan.

The way to cut MaineCare costs is by reducing need for the program and being smarter about delivering services.

Maine doesn’t need an expert to tell it where the problems are. It needs Mainers who are ready to work on them.

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