Thursday, April 17, 2014
In the midst of the Vietnam quagmire, Vermont Republican Sen. George Aiken offered some sound advice for handling the war: Declare victory and get out. The president would have been wise to listen.
The same advice works for Gov. LePage on the issue of a pair of proposals linked by legislative Democrats and likely heading his way for a signature. The combined bill would pay back the state's hospitals for previously delivered Medicaid services and accept federal money to expand Medicaid to nearly 70,000 uninsured adults.
Declaring victory should be easy because this would be a big win for the state. It would result in low-wage workers who could never afford to buy health insurance on their own being able to see a doctor. It would lower hospital costs for overuse of emergency departments and bad debt and charity care. And it would spend millions of federal dollars in Maine communities, stimulating economic activity and creating jobs.
GOVERNOR GETS HIS WAY
As big a win as it would be for Maine, the Democrats' proposal would also be a personal victory for Gov. LePage. He would get his way on paying back the entire hospital debt, freeing up federal matching funds, pumping $480 million into the Maine economy. It was an issue the governor campaigned on in 2010, and one he would probably like to campaign on again in 2014.
He convinced lawmakers that the payment should be made in one lump sum and not over time. He got his way on the source of the money to pay off the debt -- a renegotiated liquor contract -- and also the mechanism to raise it, which is a revenue bond.
This could be a rare moment when Maine's divided government shows the nation how parties that are miles apart ideologically can act for the good of the people. We hope Gov. LePage will sign the combined bills, but he has not given us much reason for optimism.
Instead, the governor and his Republican allies in the Legislature are making arguments against expanding eligibility for Medicaid (called Maine-Care here). They are on a dangerous road that risks hurting the very institutions that LePage says he wants to help.
The governor has argued that the people who would receive coverage are, for the most part, single adults. He's right, but so what? They still need health care, and they won't be able to afford insurance on their low incomes. These are, in many cases, people with jobs and people who earn less than $15,856 a year. They don't qualify for public assistance but will almost certainly end up in a hospital someday with no ability to pay.
The governor has also charged that these same people would be eligible for subsidized coverage under "Obamacare" when federal exchanges open at the start of 2014. But this is not the case.
Few people in this income bracket would be able to afford insurance, even with a partial federal subsidy. Refusing to change the guidelines for Medicaid eligibility in Maine would not be choosing one form of health coverage over another; it would be denying them coverage outright.
And the Republicans charge that even if the federal government is paying 100 percent of the added cost in the first three years and no less than 90 percent after that, expansion would create an added cost burden for the state. But they can't back this up.
In fact, the Legislature's nonpartisan Office of Fiscal and Program Review, which reviews the fiscal impact of all legislation, has determined that the state would save money. In addition to insuring new people on the federal tab, Maine would receive 100 percent support for people currently insured under MaineCare, whose coverage now draws a 60 percent federal match.
NOT A BUDGET-BUSTER
That would result in $8.6 million a year for the first three years. Under the Affordable Care Act, the federal government would pay 75 percent of the administrative cost associated with the newly covered Mainers, which is projected to be $4 million.
Maine's share of that cost is far less than the savings, making this a money-saver, not a budget-buster.
Maine people have elected a Republican governor and a Democratic-controlled Legislature. Neither party has the ability to rule without working with the other. Neither will accomplish anything by holding out for all or nothing.
Republicans should stop fighting for a minute and look at the deal they are being offered. It's a good one.
Instead of a compromise where both sides get part of what they want, this is one where each fulfills a major policy objective that would benefit the state as a whole. This is how state government should function.
Gov. LePage should follow George Aiken's advice: It's time to declare victory and move on to other issues.