February 27, 2013

Our View: Federal health-care grant targets the right problem

The money to find new ways to pay for health care could change the system for the better.

Every once in a while, we get some good news from Washington.

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Maine will receive $33 million over the next three years to expand its experiment with health care payment reform.

2012 Press Herald file photo/Gregory Rec

That was certainly the case last week, when the LePage administration announced that Maine would be one of only six states to get a federal grant to implement new programs to lower health care costs through reforming the ways we pay for services.

Maine will receive $33 million over the next 3½ years to expand its experiment with payment reform, including accountable care organizations, group practices that receive incentives to improve their patients' health instead of simply being paid for tests and procedures.

The model is designed to lower costs and improve outcomes at the same time. That's exactly the right place for the state and federal governments to be directing their efforts.

With all the strong words and posturing from Augusta and Washington, it's easy to lose sight of the fact that both capitols are struggling with the same issue.

The shortfall in Maine's Medicaid program (known as MaineCare) reflects the overall high cost of health care throughout the nation. Market reforms in the Affordable Care Act are designed to reduce the number of people who don't have insurance by, among other things, requiring insurers to cover people with pre-existing conditions. It also creates exchanges, which allow insurance companies to compete to provide coverage to consumers and businesses and which administer tax credits and subsidies to help more people buy coverage.

Covering more people will lower overall health costs by taking pressure off emergency rooms and charity care in hospitals, but it won't by itself significantly lower the cost of health care.

Payment models that encourage patients to take better care of themselves and encourage providers to take an interest in their patients' overall health are the best way to lower health care costs. And when overall health care costs decrease, the cost of government programs like Medicare and Medicaid will also go down.

There are other ways in which the state could work with the federal government under the Affordable Care Act. The most important would be expanding MaineCare to ACA standards, covering thousands of Mainers and bringing millions of federal dollars into the state's economy.

There is still time for the governor and the Legislature to do that. In the meantime, it's nice to see the state and federal governments working together on the people's problems and not just fighting each other.


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