Wednesday, April 16, 2014
The best reason for Maine to expand Medicaid eligibility to the limits of the federal Affordable Care Act is that it would be good public policy.
It would make about 69,000 uninsured Mainers eligible for the program.
Ample research shows that people with health insurance are healthier and live longer than those without it. They are also less likely to end up in emergency rooms, because they seek earlier interventions in less costly settings.
Uncompensated charity care in emergency rooms is one of the cost drivers in health care that all insured Mainers and taxpayers are paying for as health costs climb.
Gov. LePage has so far refused to accept that argument, insisting instead that Maine trim its Medicaid rolls, calling the cost shift "welfare reform."
But even if he doesn't accept the underlying public policy argument, there are still strong reasons for Maine to participate in the Medicaid expansion, as Republican governors in other states have come to see.
The first is the cost: There isn't any, at least at first. If states extend Medicaid eligibility to people with annual incomes up to 138 percent of federal poverty limit -- $15,000 a year for an individual or $25,500 for a family of three -- the federal government would pay 100 percent of the additional cost for the first three years of the program.
After that, it would pay no less than 90 percent. Accepting the federal money now does not obligate the state later, and Maine could chose to opt out of the program in three years if it doesn't want to pick up the cost. That convinced Florida Gov. Rick Scott, who abandoned a rhetorical stance similar to LePage's and announced that his state would accept the funds. Maine has an opportunity to benefit even more than Florida, because even without the expansion Maine exceeds the federal minimums for Medicaid eligibility. If Maine complied with the ACA, the state would receive the 100 percent subsidy for those recipients, instead of continuing to pay 40 percent of their coverage as we do now.
The second reason Maine should participate is the economic benefit that would flow from what could be $100 million a year in federal spending. That money goes to hospitals, clinics and doctors who maintain offices and employ people. It's money ultimately spent on real estate, property taxes, groceries -- even to the contractor who plows snow from the parking lot. Why would Maine say no to these funds? That was enough to convince New Jersey Gov. Chris Christie to drop his opposition to the ACA and expand Medicaid in his state.
And the governor should remember that Mainers pay federal taxes too, so while he takes a principled stand on not expanding MaineCare eligibility, we will help subsidize expanded Medicaid in New Hampshire, Massachusetts, Connecticut and New York while we struggle to balance our budget at home. That's what swayed Arizona Gov. Jan Brewer, who stopped blocking her state from participating. LePage and these other governors were opposed to the health care reform act. Republicans tried to stop it in Congress. They tried to stop it in the courts. Mitt Romney promised to repeal it if he were elected president.
But all of those efforts failed. Gov. LePage does not have to agree that expanding MaineCare eligibility is the right public policy, but he can't argue that it's not the law of the land.
He can continue to hold an ideological position that has been abandoned by other ACA opponents, or he can take a more pragmatic view, based on reality. The reality is that expanding MaineCare eligibility is the right thing to do for a variety of reasons. Maine proves nothing by holding out.