Sunday, December 8, 2013
By GEOFF GRATWICK, M.D.
I am caring for a lovely 37-year-old woman with active lupus. She worked in retail until about a year ago when she lost her job -- as well as her insurance -- due to worsening disease.
She can no longer afford her complex, expensive medications and has recently visited the EMMC emergency room five times for worsening shortness of breath. Her disease is progressing.
Despite the fact that she has paid taxes since age 19, my patient has fallen through the cracks of our health care system at a time when she is medically and economically most vulnerable.
She has no children at home and thus isn't covered through regular Medicaid, despite her lack of income.
Maine created a program that provides so-called "childless adults" with access to Medicaid coverage but it is currently capped. This is because the Legislature passed a tax cut in 2012 financed by the elimination of health care coverage for people like my patient. She will not receive Medicare federal disability insurance until next year.
There is a solution, one both complex and very simple. It will not take care of my patient's immediate needs but will help others like her, boost the state's economy and support employment.
Maine can take advantage of $430 million of new federal funds now available through the Affordable Care Act, or ACA.
These funds will pay for basic medical needs, medications, inpatient services and mental health care for childless adults, working parents and hardworking people who need the security of medical care.
Healthy people are productive people, sick people are not. We can use this money to care for nearly 70,000 of our 106,000 citizens without health insurance whose income is below $16,000 for an individual or $27,000 for a family of three.
The money will cover 100 percent of the costs of MaineCare for these groups from 2013 to 2016. Then, the reimbursement will slowly decrease to 90 percent by 2022.
There may be an initial cost to Maine to comply with certain technical aspects of the grants, but it is small compared to the benefits.
The Kaiser Foundation, an impartial health care think tank, estimates that Maine will save $350 million or 3.8 percent of its health budget from 2013 to 2022 if it adopts this part of the Affordable Care Act. Other groups think the benefit will be smaller, but not significantly so.
In addition, these federal funds constitute a huge jobs bill for Maine. They will finance clinics, hospitals, nurses, labs, pharmacies and other services that support health care.
Hospitals will gain because they will get cash for the care they provide to these newly covered patients instead of having to write off their charity care as bad debt.
Employers and employees paying for their own health insurance will gain because fewer costs will be shifted to them. Nationally, the cost of caring for the uninsured increases premiums for the average insured family by an estimated $1,000 per year.
Congress has already appropriated these funds and Maine's taxpayers are contributing to them. If we do not use this money other states will.
Recently, conservative Republican governors in New Jersey, Florida, Arizona, Michigan, and Ohio have accepted that they have little to lose and much to gain for the people of their states by accepting these ACA funds. They will be leveraging an enormous investment at a small cost. Each found an adroit face-saving way to change his mind. Maine is the only state in the Northeast that has not signed on thus far.
There are challenges.
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