March 15, 2013

Maine Voices: Maine needs to take advantage of federal health care funds

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.

Hospitals are worried that the state will no longer feel the same obligation to pay its share of the current Medicaid debt once their immediate fiscal needs are met by this new infusion of federal money.

Others are concerned that the federal government will not live up to its promise and will decrease its Medicaid reimbursement to less than 90 percent, although Maine has the option to 'opt out' if the program does not work.

In 1944, near the end of the World War II, President Franklin Delano Roosevelt said in his State of the Union address, "We cannot be content, no matter how high (our) standard of living may be, if some fraction of our people -- whether it be one-third or one-fifth or one-tenth -- is ill-fed, ill-clothed, ill-housed and insecure."

In Maine, too many are ill-clothed, ill-housed, and insecure -- and without health care. While this program does not solve the fundamental flaws of our health care system, it is, for some, a lifesaving step in the right direction.

Gov. LePage can follow the lead of other Republican governors and accept these funds to rescue those who live with insecurity and ill health through no fault of their own.

It is an easy and potentially lifesaving decision with little downside. We will all reap the long-term benefits. Accepting federal funds already set aside to cover the health care of more Maine people is too good an opportunity to pass up.

Geoff Gratwick, M.D., a Democrat, is state senator from District 32, Bangor and Hermon.  He is a doctor in private practice.

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