January 7, 2013

Maine Voices: MaineCare solutions shouldn't place biggest burden on the most needy

Instead of indiscriminately slashing programs, let's better manage care for the highest-cost patients.


GORHAM - If there is one take-away from Washington's "fiscal cliff" debacle, it's that drawing political lines in the sand won't help anyone. As lawmakers, we have a duty to put politics aside and work together to get results -- especially when it comes to balancing the state budget.

Maine’s Medicaid program, known as MaineCare, provides health insurance to “some of our most vulnerable citizens: the elderly, veterans, low-income children and families, and people with disabilities,” says a legislator who is a retired family doctor.


Our first priority is having an honest conversation about why Maine is facing a budget shortfall. We have a lagging state economy and a looming shortfall in MaineCare, the state's Medicaid program.

While every other state in New England has begun to emerge from the national recession, Maine's economy has moved backward, according to the federal Bureau of Economic Analysis. We are one of three states nationally where revenue fell below projections.

Maine's economy needs a boost. We need to put more people back to work in the jobs we have now, so they have more money in their pockets to shop locally, and in turn help the whole community and the state.

And we need an action plan to grow Maine's economy long term and train our work force for the jobs we have available now and in the future. We must get our state on the right track.

As well, we must take the projected $100 million shortfall in MaineCare head on. MaineCare is the state's health insurance program, and it serves some of our most vulnerable citizens: the elderly, veterans, low-income children and families, and people with disabilities. While enrollment in MaineCare has been cut by thousands during the past two years, its costs have not gone down as promised.

A recent Maine Voices column by state Rep. Heather Sirocki, R-Scarborough, ("Maine must remain on road of moderate spending, debt reduction," Jan. 2) uses campaign slogans and misleading data to distort the cause of the shortfall in this program.

It's too bad because the problems we face are too big for one party to solve alone. Partisan politics won't close the budget gap or improve the lives of Maine people.

It's no secret that Democrats and Republicans have starkly different views on our health care system, but we all want it to work better. As a retired family physician and a member of the state's budget-writing committee, I look forward to working with my Republican colleagues to diagnose and treat the problem based on facts.

We know that 5 percent of the patients who participate in MaineCare -- the elderly, the disabled and the very sick -- generate 55 percent of the costs. Our solutions must address those cost drivers. We cannot just take the easy way out by simply slashing programs and taking health care away from people who need it most.

The best way to lower costs is by better managing health care, putting a greater emphasis on the prevention and treatment of chronic illness. Better care management for the highest-cost individuals would save much more money than cutting people off from care.

For example, congestive heart failure patients are among the most expensive patients to take care of. If we can find a way to better manage their care to reduce readmission rates to hospitals, not only do we see healthier outcomes, but we also see a cost benefit to the state.

If we pay our providers for healthier outcomes rather than the number of tests performed, we will be able to both bring down the cost of health care and improve the health of Maine people.

We must accomplish real reforms that truly address the problem. Democrats stand ready and willing to work with Republicans, the governor and his commissioners to do just that.

State Rep. Linda Sanborn, D-Gorham, represents District 130 (part of Buxton and part of Gorham) in the Maine Legislature.


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