Wednesday, April 23, 2014
Paying for health care is a game of hot potato, and the players who can't pass costs to others are the ones that get burned.
Gov. LePage and Republican lawmakers in Augusta are preparing to balance the state budget by dumping more health care costs onto other payers, and the big losers will be middle- and low-income Mainers who will end up paying more and getting worse care.
Two recent studies show how this could play out: Last week, The Portland Press Herald reported how demand for uncompensated "charity care" delivered by Maine hospitals has doubled in the last five years. This is the care hospitals provide to people who don't have health insurance or the ability to pay for treatment.
A few days later, the journal Health Affairs found that one in five American adults under the age of 65 have seen their access to health care worsen over the last decade. These include people who have insurance but can't afford to keep up with the rising copays and deductibles their insurance plans demand. Many report self-rationing health care and not getting treatment they know they need because they can't afford to pay.
LePage and Republican lawmakers are proposing for the Department of Health and Human Services what they call "structural reform," which is really just eliminating health insurance for 21,000 people who now receive services under MaineCare.
They would also slash the programs that help seniors pay for prescription drugs, and public health programs that seek to head off future health problems. This may indeed lighten the state budget, but it won't do anything to address the cost of health care, which is what has made the Maine-Care budget such a burden.
Charity care may be better than no care at all, but that's not saying much. An emergency room won't trim a diabetic's toenails to prevent an infection, but it would amputate his leg if the condition has gotten out of control.
LePage wants to push more people off the MaineCare ranks and into a private-pay environment in an effort to end a culture of dependency. More likely it will cause already sick people to get sicker and burden providers of "free" care.
Hospitals have the ability to pass those costs on to the people who pay the bills. Over time, that means higher insurance rates and more cost sharing with patients who are covered by private insurance.
The ultimate losers will be the people who go without care either because they don't have insurance or they can't afford to pay for what their plan won't cover.
The MaineCare budget's growth is a symptom of the underlying disease, which is growth in the cost of health care across the board. Programs that cover preventative care will do more to lower costs than would increasing the ranks of the uninsured.
The potato has to stop somewhere, and if the state government shirks its responsibility, the middle class will end up getting burned.