Thursday, April 24, 2014
AUGUSTA — A consultant hired by the LePage administration faced withering questions Tuesday from Democratic lawmakers who tried to undermine his report recommending that Maine not expand Medicaid to cover tens of thousands more people.
Alexander Group President Gary Alexander, left, senior associate Erik Randolph and Maine health and human services commissioner Mary Mayhew, listen at a legislative hearing Tuesday.
Photos by Joe Phelan/Kennebec Journal
Rep. Drew Gattine, D-Westbrook, asks a question of consultant Gary Alexander during a meeting of the Legislature’s Health and Human Services Committee in Augusta.
The Democrats on the Health and Human Services Committee homed in on the report’s projection that poverty will increase in Maine at rates that exceed federal estimates, saying it calls the entire report into question.
The report’s conclusions jibe with Gov. Paul LePage’s stance that the state should not expand Medicaid eligibility under the federal Affordable Care Act, a position that many Republican governors are taking.
If the state’s Medicaid program, MaineCare, were expanded, 70,000 to 100,000 people would immediately gain no-cost, taxpayer-funded health insurance, which Republicans say has the potential to break future state budgets. The 70,000 figure comes from expansion advocates, and the 100,000 estimate is from Alexander’s report.
At one point in the hearing, Mary Mayhew, Maine’s health and human services commissioner, defended Gary Alexander, the Rhode Island-based consultant who was hired to study the state’s public welfare programs.
Issues brought up by Democrats “(do) not discredit ... the benefits of this report,” Mayhew told the panel.
But Rep. Drew Gattine, D-Westbrook, said Alexander’s report is disappointing and represents a step backward in the Medicaid debate. “This is a repackaging of things we have already been hearing,” Gattine said.
He said the report arrived “late in the game,” prompting a direct response from Mayhew.
“We are not here late in the game. I take offense to that notion,” said Mayhew, pointing out that Alexander will not only look at Medicaid enrollment, but will examine how the state can make its public welfare programs more efficient.
Alexander is still working on two other reports for the state, focusing on other social assistance programs. The administration said Tuesday that those studies are behind schedule because of their complexity, and will be finished “in the coming weeks.”
CONFLICTING POVERTY ESTIMATES
Democrats and health advocacy organizations railed against assumptions in the Medicaid report about Maine’s rising poverty rate, and said the report lacks an analysis of how the expansion could save money, primarily through state-based health programs that would be funded entirely by the federal government.
“(Alexander) is predicting an 18 percent poverty rate in 2022. That’s unprecedented, and higher than it was during the Great Recession,” said Sara Gagne-Holmes of Maine Equal Justice Partners, a nonprofit group that favors Medicaid expansion.
Gagne-Holmes, who testified before the committee, said the poverty rate projected in the report is much higher than projections by the U.S. Congressional Budget Office and the federal Office of Management and Budget.
The poverty rate is built into the report’s projection that expanding Medicaid would add 124,000 recipients and increase the state’s costs by $807 million over 10 years. Without those poverty assumptions, Gagne-Holmes said, the projections in the report fall apart.
“That is the heart of the analysis in this report, that more people will be poor and need to be on Medicaid,” she said.
With poverty projections so different from the federal estimates, the methodology for reaching those numbers should have been detailed in an appendix of the report, Gagne-Holmes said. The report contains no explanation of the methodology.
CENTRAL ISSUE: COST VS. BENEFITS
Erik Randolph, a senior associate with the Alexander Group, said a team of actuaries and accountants devised the poverty projections, spending “a considerable amount of time pulling data to reflect these trends.”
Alexander said his firm made projections not on what it hopes might happen, but on realistic estimates about how poverty will climb.
He presented his report last week, as the first installment of a $925,000, taxpayer-funded study of Maine’s public assistance programs. The LePage administration says the report reinforces its decision to not expand MaineCare eligibility despite the promise of federal funding to cover most of the cost.
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