October 20, 2013

LePage signals interest in Medicaid expansion compromise

Legislators are starting to discuss state-designed alternatives.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

(Continued from page 2)

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With the health insurance marketplace open for business, Outreach Specialist Libby Cummings, at Portland Community Health Center, answers questions on the phone about the new system on Oct. 1.

2013 Telegram file/Carl D. Walsh

Gov. Paul LePage

Peter Damiano, director of the Public Policy Center at the University of Iowa, said it remains to be seen whether Iowa’s plan would be better, worse or about the same as if Iowa had gone the route of the traditional Medicaid expansion. He said some elements of the plan, if successful, could encourage healthful behavior, which would drive down health care costs.

“It will definitely be better than doing nothing,” Damiano said. He said the Iowa-specific solution provided political cover for Republican Gov. Terry Branstad.

Farnsworth, the Portland Democratic legislator, said reducing emergency room usage should lower the overall cost of health care and is a worthwhile goal.

Maine does have some unique snags to work out that will make it more difficult to devise an alternative to Medicaid expansion, according to Mitchell Stein, policy director with Consumers for Affordable Health Care, an advocacy group.

For instance, the cost of private insurance is higher in Maine than Arkansas, and the gap between what Medicaid pays to providers, such as doctors and hospitals, is higher in Maine than in Arkansas and many other states.

Stein said that means shifting the program to private insurers will be more costly in Maine, and would be frowned upon by the federal government because the service would be less cost-effective.

“The truth is, it wouldn’t be as viable in Maine,” he said.

However, Stein also said that doesn’t mean a Maine-specific solution couldn’t be worked out.

But Katz said shifting administrative costs of the Medicaid expansion from the state to insurance companies is attractive and also more palatable to conservatives, because it wouldn’t increase the size of the state bureaucracy.

Other legislators gave more lukewarm responses, noting the logistical issues behind trying to start up a new system in Maine and other concerns.

Rep. Heather Sirocki, R-Scarborough, said the alternatives should be studied, but she pointed out that Maine already has a more generous Medicaid system than many other states, and the state shouldn’t set itself up for budget problems down the road.

And Rep. Drew Gattine, D-Westbrook, said that Arkansas and Iowa have already spent a lot of time devising workarounds, while Maine would be at the beginning of the process.

“There’s an awful lot of legwork involved,” Gattine said.

Rep. Sharon Treat, D-Hallowell, said she wonders if the state could create such a system if the LePage administration ended up not being an enthusiastic supporter. But Treat said an alternative to Medicaid expansion may be the only way in the current political climate to improve health care access for low-income residents.

“I’m very interested in what other states are doing, so I’m always open to discussion. I personally never give up on these things,” Treat said.

Joe Lawlor can be contacted at 791-6376 or at:


Twitter: @joelawlorph


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Today's poll: Health care

Should Maine do more to extend health care coverage to low-income residents?



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