February 12, 2013

Mayhew to Fla. lawmakers: Don't expand Medicaid

Maine's DHHS chief says the state's decision a decade ago to increase Medicaid eligibility didn't live up to expectations.

By Steve Mistler smistler@pressherald.com
Staff Writer

AUGUSTA — Florida lawmakers are weighing whether to participate in the federal health care law's proposal to expand Medicaid. On Monday, Maine Health and Human Services Commissioner Mary Mayhew attempted to explain why they shouldn't.

click image to enlarge

Mary Mayhew, commissioner of the Maine Department of Health and Human Services, is expected to warn Florida lawmakers that increasing Medicaid eligibility won't significantly reduce uninsured rates.

Joe Phelan / Staff Photographer

Mayhew testified before the Florida Senate's committee reviewing implementation of the Affordable Care Act, or Obamacare. Mayhew, appearing via video conference, or Skype, told Florida lawmakers on Monday that Maine’s decision a decade ago to increase Medicaid eligibility did not live up to expectations.

She said it didn’t significantly reduce the number of uninsured or the free care that hospitals have to provide to individuals who can’t afford health insurance.

Mayhew also linked the state’s Medicaid expansion efforts to $484 million in delayed Medicaid reimbursement payments to the state’s 39 hospitals.

Mayhew’s testimony dovetailed with a 20-minute presentation by Tarren Bragdon, the former CEO of the Maine Heritage Policy Center, the conservative advocacy group that has spearheaded several major health care reform efforts with the assistance of the Gov. Paul LePage. Bragdon was also a lead member of the team that helped LePage select his cabinet when he was elected in 2010.

Mayhew was appointed by LePage in February of 2011.

Bragdon is now the head of another conservative advocacy group in Florida, The Foundation for Government Accountability. On Monday, Bragdon said that Maine’s experience with Medicaid was proof that the expansion would be more costly than the federal government and health care advocates have acknowledged.

Mayhew’s testimony comes as Florida and other states consider whether they want to enroll in the health care law's plan to expand health care coverage for low-income residents. LePage has already ruled out expansion for Maine, telling the Obama administration in November that it doesn't plan to participate.

Mayhew reiterated the administration’s position on Monday, telling Florida lawmakers that Maine could not be assured that the federal government would deliver on its promise to fully fund states’ Medicaid expansion through 2016 and 90 percent of it after that.

State Sen. David Simmons, R-Seminole County, asked Mayhew if she didn’t believe that “the federal government would live up to its promise.”

Mayhew said that is was difficult to envision the federal government could afford to pay for the program amid ongoing fiscal crises and debates over the national debt.

Other states, particularly those with Republican governors, have wavered on Medicaid expansion, which has been highly politicized as Republicans are under pressure to avoid implementing any provisions of the health care law that are not mandatory. However, some Republican governors, most notably Arizona Gov. Jan Brewer and Ohio Gov. John Kasich, have broken ranks.

Florida is one of eight states that has not decided if it will participate in expansion, according to the Advisory Board Company, a national health organization. Maine is one of 15 states that has either rejected expansion or is leaning against it. Twenty-seven states have either agreed to participate or are leaning in that direction.

With the exception of six states like Ohio and Arizona, the state-by-state breakdown largely aligns with the party controlling the governor's office.

The remaining ambivalence among Republican governors is due to the fact that the federal government will fund 100 percent of the expansion from 2014 to 2016, gradually declining to 90 percent after that. Accepting federal dollars, an estimated $1 trillion, may seem like a no-brainer, but Republican-controlled states face ideological and political dilemmas.

Expansion of Medicaid, known as MaineCare in Maine, was mandated in the Affordable Care Act as a way to increase coverage for 17 million low-income Americans, including an estimated 37,000 uninsured Mainers. States that didn't comply with the law's 2014 deadline to increase coverage faced losing all Medicaid funds.

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