– PORTLAND – Maine people are generous and are traditionally willing to help out fellow citizens facing hard times. We experience recessions here first, before the national economy slows down — and then recover after the rest of the country.

These long cycles are why Maine people have the well-earned reputation for being tough and thrifty. Our people know how to work hard when we have opportunity, how to save for a rainy day and what it’s like to struggle in lean times.

Unfortunately, some government policies intended to help people during tough times have actually made it harder for Maine to compete in a global economy.

Medicaid (known as MaineCare here) is a prime example of a good program that has spiraled far beyond what we can afford.

Medicaid, funded with federal and state tax dollars, provides health care for people who cannot afford health insurance. This program primarily supports people under the age of 65 as well as those with disabilities.

About two-thirds of the funding comes from Washington; Maine, which administers the benefits and sets eligibility requirements, is responsible for the remaining one-third of the costs.

This program, which comprises a large part of our state budget, should only be for those who are among our state’s neediest. Yet, Maine’s Medicaid crisis is that we have too many people under the age of 65 who are not disabled, but still enrolled in this program. Over the last decade, Maine has grown to have the highest percentage of our population (about 25 percent) enrolled in Medicaid — more than any other state in the nation.

We have the nation’s highest Medicaid enrollment because our private insurance rates are too high due to our own state mandates and regulations.

High premiums cause employers to reduce or eliminate health care benefits — leaving hardworking employees with no option but to enroll in Medicaid. It is a damaging cycle. But let’s be clear: this is a problem that has been created by Maine’s government.

Having the country’s highest Medicaid enrollment puts an enormous strain on Maine’s budget and health care providers. It is a major factor in the state’s perpetual budget crisis. Hospitals, nursing homes and other providers also struggle because their Medicaid payments are low and often several years late.

There are three actions Maine can take to lower costs, reduce MaineCare enrollment and improve outcomes:

1) Open Maine’s health insurance market to competition. Medicaid is overused in Maine because insurance rates are too high — and much of this is due to state regulations. New Hampshire has fewer mandates and monthly premiums can be one-half or even one-third of what Maine people pay.

Maine’s high insurance premiums are also caused by the need to offset the low Medicaid reimbursements to providers. These issues must be resolved to lower premium costs.

2) With premiums lowered through competition, Maine must tighten Medicaid income eligibility to the national average and, where federal law allows, implement a residency requirement for public welfare benefits.

With more affordable private health insurance, fewer Maine families would need to resort to Medicaid. Establishing a residency rule for specific state-level and federally approved programs will discourage people who don’t qualify for assistance in their own states from traveling here for “free” health care paid for by Maine taxpayers.

3) Manage and lower the costs of Maine’s Medicaid program through greater use of care management and care navigation that is coordinated and not duplicative. Too often, chronically ill and low-income patients use emergency room services rather than primary care providers. This is often the most expensive option. Use of more efficient management will improve patient outcomes and will also lower the expense to taxpayers.

We also need a long-term solution to overall welfare in Maine — and other states have provided us with successful examples. Maine would be wise to follow the lead of former Wisconsin Gov. Tommy Thompson, who reduced welfare rolls in Wisconsin through his “Work not Welfare” program that became the cornerstone of the federal welfare reforms in the 1990s.

We must end the cycle of generational welfare in Maine, and we must have a state government that promotes opportunity rather than dependency.


– Special to the Press Herald


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