If Gov. LePage were a doctor, he might be sued for malpractice: He has not only prescribed the wrong medicine for a budget shortfall in Maine’s health care safety net, he has diagnosed the wrong disease.

First, his proposed solution, cutting health benefits to 65,000 Mainers, young, old and the disabled, would take an unconscionable toll on the lives of Maine’s most vulnerable people. From the Alzheimer’s patient who would lose her housing to working parents who would have to choose between putting food on the table or visiting a doctor, the need is real and the consequences serious.

Then, Gov. LePage continues to misstate the cause of the problem. On Wednesday he avoided the assembled crowds who had come to the State House to testify against the cuts. Instead, he spoke to a friendly audience in Franklin County, blaming fraud and overly lax eligibility requirements for the massive hole in the MaineCare budget. “We need to change the rules,” he said.

But the administration’s own numbers show that is untrue. While the Department of Health and Human Services does have a massive deficit — $220 million in the next 18 months — most of that is a result of budgeting errors and system deficiencies that caused Maine to miss out on enhanced federal matching funds. Most of the shortfall is not due to increased demand for services.


As tempting as it would be for the governor’s political opponents to explain away the problem as a management failure, that is not the answer, either. DHHS is a mammoth department that had been leaking money due to errors long before LePage came to office. The agency is an expensive and inefficient response to real medical needs.


What Maine faces is not an accounting problem or a fraud problem but a demographic one. Maine is the oldest state in the country, and older people get sick more often and are more expensive to treat. Gov. LePage likes to talk about providing incentives for people to get off welfare and go to work, but it’s not a lack of initiative that keeps someone in a nursing home bed.

The governor is wrong if he thinks that he can solve that problem by flipping a switch and cutting off people’s health insurance. The insurance might go away, but the health needs do not.

All he would be doing is shifting costs onto families, cities, towns and health care providers that would be expected to pick up the slack. What’s not picked up would lead to suffering by the people forced to go without the care they need.

Cost-shifting of this magnitude would have wide-ranging effects. As hospitals take on more uncompensated care, insurance premiums will rise, causing more people to go without coverage.

Reducing the pool of people with insurance would drive rates up even higher, setting off what health economists call a “death spiral.”

Treating this crisis as a health care problem and not just a budget problem would result in a variety of cost-cutting strategies that would make a dent in the shortfall. But that still might not be enough. Unfortunately, the governor has taken all other options off the table.



First, he has said that the shortfall could only be made up with cuts in DHHS, an approach that makes no sense. It would be as if his car needed an expensive repair so he paid for it by eliminating oil changes while still eating out in restaurants. Needs don’t go away because there is an unexpected expense, and no one in business or private life budgets that way.

He has also said that new revenue, including scaling back his signature tax cuts, cannot be considered. That is the governor’s position, but it is hard to justify eliminating health care for poor people while reducing the top income tax rate from 8.5 percent to 7.95 percent.

Legislators should take over the DHHS case and offer a second opinion.

That calls for diagnosing the real cause of the DHHS shortfall, and balancing the budget with an approach that protects the neediest, reforms the system to minimize future waste and puts health care in perspective with the other responsibilities of state government.


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