AUGUSTA — To mention the word “MaineCare” under the State House dome is the equivalent of throwing off your gloves in a hockey game. It’s an invitation to a brawl.

But I am invoking MaineCare in this column for a different purpose – as an opportunity for Democrats and Republicans to find common ground.

Let me start with two incontrovertible facts.


First, the MaineCare program has been a management mess for years. It is an equal opportunity problem; it has tormented Republican, independent and Democratic governors alike.

The system reimburses some providers for more than they are owed, while others don’t get enough. For the past dozen years, like clockwork, the governor has submitted supplementary appropriations requests to cover the “unexpected” cost overruns of MaineCare. Then every few years or so, as with Riverview Psychiatric Center right now, the federal government penalizes the state for making illegal expenditures, and the Legislature has to scramble to fill yet another budget gap.


This is no way to run a railroad. Meanwhile, the railroad is growing. In the 15-year period between 1997 and 2012, MaineCare costs to the General Fund increased by $500 million, and the proportion of the state General Fund budget dedicated to MaineCare grew from 13 percent to 24 percent.

For Democrats and Republicans who care about having state funds available in the future for our university system, for early childhood education, for highways, for public schools and for municipal aid, MaineCare is a major problem. It is a system with chronic mismanagement, growing to absorb more and more of discretionary state spending over time. It must be addressed.

That is fact No. 1.


The second fact is more simple – in many ways, the MaineCare expansion that the federal government is offering Maine is a sweet deal. It would bring around $330 million a year into the state were we to accept it. Almost $1 miilion a day. Every day. Sundays included.

This new money would pay for rural clinics, family doctors, home care workers, nurses, X-ray technicians, hospitals and health workers of all kinds. The money would support between 2,000 and 2,500 middle-class health care jobs in Maine (and many other indirect jobs).


Remember that while low-income and elderly people are the beneficiaries of MaineCare, they don’t actually see any of the money – the checks are cashed by middle-class workers. The MaineCare expansion could, by itself, reduce the unemployment rate in Maine by as much as half a percent.

This is an effect on the Maine economy comparable to when the federal government funds a new destroyer at Bath Iron Works. It is the equivalent of the major manufacturer that the governor hopes to attract to his proposed Open for Business Zones.

But the difference is that the benefits from the MaineCare expansion would be statewide, and not concentrated in one geographic area. Washington County would gain around 150 jobs, Aroostook County around 250 and Penobscot County around 500. Everybody would win.

And, oh yes, by the way, 70,000 people would get health insurance coverage, and would get better care for problems like cancer and drug addiction and heart disease. And the rest of us who pay for private health insurance would benefit from the lower rates that would result from our not having to pay for so much charity care.

For Democrats and Republicans who worry about the unemployment rate in rural Maine, there is no more effective single action that they could take to stimulate the economy next year than by voting for the MaineCare expansion.

So we have two facts: The MaineCare program is chronically mismanaged. The MaineCare expansion offers an unparalleled opportunity for economic gain. This should be our common ground.


So how do we move forward? It is not enough to do what some Democrats want, which is to add millions of dollars of new MaineCare expenditures on top of a rickety and already overburdened management system. But nor is it enough for Republicans to simply turn our backs on the potential jobs and health benefits that the expansion would offer without considering any alternatives.


There is a third way. A group of us have a proposal that would approve the expansion of Maine-Care, but at the same time institute major management reforms.

We propose to adopt a “managed care” model for MaineCare, and to put the management of the program out to bid. This is a model that already works.

Martin’s Point Health Care, in Portland, manages family health care programs for the Department of Veterans Affairs and Medicare Advantage. It is one of the most progressive and forward-thinking health care providers in the country. Martin’s Point could apply to manage MaineCare, as could many others around the country who have a track record of success.

Managed care is a system that can provide realistic budgets, caps on costs and incentives for best-practice medicine. Much has been learned about health care since managed care systems were tried in the 1990s. New models of managed care support the goals of encouraging preventive care and restricting overuse.


Here in Maine, our cost in MaineCare to serve disabled adults is around 70 percent over the national average. A managed care structure can address such financial anomalies without reducing the quality of care. Other states, such as Georgia, are using managed care in Medicaid with success, and we can learn from their experiences.


The bill we are sponsoring would also generate the funds to eliminate the waiting lists for services to the disabled that the governor is concerned about, and add fraud investigators to make sure that cheaters are caught and prosecuted.

The bill would sunset the MaineCare expansion in three years. It is not a blank check. By three years from now, we should know whether our management reforms have worked, and can make the appropriate adjustments.

So Republicans and Democrats, put your gloves back on. Keep on skating. MaineCare provides us with common ground. We can achieve the grand bargain in Augusta that eludes Washington. In the process, we can restore confidence in our democratic process for the Maine people.

— Special to the Press Herald

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