There are plenty of differences between the Maine gubernatorial candidates this election. Whether it concerns tax, labor, business or welfare policy, the differences are clear. One particular issue, however, looms larger over the others and illustrates best the clear choice between Gov. LePage and his opponents – MaineCare.

Both independent Eliot Cutler and Democrat Mike Michaud have promised to dramatically expand this welfare program using temporary Obamacare dollars and despite MaineCare’s exorbitant long-term cost and difficult history.

OUR LARGEST PROGRAM

MaineCare is the name we give Maine’s Medicaid program — in terms of enrollment as a percentage of total population, it’s in a three-way tie for second-largest in the country. It is by far our state’s largest single program, eating up one-quarter of the state budget.

It is the reason we have budget shortfalls every year; why we can’t spend enough on roads or education; why there is never enough in the “rainy day fund”; and why we must resort to budget-balancing “gimmicks” such as bonding for current expenses, borrowing from the highway fund and shifting expenses to the next fiscal year. Ultimately, MaineCare is the reason Maine’s taxes are so high.

All of this puts a strain on Maine families, businesses and individuals and ultimately takes a heavy toll on our economy.

Hospitals and health care providers suffer, too, as Medicaid is notoriously slow in paying its bills. When and if it does, Medicaid pays only around 66 percent of the cost of any treatment. The other 34 percent of the cost must be made up through cost shifting to everyone else who either pays directly or through private health insurance.

And when the state can’t keep up with its MaineCare bill, it comes back to haunt us as our ever-growing hospital debt. Only recently, Gov. LePage, after months of contentious deliberation with legislative Democrats, was finally able to pay off the accumulated hospital debt of around $500 million.

The actual enrollees pay no premium, no co-pay and no deductible. It’s absolutely free. However, MaineCare might not be such a great deal for them.

Recent studies by the University of Virginia, the state of Oregon and several others have found that outcomes for patients on Medicaid are fair at best, much worse than with private insurance and often worse than with no “coverage” at all.

MYTHS, COME-ONS AND FACTS

The promises to expand our already unsustainable Medicaid program are enticing: Maine’s uninsured rate will drop; there will be less charity care and fewer emergency room visits, and – the most outrageous claim of all – expanding welfare will create economic stimulus.

Sadly, none of this is true. Maine’s Medicaid expansion and expansions in other states have proven it. We now know that emergency room visits actually go up and that there is no significant change in charity care or our uninsured rate.

The “free” Obamacare money doesn’t begin to cover all of the associated costs, either. Recent expansions in Arkansas, Rhode Island and California are dramatically over budget. And when the federal reimbursement rate drops off as promised, this situation will certainly not improve.

Even without the proposed expansion, MaineCare is still expected to continue to grow dramatically, and costs to all involved will escalate. With the expansion, however, the future costs and debt will explode.

That means not only will our other budget priorities – roads, schools, environment, the truly needy – continue to languish, but also that taxes will have to be raised. We can safely predict increases and/or expansions to our sales, meals and lodging taxes, increases to our already high income tax and indirect increases to our property taxes as state-funded programs and revenue sharing are squeezed.

BLIND FAITH

Even with this history of economic misery, these two wanna-be leaders of Maine, Michaud and Cutler, tell us expansion is the direction we must take and that it is “morally the right thing to do” and “a wise investment.” This is called ideological blind faith.

There are alternatives.

• We need to bring our Medicaid program back down to the national average, both for what is covered and who is eligible. That step alone could balance our budget.

• There are alternatives for the uninsured. More than half of the proposed 70,000 expansion recipients could get subsidized Obamacare insurance, many for as little as $5 per month.

• Federally qualified health centers give free or subsidized care for all.

• Finally, physicians associated with hospitals have charity plans available.

MaineCare is a vital health program for our most needy. Its history, however, is plagued with economic stress and lackluster performance. It needs reform, not expansion. Expanding it in these precarious economic times would be irresponsible, unnecessary and disastrous.

Jonathan McKane is a former Republican state representative from Newcastle. He can be contacted at:

Twitter: JBMcKane

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