AUGUSTA — Five times over the last five years, the Legislature has voted to expand MaineCare to provide insurance for about 70,000 or more low-income Mainers and each time, Gov. Paul LePage vetoed the legislation.

In November, Maine voters will decide the issue at the ballot box.

State referendum Question 2 — An Act To Enhance Access to Affordable Health Care — asks “Do you want Maine to expand Medicaid to provide healthcare coverage for qualified adults under age 65 with incomes at or below 138% of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?” 

Proponents say expansion is needed to insure 70,000 or more low-income Mainers (about 8,000 in York County) who can’t afford preventative care and are putting a strain on emergency care facilities, and are increasing health insurance rates for others. Opponents say that many of those who would be eligible for the expanded coverage are able-bodied, childless adults and should work and contribute to their own health insurance. 

Medicaid — known in the state as MaineCare — expansion was approved when the Affordable Care Act — Obamacare — was passed, and which went into effect Jan. 1, 2014. Maine is one of 19 states that opted not to accept federal funds to expand insurance coverage for additional low-income residents.

If the referendum is approved, starting in 2018 the federal government would cover 94 percent of costs for most newly eligible participants. The federal share would decline each year until 2020 when it hits 90 percent where it would remain.

According to Maine Equal Justice, the higher cost to expand MaineCare and insure more people at the 90 percent contribution by the federal government would be only 5 percent higher than the current cost of the program to the state.

Many of Maine’s health care professions favor a yes vote on Question 2, including Southern Maine Health Care President and CEO Edward McGeachey.

The hospital takes care of all patients who enter its doors “regardless of their ability to pay,” said the head of the Biddeford-based hospital with facilities in Sanford and elsewhere in York County.

But treating the uninsured is expensive. “We, like the majority of hospitals in Maine, lost money over that last several years,” McGeachey said.

“When Obamacare was passed,” he said, “hospitals were actually being asked whether it would be better to (take funds from the Medicare program) and spend that extra money on Medicaid, on people who were poor and disabled.”

“Hospitals agreed to take money out of Medicare,” said McGeachey. Medicare insures senior citizens and some people with disabilities.

In the last fiscal year the hospital saw a $3.3 million reduction in Medicare payments, he said. “In the same year, we provided $15 million in care we didn’t get paid for.”

If Medicaid expansion were in place, McGeachey said, the hospital would have received an additional $8 million in payments.

Instead of getting preventative care, those without insurance often wait to seek treatment when health problems are serious and go to hospital emergency rooms.

Caring for the uninsured drives up the costs of health care for everyone, he said.

“The reason health care costs are so high is because so many people are uninsured or underinsured,” said McGeachey.

Also, Medicaid expansion could be a significant tool to deal with the opioid crisis affecting the nation and the state as many who want help don’t have insurance and can’t afford it.

“By expanding Maine care, Question 2 would dramatically increase access to drug treatment for those who need it the most,” said Noah Ensign, MD, vice president of Medical Affairs at Penobscot Community Health Care.

One of the opponents of the expanding Medicare is Republican Gov. Paul LePage. He says it would cost too much.

“Medicaid expansion will cost Mainers $500 million over the next five years,” said the governor in a recent press release. “The last time Maine expanded Medicaid, the elderly and disabled were sent to the back of the line so working-age adults without dependents could get free healthcare.”

The conservative think-tank Maine Heritage Policy Center also states Medicaid expansion would be expensive to Maine taxpayers.

According to the state’s Office of Fiscal and Program Review the fiscal note for Medicaid expansion projects an annual appropriation from Maine’s General Fund of roughly $54.5 million and estimates that expansion will save approximately $27 million annually within existing programs.

“Proponents of Medicaid expansion claim that only 70,000 new Mainers would enroll in the program,” according to a statement by the MHPC.

The Office of Fiscal and Program Review fiscal note anticipates expansion enrollment to reach 90,000, which the MHPC notes is “well above the estimates offered by expansion proponents.”

The MHPC said it believes that is a low estimate. “In 2002,” it stated, “when Maine expanded Medicaid to childless, able-bodied adults earning up to 125 percent FPL, proponents promised that only 11,000 new Mainers would enroll. However, within 14 months, 17,000 new Mainers enrolled and the program was eventually capped at 25,000.”

According to Mainer’s for Health Care who endorse Medicaid expansion during, “Maine’s earlier Medicaid expansions between 2000 and 2012, the growth in Maine’s Medicaid spending during that period remained squarely in line with the national trend rate” Although costs increased, this “was due to factors associated with the major recession.”

On Nov. 7., Maine residents will get their chance to decide this and three other referendum questions including allowing a casino in York County, a $105 million bond to pay for highway and other transportation infrastructure and a technical issue on the state pension plan that is expected to save money in the general fund.

— Associate Editor Dina Mendros can be reached at 282-1535, ext. 324, or dmendros@journaltribune.com.

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