During every legislative session
there are many difficult decisions that every state senator and representative
must make. Before I cast my vote, I try to gather all available facts and
carefully weigh them before deciding how I should vote. I also review all of
the correspondence that I have had from constituents on that particular issue.
One of those decisions I faced
during the last session was whether to expand Medicaid in Maine, also known as
MaineCare. My research became particularly difficult even though there was
extensive information available. It was not easy to separate fact from fiction.
The Legislature had two major
votes on Medicaid expansion. The first time, it was coupled inappropriately
with a bill to pay off Maine’s hospital debt. The Governor vetoed that bill
(but later signed a separate bill to pay off the hospitals). The Medicaid
expansion legislation was then reintroduced to the Legislature as a standalone
bill. It passed the Legislature, was vetoed by the Governor, and the
Legislature upheld that veto.
Throughout the process, Mainers
were inundated with messaging from both sides of the issue. The disagreement
centered on how much the expansion would cost Maine, could we afford it, and
whether it was in our best long-term interests.
A few weeks ago, I was asked to
attend a meeting with a group of people who favor the expansion of Medicaid.
The meeting day came and I sat around the table with three ministers, a
representative from AARP, a representative from Maine People’s Alliance, and a
group of other interested constituents. I listened as each person
expressed his or her concerns. I expressed my uneasiness with the potential for
the huge costs of this “free” health care.
Those concerns are detailed below.
At the end of the meeting we shook hands. Although we still had differences, I
believe we all had a greater understanding of the complex issues involved in
Medicaid expansion.
The proponents of Medicaid
expansion told us repeatedly that this deal would be too good for Maine to pass
up because the federal government would be picking up the entire tab to cover
Medicaid for an additional 70,000 Maine residents.
But it turns out that money isn’t
so “free” after all.
Under the proposal, the first
three years of the expansion would be on the federal government’s dime; however
during that time Maine would have to come up with $10 million to cover
administrative costs during each of those years. Where would that money come
from? After that, the federal reimbursement rate would drop to 90 percent.
Maine’s Department of Health and Human Services predicts that under the best
case scenario, after those first three years, Maine would have to come up with
an additional $75 million annually to pay for the expansion. In every two-year
budget cycle, that would be $150 million less we would have for essential
government services such as education and public safety.
It’s also important to note that
when it comes to Medicaid, Maine has already been much more generous than most
states, spending more than 30 percent above the national average for state-funded
health care. Those states that are accepting federal dollars to expand Medicaid
as part of the Affordable Care Act (ObamaCare) will be catching up to Maine
when it comes to paying for these subsidized services.
Earlier I mentioned how the State
of Maine recently paid off its debt of nearly half a billion dollars to
hospitals around the state. That debt came as a result of Medicaid services
these hospitals performed without being reimbursed by the State in previous
years. It also coincided with Maine’s decision to rapidly expand Medicaid
beyond our ability to pay the bills.
We were able to retire this debt
thanks to revenue that will come from a renegotiated state liquor contract. But
with the ink hardly dry on the checks to Maine’s hospitals, we are once again
talking about recreating the very problem that got us into debt: expanding
MaineCare beyond our ability to pay for it. Democratic leadership in the Maine
Legislature has indicated it wants to reintroduce the legislation in the next
session that begins in January.
For the reasons mentioned above, I
could not vote in favor of the expansion. I will certainly consider any new
bill in the same way that I have before. However, there will need to be many
more answers to the funding sources before I could vote to support Medicaid
expansion.
Meanwhile, the market-based
reforms for health insurance passed by the previous Legislature have led to two
positive developments in Maine: more Mainers, particularly young adults, are
signing up for health insurance and most of those who are already enrolled are
seeing lower premiums or at least drastic reductions in their yearly increases.
These are the types of reforms we
should be embracing instead of contemplating more debt we can’t afford to pay
back.
Senator Gary Plummer represents Maine Senate District 12
which includes the Cumberland County towns of Casco, Frye Island, Raymond,
Standish, and Windham as well as the York County town of Hollis.