PORTLAND — As state lawmakers in Augusta debate whether Maine should broaden eligibility for MaineCare, the state’s Medicaid program, health-care policy experts came to Portland Monday to debate the same question.
About 50 people turned out at the University of Southern Maine’s Wishcamper Center to hear a forum on the expansion of MaineCare. The panel of speakers assembled by the Muskie School of Public Service included Mary Mayhew, commissioner of the state’s Department of Health and Human Services, and David Howes, president of Martins Point Health Care.
Medicaid, the joint federal-state program that funds health care for the poor and disabled, was expanded under the federal Affordable Care Act, also known as “Obamacare.” After a U.S. Supreme Court decision last summer, states were given the option of broadening eligibility standards for their Medicaid services – with the federal government picking up 100 percent of the cost for three years.
But Gov. Paul LePage has been ambivalent about the offer.
As he tries deal with a projected $120 million revenue shortfall in MaineCare and another $484 million in payments owed to the state’s hospitals, LePage at first resisted any expansion of the program. The administration also claimed that most of the people who would become eligible for Medicaid under Obamacare were already covered by benefits MaineCare has added over the past decade.
Nevertheless, Mayhew opened the door last month to possible expansion of the program under Obamacare. Mayhew and the governor proposed a deal: Maine will participate in Medicaid expansion, if the federal government extends the length of its funding and gives the state greater flexibility in running MaineCare.
“We believe that if the federal government funds 100 percent of our Medicaid costs for expansion populations for 10 years, we can put our Medicaid program on a track to succeed in the long term,” Mayhew wrote in a March 18 letter to U.S. Secretary of Health and Human Services Kathleen Sebelius.
“Maine’s last decade was marked by unsustainable growth in our Medicaid program,” she said, “and our taxpayers have shouldered the burden of early expansion.”
On Monday, Mayhew repeated the quid-pro-quo offer.
“Without a significant commitment from the federal government to support this expansion, I am concerned about the inability to support people with disabilities today with services they need and should be getting from the state,” Mayhew said. “We need a much greater level of support from the federal government, both to support ongoing costs to the program and to lead the transformational efforts we know are necessary to improve the way the health care delivery system functions.”
Joseph Antos, a scholar at the American Enterprise Institute in Washington, D.C., backed Mayhew’s offer, but urged caution.
“What Maine should do is not rush into anything. The governor’s letter is right on in wanting greater flexibility in managing a program that it has the legal responsibility to manage,” he said. “If the federal government is unwilling to release you from unnecessary oversight, there will be massive failure.”
Still, other panelists looked at the federally funded expansion as an opportunity Maine cannot afford to miss.
“We need to do this,” said Sara Gagne-Holmes, executive director of Maine Equal Justice Partners, an advocacy group for low-income people. “There is no reason that childless adults (the primary population covered under the expansion) have not been covered. They’re some of the poorest people in the state, but we continue to say they don’t need coverage because should be able to afford health care themselves.
“Accepting these federal funds is an opportunity for Maine to provide some fairness.”
Howes, a physician, said the expansion will allow MaineCare to better manage health care for an uninsured population that otherwise seeks more expensive, less-efficient care in hospital emergency rooms.
“These people are out there being cared for in an uncoordinated, unmanaged system,” he said. “We obviously have to go for the best deal we can get, and as much autonomy as we can get in managing the program. … But the care today is uncompensated, and we’re not managing it in a go-to way.”
Sara Rosenbaum, a professor at George Washington University School of Public Health, called the question of MaineCare expansion a “no-brainer.”
“Do we keep our residents covered?” she said. “Given the fact that this is a chance to create a continueous coverage system for almost everyone in Maine, the answer is of course we want the coverage.”