Medicaid coverage

A recent study by Families USA found that nearly 1 million low-income working parents in 15 states lost Medicaid benefits when they did what they were supposed to do — get off welfare and into the world of work. Maine can take pride in the fact that not only didn’t its Medicaid numbers fall with its welfare rolls, the state actually increased the number of residents receiving the health-care benefits since welfare reform began in 1996.

Extending health-care benefits, like providing day care, is one of those political choices that policymakers point out but only occasionally do anything about. Low-income workers, like everyone else, make rational choices about their financial situations. If it costs them more to get a job and pay for health and child care vs. staying on state assistance, through the early ’90s, at least, they stayed on welfare. With welfare reform, not only did tougher rules and time limits eventually make this no longer possible, a range of mistakes, from computer error to failure by caseworkers to tell parents leaving welfare that they still could qualify for Medicaid, led to many people missing out on benefits.

Without them, those formerly on welfare in low-pay jobs, without benefits, have had to hope they and their family members stayed well. The problem is pervasive: The 15 states examined by Families USA account for 70 percent of the uninsured non-elderly adults in the United States. When these workers did become ill enough to seek medical treatment, their options for paying were limited: ask care providers to forgive some or all of the cost, go into debt to pay it off or go into bankruptcy.

Maine took another path from the beginning. Not only did Maine Sen. Olympia Snowe insist on extending benefits like child care in the federal reform, Department of Human Services Commissioner Kevin Concannon sought waivers where possible to extend benefits beyond the standard time limits, which was especially important in regions of the state where unemployment was high.

With legislative leadership on such issues as Cub Care and coverage for parents whose incomes were less than 200 percent of poverty, Maine has increased its coverage even as health care costs have risen sharply. There remain more than 160,000 Mainers without health insurance, but, as the example of other states suggests, the numbers in Maine could have been far worse.

Though President Clinton might declare welfare reform a success, the dramatic increase in the number of people without health insurance and the consequences of that rise have yet to be effectively accounted for. When they are, states like Maine are likely to prove that the more moderate course that both strongly encourages people to work but does not force them to give up life’s necessities was the best choice of all.