Expanding Medicaid

By calling for $28 billion in additional Medicaid spending over the next three years, the U.S. Senate recently responded in a small way to legislatures across the country that are looking for ways to expand health care coverage to the uninsured. Maine’s Legislature, when it eventually emerges from its current budget debate, might take it as a reminder to get back to work on what was to be the major issue of the session.

The Senate approved the $28 billion in its budget resolution without debate, knowing that it was a small step in the overall attempt to extend coverage to the 44 million Americans who are uninsured. The money likely would be used to match dollars from states that extend Medicaid programs beyond the minimum of the federal law. Maine has done this in the past, and state lawmakers have before them LD 1303, which would further expand Medicaid to children up to 300 percent of the poverty line, and to their parents, 19- and 20-year-olds and adult singles up to 200 percent. It would also expand Maine’s Low Cost Drug Program to add cancer drugs and would make it easier for people with disabilities to continue working.

The bill, presented by House Speaker Michael Saxl, is large. In addition to raising Medicaid limits, it would provide for dental health screenings and support Maine’s rural health care network and provide outreach money for the Department of Human Services. None of the details in the bill, however, will be a surprise to lawmakers who have been following this issue, nor will the support for this bill from the Maine Hospital Association, Maine Lung Association and Maine Cancer Association.

After a decade of trying to patch the health coverage system, the problems with it are well known: Without insurance, preventive care is skipped, small health problems become large emergencies, costs are unfairly carried by people who have insurance. With one serious illness in an uninsured family that earns anything near the average wage in Maine, the family will be deeply in debt and paying off medical bills for years and years. One woman, Beverly Shaw of Clifton, who needed emergency gall bladder surgery, recently reported that it required only 18 hours for her to owe $12,000 in care. Her employment at a convenience store doesn’t include coverage, nor can she afford to buy it on her own. While one hospital wrote off some of her costs as free care, an expanded Medicaid would have provided the coverage she needed without putting her in debt nor relying solely on local charity.

Speaker Saxl intends to pay for the Medicaid expansion through a 50-cent cigarette tax increase. This would seem to doom his bill. Senate Republicans are saying no to a 26-cent cigarette-tax increase in the current budget debate, and Gov. King promises that if the 26 cents does pass he will oppose any further increases, referring specifically to this proposal. But rather than being discouraged, supporters of LD 1303 might use this time to sharpen their arguments and look for other funding sources.

Taxpayers, certainly, save long-term when more people receive adequate preventive care, and they would save further if there were agreement and state recognition of best practices among doctors that avoided needless defensive medicine. Lawmakers might also consider their own actions. Obesity rates, for instance, have risen 40 percent in the last decade, bringing a variety of serious illnesses. The Legislature last year responded by making snack food cheaper. They might find out what that action will cost Maine’s health care budget and, while they’re in the unhealthy aisle, they might look at how much extra smokers actually pay when the cigarette tax is increased – between the lower-priced discount brands appearing and the special sales that drop the price of a pack 60 cents or 80 cents, it is not as much as they might think.

In short, the need to expand coverage is clear and pressing, and the sources of funding are not as out of reach as they first appear. The Legislature’s duty is to start examining these issues and to find ways to fund this important bill.