Solve health care crisis

In the past year, there have been no fewer than a dozen guest commentaries or stories in this newspaper and others about Maine’s new Office of Program Evaluation and Government Accountability (OPEGA). They discussed the growing need for greater accountability for state programs and lack of credible information available to aid legislators with important policy decisions.

Now that the new office is close to reality, it’s time to talk about how we can use this new resource to improve Maine government and your quality of life. Healthcare is the single variable that all Maine people share. We all, at some point, must use a doctor or hospital for care. Some, who are lucky, have a good private health insurance plan, some have no insurance and others rely on Medicare or Medicaid (Maine Care, state plan for the poor and disabled) Unfortunately, the latter, Medicaid, has several problems that are impacting all forms of healthcare in the state; fortunately, this is where Maine’s new OPEGA office can help.

First, the problems:

In a recent study for the Maine Hospital Association, by Baker, Newman & Noyes, a Portland-based accounting firm, it was reported that low Medicaid reimbursement formulas caused a $39 million shortfall for Medicaid Services in 2000. Medicaid paid providers just 80 cents for every $1 of care provided to patients. This shortfall, according to the study, pales in comparison to the $115 million Medicare shortfall. The combination of these two factors, according to the report forced hospitals into “shifting costs to individuals with commercial insurance or who pay out-of-pocket for hospital services.”

Reimbursement rates in areas like dental care, long-term care, and treatment of mental illness are acute. Every constituency within Medicaid is vulnerable to loss of access and the quality of care when government under pays providers. In light of the recent announcement by Health and Human Services Secretary Tommy Thompson of the expansion of Medicaid to another 11,000 low-income, Maine childless adults it is time to insist that expansion of Medicaid coverage should also come with the assurance of access to high quality care.

Logistics Management Institute (LMI), a Mclean, Va., not-for-profit organization that works for the federal government in the area of Medicare and Medicaid fraud estimates 10 percent of these two programs is lost to fraud. In this state, Medicaid fraud alone would amount to $140 million a year.

The Year 2000 Governor’s Blue Ribbon Commission on Health Care reported that in Maine, “healthcare delivery and financing is inefficient, unreasonably complicated, and unfair.” It went on to say, “administration and inefficiency account for approximately 25 percent of the total annual healthcare expenditures, 1 billion in Maine.”

Now the solutions: In November 2000, the Idaho Office of Program Evaluation, The Lewin Group, and Sjoberg Evashenk Consulting, LLC, released the result of a program evaluation of Idaho’s Medicaid system. The evaluation recommended changes that saved an initial $4.7 million to $6.7 million, and several ways they could better utilize federal dollars. This report was not a bombshell, but what happened this Aug. 9 was. The Idaho Statesman reported that, “The Idaho Health and Welfare Department has plans to slash $70 million in spending.”

Using many of the findings in the 2000 Medicaid program evaluation, the Idaho Health and Welfare Department made comprehensive changes to their Medicaid system that will save $70 million each year. This is significant, in that Idaho is as close to Maine in population and geography (Idaho, 1.32 million, Maine, 1.28 million) and per capita income, (Idaho, 40th, Maine, 36th) as any state in the nation.

I have introduced legislation for the next session that will ask the Health and Human Services Committee to hold public hearings to hear from Medicaid providers, recipients and other interested parties to identify problems like the ones mentioned above. It will also call for an evaluation of our entire Medicaid system with an emphasis on the problems identified. The legislation will create a dedicated account within the Medicaid system, specifying that any savings found during the evaluation will be transferred into this account. The savings, in combination with a potential 2-to-1 federal match, would be used to raise Medicaid reimbursement rates and pay for any problems identified in the study.

Health care is often complex and overwhelming, but we now have a new resource, OPEGA, that can be directed to dissect and identify weaknesses, offer recommendations and solutions using other states examples, and bring together the nation’s most experienced program evaluators to give Maine lawmakers credible information and proven policy direction in health care and other essential government services. It’s time to use new ideas and approaches to solve the health care crisis.

David Trahan is a Republican state representative from Waldoboro.