RE-EXAMINE MEDICAID

At $1.4 billion in the coming state budget, Medicaid is second in cost only to kindergarten through grade 12 education, at $2 billion; together they account for more than half of the total budget, making any attempt to lower Maine’s tax burden unlikely without examining these areas. Gov. John Baldacci this session has prodded lawmakers into looking at education, and now, an important bill by Rep. Dick Woodbury of Yarmouth would look for savings in Medicaid.

LD 984 would spend $1 million on an independent study of the state’s Medicaid system, called MaineCare. Rep. Woodbury said he wants the study to evaluate and compare against national figures Maine’s eligibility levels, range of services, mental and behavioral health coverage, as well as whether some services are overutilized. He said he turned to this legislation after asking for breakdowns of federally required services versus optional services but got no answer. Rep. Woodbury, a political independent and an economist, says he hopes the analysts who bid to do the work come up with their own questions to guide the study as well.

The bill deserves strong support from the Legislature, if only because such a large and costly system as Medicaid should have periodic outside review. But LD 984 could go further. The areas Rep. Woodbury raises address only the patient side while ignoring the providers. Maine would learn much more by doubling the budget for this study and also asking how well provider charges compare with national averages, how efficiently they treat various illnesses and where Maine’s costs are unusually high or low. While the analysts are looking over mental and behavioral health, they would do everyone involved in the field a favor by determining whether the state or private nonprofits provide more cost-efficient services.

These are obviously difficult questions, and any answer would come with exceptions and demographic complications. But producing this work is essential to making thoughtful policy changes. Currently, Maine legislates this multibillion-dollar program – remember, the federal government pays nearly an additional $2 for every state $1 – by half-data and half-anecdote, with a smattering of scare stories and inappropriate comparisons thrown in to confuse the issue further. Maine simply does not have adequate data to make informed decisions about broad changes to Medicaid, but nearly every legislative session, bills propose exactly that.

The Woodbury bill properly asks the state to step back and figure out where it stands with this crucial program. Advocates for MaineCare may be concerned that such a study would reveal that Maine spends for many more services than other states, making some programs vulnerable to cuts. Two thoughts on this: MaineCare detractors already assume Maine spends far too much on this health-care program, and spelling out real weaknesses rather than legislating based on imagined faults is far more likely to keep MaineCare healthy.

A full analysis, looking at both patient and provider costs, would change the conversation about MaineCare and focus the program more on care and less on politics.