HEALTH CARE AS MAINE AGES

Behind the good news that Maine continues to have among the lowest percentage of uninsured residents of any state, the costs of keeping up this standard means that health-coverage reform is still desperately needed. With federal-level reforms years away, if they arrive at all, Maine is limited to the sort of change it should seek here, but there is much it can do to hold down health-care costs.

Maine had the fifth lowest level of uninsured residents nationally, at 9.5 percent, a slight drop in percentage from the last several years and a positive sign in the face of an increase of 2 million uninsured nationally to 47 million, or 15.6 percent. A vigorous expansion of the state’s Medicaid program explains some of this difference: Maine ranks at the top for states that ensure residents below 200 percent of the federal poverty level.

But Maine’s health care costs are unusually high, imperiling these important gains. According to the Kaiser Family Foundation, Maine’s rate of growth in health care costs between 1980 and 2004 was 9.6 percent, 10th highest in the country and well above the 8.6 percent national average. Health care costs were equal to 19 percent of gross state product in 2004, second highest in the nation, and government health-care expenditures as a percent of GSP were third highest in the nation.

Legislators on the Insurance Committee tried last spring to bring reform to the state’s individual market for health insurance, but they failed to find a plan the majority could support. Part of the problem may be that they are looking at only one small portion of the market. No covered group is doing well, and, as a result, just finding a more efficient distribution of risk in one market isn’t enough. Maine must actually bring down the cost of care; legislators should look at what the Bush administration did with Medicare last month – the federal program for seniors no longer will pay hospitals for errors and preventable complications in care – to see what applications it has for health coverage generally.

Maine is right to have a strong health care safety net for working-class residents, but it also has the oldest population in the country and a relatively small number of young adults who can help support the system. This age shift is expected to grow more in the next few years, increasing a demand for health care services among older adults who are too young for Medicare.

If the state is going to maintain its low rate of uninsured residents, it must be more aggressive in its reforms, and that means not just one segment of the market needs attention but the entire health care market.