Medicaid program invests in our community health

The state government needs to make some difficult choices this year because of a deficit resulting from lower-than-expected revenues. The cuts proposed by the governor to balance the budget fall on some of the state’s most vulnerable individuals. I do not believe that the serious harm that would result from these cuts is acceptable to most Maine residents.

One proposed cut in MaineCare, the state Medicaid program, appears particularly shortsighted to me as I had a chance to interview some program participants in December 2006 and was struck by what a good investment was made in the overall health of our communities. The “Childless Adult” MaineCare waiver program provides health insurance to very low-income individuals – with incomes below the poverty level of $10,400 per year – who do not have dependent children and are between 18 and 64 years of age. While many have chronic diseases, they have not been judged too disabled to work and many are trying to stay in the work force. Before 2002, these individuals were not eligible for MaineCare as they did not fit the usual categories of eligibility (having dependent children, being 65 or older, or having a severe disability).

In December 2007, nearly 20,000 individuals were served by this program in Maine. The governor’s curtailment order for this fiscal year and supplemental budget for the biennium will reduce this program dramatically: As many as 8,000 individuals will lose access to health insurance. Furthermore, the recent additional proposed cuts would eliminate prescriptions drug assistance for participants in this program. What makes these particular proposed cuts especially appalling is that they will lead to the loss of $10 million in federal dollars that have been used to help very low-income members of our communities receive needed health care. For every one dollar of state money “saved” by cutting MaineCare, we lose about two federal matching dollars.

This program saves the state money in the long run. Research has shown that access to health care increases health and productivity and thus leads to increased state revenues through income taxes. One 52-year-old woman I interviewed had several chronic conditions that she was able to treat with help from this program, thereby allowing her to continue to work at a residential home for disabled adults and even increase her hours. She said: “MaineCare allowed me to prevent things from getting worse. It has allowed me to remain at least as healthy as I am. I’m healthy enough to work, which I would not be without MaineCare. By now, I truly believe I would be eligible for full disability if I hadn’t been able to take care of my health.”

The loss of insurance for some individuals will mean loss of access to services that help to keep them stable; without this access there will be increased costs for our corrections system and homeless shelters. A 35-year-old man I interviewed, who had lived on the streets and in homeless shelters, was able to improve his health, secure an apartment, and begin a part-time job with the assistance he received through this program. He said: “I’ve gotten over a severe case of walking pneumonia; I was around black mold and that infected my lungs really badly for a while. I’m still being treated for depression and PTSD [post-traumatic stress disorder] and anxiety attacks, but I mean they were far more severe. Having MaineCare, I started going to counseling. I started seeing a psychiatrist, which helped improve my emotional state of being, which put me in a place and an ability to get a place to live.”

Cuts in this program will shift costs to our local general assistance programs which have shown a 90 percent decline in expenditures on prescription drugs since the inception of the Childless Adult MaineCare program in 2002. Moreover, half of the health care expenses under this program have been for hospital care; individuals no longer covered will certainly still need this care, but now there will be no one to pay for it and those costs will be shifted by hospitals to the rest of us – everyone’s health insurance will increase.

In short, these proposed cuts are penny-wise and pound-foolish. Ultimately they will not save the state money and there will be a lot more suffering in our communities as a result.

Sandra Butler is a professor in the School of Social Work at the University of Maine.