MaineCare is the second-largest expenditure from the state’s general fund, at more than $600 million annually, which is still not enough to cover its costs. The state still owes hospitals millions for past MaineCare services, and the program itself may go bankrupt by May 8, unless a budget is passed, which would unlock federal help.
Myriad reasons exist for this. Ever-rising health care costs is certainly one. So is increased membership in MaineCare: enrollment about doubled from 2000 to 2006, from 169,000 to 313,000, according to a January 2008 study by the Muskie School of Public Service, at the University of Southern Maine.
This road was traveled with good intentions, though. Maine can boast of the country’s lowest rate of uninsured residents, yet the cost of this status is a low-income health care program that has become financially unsustainable. We simply cannot pay for the coverage we’re providing, a situation bound to worsen as government revenues dwindle and the economy further sours.
The solution is reform. We must turn MaineCare into a program that pays its bills, while providing efficient, accessible health care coverage to Mainers who need it most. This is a complicated balancing act that belies simple solutions or hasty decisions, like stopping advertising, waiting periods or residency requirements (all broached this year in the Legislature).
Cutting reimbursement rates to hospitals is another bad notion. Better ideas are needed to reform MaineCare than having the state pay caregivers less tomorrow for the same care they are providing today.
In Lewiston, Central Maine Medical Center estimates losing $5 million if MaineCare reimbursements for hospital-based doctors are reduced. If its sister hospitals in Bridgton and Rumford are included, the figure grows to $7.4 million. The hospitals call this cut “discriminatory.”
Yet while this is true, Maine hospitals must also admit they are part of the problem. Hospital outpatient costs for MaineCare, according to the Muskie School study, is roughly three times that of physician offices. 
The state wants savings from this expense. While this makes sense for the budget, it makes poor sense for patients, as physician offices in Maine have taken to capping, or ceasing, treatment of MaineCare patients, citing low reimbursement rates as a cause.
Physicians who provide the best value for MaineCare, then, are also now least likely to see its patients. Hospitals, however, don’t have that luxury of selectiveness. They are the rarest of business that is expected to serve every customer, regardless of their ability or intention to pay their bill.
And while we see that reducing hospital reimbursements from MaineCare might be a powerful incentive for cost efficiency, this strikes us as an uncomfortable mandate coming from a government that has helped build MaineCare into its current unsustainable form and is in danger of maxing its credit.
Worse is the potential impact on patients. Dr. Erik Steele, chief executive of the Blue Hill hospital, told lawmakers in January that every cut to MaineCare reimbursements to hospitals would come “out of somebody’s hide” at his facility, which would affect available care.
Any system that cannot afford what it has pledged to provide is broken. In MaineCare, this reality is doubly dire, as the program’s inability to sustain itself is closing avenues to care for patients, while straining the resources of the facilities that still do. 
editorialboard@sunjournal.com

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