I cannot begin to comprehend the failure by the state Senate to overturn Gov. Paul LePage’s reckless decision to veto — for a third time — legislation that would have expanded Medicaid coverage to roughly 70,000 residents. What they have done could cause great harm to not just the roughly 70,000 low-income residents who have, once again, been denied coverage under MaineCare, Maine’s version of the Medicaid health insurance program, but to all Maine citizens.
Because of that short-sighted veto and the Senate’s failure to overturn it, both of which appear to be motivated more by politics than economics, the state will lose roughly $1 million per day in federal money. That comes to more than $1 billion during the next three years, when the federal government is expected to cover 100 percent of the cost of expansion.
I believe what happened is nothing short of government malpractice — especially when you consider that the services that would have been paid for by the Medicaid expansion will still be rendered by hospitals and health systems, but now will be written off as charity services.
And who will pay for that charity? The rest of us, through increases in our own insurance premiums, not to mention charges such as $4 for an aspirin or $20 for one bandage during a hospital stay.
What is really unfortunate is that the legislation would have also brought a measure of sanity to health care in Maine by moving MaineCare administration to a managed care model. Under the current health care payment system, providers are rewarded for each doctor or hospital visit. There is little financial incentive to keep patients healthy.
With managed care, doctors, hospitals and health systems are given a fixed amount to treat each condition or injury, regardless of the number of visits or hospital stays that requires. It then becomes in their best financial interest to help patients become and stay healthy, because more visits means the providers lose money.
As health care reform advocates such as Dr. Patrick Soon-Shiong have stated, if you want to change the way health care is delivered in the U.S., you first have to change the financial model.
The managed care model also focuses on having patients work more closely with their primary care physicians to remain healthy, which not only reduces health care costs in the short term but has also been shown to be a long-term solution to reducing the number of people with chronic conditions (such as diabetes and heart disease) that make up 75 percent of the overall cost of health care.
Regular primary care has also been shown to improve productivity and lower absenteeism in the workplace — an added bonus to the state.
Finally, there is the human/moral aspect. It is unthinkable, in a society such as ours — one that leads the world in innovation in medical technology — that 70,000 of our fellow citizens should have to live without the means to afford to care for their own health.
As someone who has worked to bring health care to under-served populations all over the world, I have seen first-hand the devastating effects that a lack of access to even basic health care services can have. It is something that should never happen in a country like ours, or a great state like Maine.
Gov. LePage argues that he doesn’t believe the money is there to support a Medicaid expansion in Maine, stating that projected savings are “mirages,” and intimating that Maine taxpayers will be left to foot the bill. That sounds more like partisan politics than real concern. The Obama administration has gone “all-in” on health care reform. It is simply not something it will abandon or under-fund.
Apparently, 26 states and the District of Columbia agree with that position, having already voted to expand Medicaid coverage, and three more are still considering it, according to The Advisory Board Company.
The state Legislature had a golden opportunity to make this right. I am disheartened by the failure of the 13 senators to show the kind of courage and leadership that the people of Maine expect and deserve. Their irresponsible decision not to override the governor’s veto will deny essential health care to residents who need it most, along with desperately needed federal funding for the entire state.
Donato Tramuto, a former selectman and owner of two businesses in Ogunquit, is an expert on patient safety and care who has served on the Maine Economic Growth Council. He is the CEO of Physicians Interactive and founder of the Tramuto Foundation.
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