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Maine Dems and GOP Continue to Disagree About Medicaid Expansion
03/07/2014   Reported By: Patty B. Wight

Republican lawmakers in Augusta this week announced what they said is an alternative to an idea they don't like, the expansion of Maine's Medicaid program under the Affordable Care Act. Their plan would be to have the uninsured buy coverage on the online marketplace. About half of Mainers who would be covered under the expansion currently qualify for subsidies to purchase insurance on the marketplace for just a few bucks a month. But expansion proponents said that solution isn't as simple as it seems.

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Expanding Medicaid, known as MaineCare in Maine, would add about 70,000 people to a program that many Republican lawmakers said is already unwieldy. Senator Mike Thibodeau said the state has two options.

"Is asking able-bodied individuals to take part in their own economic future the best course?" asked Thibodeau. "Or is growing state government and expanding the very program that is consuming huge portions of our budget and creating tremendous cost overruns the best course?"

Thibodeau's choice would be the former and Republican Minority Leader Ken Fredette said this would be a viable alternative to Medicaid expansion.

"Most of the people who will be eligible for Medicaid if we expand are already eligible for plans on the exchange for about ten dollars a month," said Fredette.

This alternative plan, said Fredette, offers a pathway to economic prosperity.

"By rejecting Medicaid expansion, many will actually have an incentive to take a raise or a promotion for a few extra hours so they can qualify for private plans," he said.

Senator Mike Thibodeau said even if a consumer doesn't currently qualify for subsidies, he or she can still access them, he said it's all about personal choice.

"They are asking you, what is your economic status, and what is your intention as far as your economic status in the future? All you have to do is commit to making $12,000 a year."

"That is very dangerous advice," said Sara Gagne Holmes is Executive Director of Maine Equal Justice Partners

"Given that when you apply for subsidies on the exchange, you do so under penalty of perjury, and there are significant civil and criminal fines if you knowingly provide false information," she said.

Gagne Holmes said those lower premium prices don't take into account other health out of pocket costs such as co-pays and deductibles. The marketplace plans with the lowest premiums, bronze plans, actually don't offer subsidies to cover those other expenses for people making between 100 and 250 percent of the poverty level.

"Most of us call the bronze plans a bronze trap, actually, for low-income individuals," Gagne Holmes said. "Because while the premiums are affordable, people will never be able to afford the cost-sharing component of it."

Because these are people earning anywhere from $12,000 to $23,000 per year. People like 30-year old Lindsay Knox, a home health care worker in Orland. Last year, she made about $13,000. Knox recently bought a silver plan on the marketplace that will cost her $50 per month. She's responsible for copays that range from $5 to $7, and has an out-of-pocket maximum of $500. Knox said, she's pleased with her purchase.

"It looks pretty good, from what I can tell," Knox said.

So, does she agree that this is a viable alternative to expanding Medicaid?

"No," Knox said. "About the only reason this plan works for me is because of the financial situation my family is in.

Knox recently moved in with her mother, who needs help with physical chores. She said her only major expense is her car.

"If I had kids, or if I had a medical condition, or if I had a flakier work schedule, I mean, I can think of a dozen ways my finances can crash and burn if one thing changed," she said.

Dr. David Austin, a family physician at Nasson Community Health Center in Springvale, said there are still a lot of uninsured Mainers who don't qualify for any subsidy on the marketplace. And while his health center can offer them discounted care, it only goes so far.

"Ya know, what they can access is my expertise for ten dollars," said Austin. "But if my expertise tells then that they have diabetes and should be on certain medication or need certain testing, it doesn't fund that at all."

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