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Maine Medicaid Expansion Proponents: LePage is Inconsistent
02/10/2014   Reported By: Patty B. Wight

In his State of the State speech last week, Gov. Paul LePage affirmed his staunch opposition to using federal funds to expand Medicaid under the Affordable Care Act. But expansion proponents say the administration is being inconsistent, as it has already accepted other ACA funds devoted to health care. They say to truly improve the health of Maine people, the state needs to embrace all aspects of the ACA. Patty Wight reports.

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What's at stake in the question over Medicaid expansion, supporters say, is the health of about 70,000 Mainers - people like Linda Salleroli of Eastport.

A few years ago, doctors found cancer in one of her eyes. Salleroli was uninsured and paid out of pocket for surgery. But at the time, she did qualify for catastrophic coverage through MaineCare, the state version of Medicaid, which covered follow-up appointments.

A year later, in 2012, Salleroli no longer qualified and lost her coverage. "I'm not a single mom, you know - I'm 60 years old," she says.

Salleroli and her husband own the Rose Garden Cafe in Eastport, and she says they make about $10,000 a year. It's not enough to cover the check-ups she needs every six months. "The boat I'm in right now, I have to have something - I have 60 percent chance of getting more cancer," she says.

So Salleroli receives charity care at her local health center. People in Salleroli's situation were supposed to covered by Medicaid expansion under the original version of the Affordable Care Act.

But the Supreme Court ruled that states should be allowed to opt out of expansion, and that's created what's called the "coverage gap." Salleroli earns too much to qualify for Medicaid, but too little to qualify for subsidies on the online marketplace.

The executive vice president of the Maine Medical Association, Gordon Smith, says he doesn't understand why the LePage administration is walking away from federal funds that would help people like Linda Salleroli.

"Starting on Jan. 1, the federal government was making over $700,000 a day available to this population to help cover their health care," Smith says.

The federal government will cover 100 percent of the cost of Medicaid expansion for the first three years, then gradually reduce that subsidy to 90 percent by 2020.

Smith says while Maine rejects this federal money, it applied for, and won, a three-year, $33 million Affordable Care Act grant. It's called a SIM grant, and its goal is to improve Medicaid, Medicare, and commercial insurance systems while lowering costs.

"We think that it is somewhat inconsistent for the administration to say, 'Well, it's okay to take $33 million of the Affordable Care Act money to improve care of the Medicaid population,' but then deny eligibility for that care to 70,000 people who are among the neediest people in the state, and who could really benefit from the promises of the SIM grant," Smith says.

"First of all, the very funds that people are referring to actually reflect even more a reason why we cannot today afford to expand Medicaid," says Maine Department of Health and Human Services Commissioner Mary Mayhew.

"They're all a reflection of the absolute problems and challenges that today exist both in Medicaid and in the healthcare delivery system, all of which should be addressed before we even contemplate adding 100,000 new individuals onto the state's Medicaid program," Mayhew says.

MaineCare costs represents a quarter of the state's general fund, and Gov. LePage says expanding it would dig Maine into a financial hole. In his State of the State speech last week, he pointed out that Maine expanded the program a decade ago - at a cost.

"Maine's welfare expansion resulted in $750 million debt to our Maine hospitals. And we just paid it off," he said. "And some in this room want to start over. Shame on you."

But the only debt Maine hospitals seem to be currently worried about is what accrues from the bills their uninsured patients can't pay.

"We have seen our charity care as an organization double over the past five years," says Rebecca Arsenault, president and CEO of Franklin Community Health Network. She, along with the Maine Hospital Association, support expanding Medicaid.

Arsenault says it's different this time around because the federal government is picking up most of the tab. And, as a member of the steering committee for the SIM grant, Arsenault says the grant gives Maine the opportunity to create a more cost-effective MaineCare system.

"Medicaid expansion across the country is an important linchpin in the overall Affordable Care Act," she says.

Lawmakers in Augusta will have the chance to vote on a Medicaid expansion bill in the coming weeks. Sponsored by Democratic House Speaker Mark Eves, it includes a sunset provision to allow Maine to opt out if it appears it will increase state debt down the line.

A spokesperson for the speaker says he's continuing to work with Republicans in hopes of crafting a compromise that would survive an expected veto from Gov. Paul LePage.


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