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Maine Dems Defend Hospital Debt Bill as Gov's Veto Looms
05/22/2013   Reported By: Patty B. Wight

Maine Democrats and Republicans agree that it's time for the state to pay the outstanding bill it owes to hospitals from unpaid MaineCare reimbursements. The Senate is expected to join the House in enacting the bill tomorrow. But Gov. Paul LePage is expected to veto it. That's because the bill would also expand Medicaid under the Affordable Care Act, which many Republicans oppose. And as Patty Wight reports, hospital administrators are also wary about linking the two bills.

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At a press conference on Wednesday, Democrats laid out the case for their bill: Not only will hospitals finally get paid the nearly $480 million owed to them, says Rep. Jeff McCabe, but with Medicaid expansion, more of their patients will be insured.

"This is a win-win for the hospitals," McCabe said. "I hope in the next 24 hours they step up and they put some pressure on the governor."

That isn't looking likely.

"We do not support becoming a pawn in a football game - political football game - between the parties at this point," says Katie Fullam Harris, a spokesperson for MaineHealth, which operates both rural and large hospitals, like Maine Medical Center in Portland.

Fullam Harris says MaineHealth supports Medicaid expansion - but not as part of the hospital payback bill. First things first, she says. "Hospitals have come to the table and provided services to patients over the last five years - patients who have Medicaid - and we have not been paid for those services."

Harris says the payback and the expansion are two separate issues. But Democrats are adamant that the linkage makes sense for hospsitals, for uninsured Mainers and for the state, because if Maine doesn't embrace the expansion now, it will miss out on the first year of full funding being offered by the federal government.

House Speaker Mark Eves says there's an added bonus for hospitals because it will cut their future costs. "We're going to get $163 million every single year moving forward if we accept these federal dollars," he said. "It will go a long way to address the problems that they're having right now with their decrease in volume and increase in charity care."

But Chuck Gill, spokesman for Central Maine Health, says expanding Medicaid doesn't necessarily equal less hospital charity care.

"Well, we don't know that because Medicare - Medicaid has been expanded in Maine, since 2003, and we still have high levels of charity care," Gill says. "So we have a lot of what we call charity, or free, care occurring now. And we have one of the largest MaineCare programs in the country. So it's an open question. It may or may not be true. We don't know."

Another argument for Medicaid expansion is that it will decrease emergency room visits. But the Muskie School of Public Service did a study in 2008 and found that those on MaineCare, the state version of Medicaid, used emergency rooms more than both the privately insured and the uninsured.

Professor of Public Health, Andy Coburn, says there have been a lot of changes since the study to cut down on excessive emergency room visits, so the rate today is likely lower. Coburn says Medicaid expansion is a moral issue and a complex one.

"It's not a magic bullet in terms of solving the problem of inappropriate use of the emergency department because this is a problem that is a national problem," Coburn says

It's because of unknowns like these that Republican Rep. Ken Fredette plans to introduce a proposal to lawmakers to create a study group to determine the costs of implementing the expansion. The federal government will pay 100 percent for the first three years, then gradually cut to 90 percent. David Sorenson is a spokesperson for Fredette.

"We should look at this thoughtfully, carefully, before we commit ourselves to what DHHS is telling us is a $75 million a year commitment on the backs of Maine - not federal - Maine taxpayers, once we reach the 90 percent match rate," Sorenson says.

Despite the unknowns of how much cost savings Medicaid expansion may or may not provide, Jeff Austin of the Maine Hospital Association says his organization supports expansion - but only as an issue separate from hospital payback.

"The issue to us is not the merits of expansion, which are clear to us that it benefits Maine," Austin says. "The issue to us is how best to achieve these goals. And it appears that the path we're on is one of failure."

The hospital payback bill could hit LePage's desk this week. If he decides to veto it, it's unclear whether the two issues will be resubmitted as separate bills.



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