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Maine Medical Association Presses for Medicaid Expansion
01/23/2014   Reported By: Patty B. Wight

As lawmakers consider the merits of expanding Medicaid under the Affordable Care Act, some groups are urging compromise on an issue that runs largely along party lines. Today, physicians from the Maine Medical Association held a press conference to express their support for such a deal. But as Patty Wight reports, it's still not clear whether any Republicans at the State House would get behind a modified approach to Medicaid expansion.

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MMA Presses for Medicaid Expansion Listen
 Duration:
3:35

Dr. Kenneth Christian

Ellsworth Dr. Kenneth Christian presses for a bill that would expand Medicaid in Maine at an Augusta news conference.

When Dr. Amy Madden, a family physician in Belgrade, thinks about what expanding Medicaid means, one of her patients comes to mind: a middle-aged man who has diabetes and high blood pressure. Madden says he works at a convenience store and is barely scraping by.

"And he and I spent some time poring over the WalMart four-dollar prescription list to see if we could save him some money on his prescriptions," she says.

During that visit, test results revealed that he made marked improvement in controlling his diabetes over the past four months. It was an exciting moment, says Dr. Madden - until the patient left.

"I came out of it with that gnawing sense of discomfort after seeing him, because I know that this isn't going to be able to be sustained," she says. "He can't sustain an out-of-pocket approach to managing his health care, where he has to chose between test strips and medication and food."

And when Maine's 70,000 uninsured patients have to ignore their health conditions, contends Ellsworth ER doctor Kenneth Christian, it can ultimately shift costs to expensive emergency room visits, "or worse, something that I see every week: Patients who need admission decline coming to the hospital because they can't afford it," Dr. Christian said.

These doctors from the Maine Medical Association say Medicaid expansion would provide much-needed access to health care. Some contend improving the health system as a whole depends on this access.

Nurse practitioner Rhonda Selvin points to efforts such as Patient Centered Medical Homes, where different doctors coordinate care for the patients they share. And Maine was one of six states recently awarded a $33 million federal SIM grant to create innovative health payment and service models.

"Primary care is the essential place that we need to develop both the communication and the service and the care for our patients," Selvin says. "And without access, none of these programs will follow through because they hinge on the fact that all of our patients have access to primary care."

The Legislature is considering a bill that would expand Medicaid, and that also offers a few compromises to tempt opponents. Those include requiring co-pays from some new enrollees, an opt-out provision if the federal government fails to cover 100 percent of the costs for the first three years as promised, and a sunset provision after those three years.

Andrew MacLean of the Maine Medical Association says the organization is open to other compromises. "I think there is little that we would categorically rule off the table, as long as we are keeping the program within the structure of Medicaid as it has been set out in state and federal law."

But while the Medical Association is hopeful that a compromise can be reached, Republican supporters have not come forward. One staunch opponent of Medicaid expansion, House Republican leader Ken Fredette, says Medicaid expansion has to be considered in the context of Maine's budget.

"Fundamentally, we see the issue here of Medicaid expansion in the realm of fiscal responsibility," he says. "Right now, we're faced with a $200 million hole. That is the result of a continual expansion of programs under the Department of Health and Human Services. And until we get that department under control, we will never get our budget under control."

Other state organizations are considering whether to back the Medicaid expansion bill. Dana Connors of the Maine State Chamber says there are compelling reasons to support it, but the chamber is not yet taking a position. He says a committee is considering what reforms should be proposed to ensure that if Maine does expand Medicaid, costs will be contained.

Photo:  Patty Wight

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