FORUM: Trish Riley

State shouldn't cut back on medical care

Copyright © 2003 Blethen Maine Newspapers Inc.

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ABOUT THE AUTHOR Trish Riley is director of the Governor's Office of Health Policy and Finance and serves on the University of Maine Board of Visitors. To top of story

A Dec. 9 Maine Voices column ("Maine's choice: Medicaid or diplomas") by two Senate Republican leaders contained serious misinformation about Maine's Medicaid program.

Certainly our economic hard times mean the governor and the Legislature are faced with difficult choices. But these choices require a careful review of facts, not polarizing rhetoric.

In this past year, Gov. Baldacci has worked in a bipartisan fashion to balance the budget, correcting a $1.2 billion deficit without raising taxes and passing Dirigo Health Care.

Maine's Medicaid program provides essential health care to 243,000 of our citizens. It covers one in every three Maine children, supports school-based programs and provides the majority of long term care for our elderly.

And it's a good deal for Maine, providing two federal dollars for every one invested here. It helps make private insurance work by serving a large number of disabled citizens whose care is expensive and who otherwise would incur bad debt and charity care which raises premiums for all the rest of us.

Medicaid costs grow because tough economic times mean fewer jobs and more enrollment in the program. Maine leads New England in the rate of decline of employer-based coverage. As more businesses drop coverage in these tight times, Medicaid is there to provide health insurance for at least some of the low-wage workers who lose private coverage.

It's true that 23,000 Mainers enrolled in Medicaid this year. Most of them were working families with children. And Medicaid is expensive because health care in Maine is expensive.

To be sure, Maine's Medicaid program has had problems predicting costs in an uncertain economy, but the program continues to hold its administration costs to about one-third of those charged by private insurers.

The problems in Medicaid are not new, but our dedication to finally resolving them and placing essential management systems in place is.

Gov. Baldacci has taken deliberate steps and responsibility by hiring a new financial management team in the Department of Human Services; by initiating a comprehensive review by Price Waterhouse Coopers to help jump-start our management improvements; and by meeting weekly with staff responsible for Medicaid to assure program oversight.

Moreover, we are committed to bringing down the high cost of health care that drives insurance premiums and Medicaid growth.

The two senators' solution is to close Medicaid enrollment and suspend Dirigo Health. To do so is, in the first instance, a violation of federal law. Medicaid enrollment cannot be capped except in relatively small waiver components of the program. We could cap enrollment on only about 10 percent of the Medicaid program.

But this would raise overall health care costs. Our citizens still get sick and their care is paid by all of us in higher insurance premiums. And to halt Dirigo Health is to stop the very activities that will bring down health care cost growth.

Dirigo Health will provide an affordable product so small employers can retain - not continue to drop - health coverage for their workers and provide subsidies to help individuals and families pay their premium costs.

Once Dirigo Health is launched with one-time state funding, subsidies are financed over time not from the state's general revenues, but from an assessment on gross revenues of insurance companies - an assessment that can only be charged if savings are realized that bring down the growth of health care costs.

In these ways, Dirigo will constrain the growth of premium costs while serving Maine's small businesses and uninsured citizens.

We in Maine are experiencing a perfect storm - rising health care costs that must be paid by all of us, including all public institutions. These costs force more employers to drop coverage, thus increasing Medicaid enrollment.

Dirigo Health, far from the problem, is an essential part of the solution to bring down costs and make sure all of us have affordable, quality health coverage.

- Special to the Press Herald

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