MAINE VOICES: Vincent S. Conti

MaineCare 'fix' could make it worse

Copyright © 2004 Blethen Maine Newspapers Inc.

E-mail this story to a friend

About the Author Vincent S. Conti is president and chief executive officer of Maine Medical Center in Portland. To top of story

State government is in a fiscal crisis, and you may well ask, "How did this happen?" A major part of the problem is that Maine appears to have expanded its Medicaid (MaineCare) program beyond what it can afford.

Some 60,000 new beneficiaries have been added through expansion of the program, and another major expansion is planned for later this year. Although increasing health care coverage is laudable - all of us in Maine's health care system are committed to providing clinically necessary care to all those in need - the state's not paying for the care of those for which it has taken responsibility is not laudable.

Already, MaineCare pays only 79 cents on the dollar for the care of its patients. Up until just a week ago, the state was proposing additional cuts of $25 million in state and federal payments to hospitals for the current state fiscal year - a 25 percent cut in payments. This on top of the $25 million in cuts it had already imposed for this year.

THE STATE is now proposing to impose a "tax" on hospitals, and then reimburse only a portion of this tax through funds it hopes to secure from the federal government.

While the idea of a "bail out" using federal funds may sound alluring on the surface, its true feasibility is in serious question.

More importantly, at best it simply postpones dealing with the fundamental problem of the state offering to provide services it's not willing or able to pay for.

For this reason, we at Maine Medi- cal Center - and I believe all Mainers - should have very serious concerns about this approach.

What then should be done? For its part, the state needs to either recognize that the current MaineCare program and that which it apparently envisions for the future is beyond the state's resources, or it needs to use other state and federal resources to pay for it. Both are real options.

For their part, the hospitals need to continue to look for ways to reduce the cost of taking care of each individual patient. In fact, this is happening.

Hospitals have worked hard to meet the voluntary cost increase limits called for under Gov. Baldacci's Dirigo Health plan.

They have cut costs to be able to sustain $58 million cuts in previous MaineCare budgets, as well as a $3.5 million hospital tax collected in February of last year. For example, through a series of very focused cost assessments, MMC has held its cost per adjusted discharge to $6,873, well below the average of $7,395 at similar hospitals nationwide.

We need to act to assure that the current crisis is not a portent of things to come. Unless and until the state faces up the true cost of the MaineCare program, it will continue to reduce payments year by year.

Increasing numbers of Maine citizens covered by the MaineCare program will bring more uncovered costs to Maine hospitals. Maine Medical Center, for instance, has seen an almost 30 percent increase of MaineCare patients in the last year, with a 60 percent increase in the shortfall of MaineCare reimbursement.

These real costs being incurred by Maine's hospitals will in turn be passed on to insurers and employers, and when they refuse to absorb those increases, there will be a crisis of huge proportions.

Hospitals would have to cut services and staff just to keep the doors open for urgent needs. The people on MaineCare who have entrusted the state with their well-being would be the ultimate victims of an unaffordable program.

Those of us in health care have a clear view of our mission: to provide appropriate and necessary care to all who need it. Maine's hospitals have always worked with the state government in good faith to preserve their ability to carry out that mission.

The state's willingness to put our mission at risk and to raise the cost of care for everyone else is disturbing. Surely we can work together and do better than this for the people of Maine.

- Special to the Press Herald

To top of page