I wish I could introduce one of my patients to Gov. Paul LePage.
This patient is a young man whose situation illustrates how Medicaid can pay huge dividends for individuals, families, communities and the state. He became my primary-care patient last fall, soon after his visit to an emergency department for physical trauma.
Besides dealing with this immediate concern, he and I also talked about his substance abuse problem. Somewhere between his prison time and seeing the havoc of the opioid crisis all around him, he understood he needed help. His low-wage job doesn’t include health insurance, but fortunately, he has it through Medicaid.
The expansion of Medicaid — also known as MaineCare — would extend such benefits to over 70,000 other Mainers like this young man, at a net cost to the state of $62 million. In other words, the state annually would effectively pay a mere $867 per person for health insurance — an incredible bargain.
Nearly two-thirds of states have capitalized on this deal. Expansion states cover people with income up to 138 percent of the federal poverty level ($16,753 annually for an individual; $34,638 for a family of four). Every other state in New England has expanded Medicaid, which has yielded them better than 9-to-1 matching funds from the federal government. The Maine Legislature has approved expansion of Medicaid five times in recent years. Each time, Gov. LePage vetoed it. Then last November, Maine voters took the veto-proof step of passing a Medicaid expansion referendum by a wide margin: 59 percent to 41 percent.
By law, Gov. LePage’s administration now has until April 3 to submit an expansion plan to the federal government. Unfortunately, he has given every indication that he will not do so.
Frugality has its place, but Maine already has the necessary money to invest. Earlier this month, the state’s Revenue Forecasting Committee affirmed that for each of the next four years there would be $180 million to $190 million of unappropriated revenue. There also are hundreds of millions of dollars in Maine’s Medicaid fund, even though Maine already forfeited tens of millions of dollars by not expanding Medicaid earlier, when the federal government was paying the entire expansion cost.
Despite that low state cost, the benefits would be profound.
• For starters, health insurance saves lives. The best estimates from the medical literature — presented by Harvard health economists in studies published in 2014 and 2017 — suggest that expanding coverage would save around 140 lives each year in Maine.
• Second, quality-of-life, chronic illness and other non-mortality outcomes significantly improve when people have health insurance, the Harvard researchers concluded last year in a separate article.
• Third, healthier people contribute to healthier families and more vibrant, prosperous communities.
• Finally, expansion would infuse Maine’s economy with hundreds of millions of dollars annually. In a report released last September, Maine-based health economist Elizabeth Kilbreth estimated that expansion would generate about 6,000 permanent jobs in the state, spread across the health and non-health sectors. Some of those jobs would help keep critical-access hospitals, departments and clinics open, which is a major concern in the vast rural Maine landscape.
The comprehensive, Medicaid-funded primary care to which my patient has access gives him much more than a fighting chance to have a fulfilling and productive life. Now, his injury has healed; he remains sober from opioids, with the help of Suboxone (the brand name for buprenorphine); he is quitting smoking; he has been exercising more; and he is working full-time.
I asked him recently to reflect on his personal journey. He told me that things have gotten much better since getting care. “(I’m) workin’ a full-time job, payin’ taxes, payin’ my fines off, helpin’ my parents pay for their house, savin’ up for a basic car,” he told me.
And then his thoughts turned to his school-aged daughter: “Since I’ve been here, I’ve gotten a lot closer with her, thinking about her. I used to just want to get high, and spend all my money on that, but that’s not ruling me now. (Instead, my daughter) wants to hang out with me all the time, so I think I’m doing all right by her.”
This young man is not simply a Medicaid recipient; he is the anchor of his family. He knows the dignity of both an honest day’s work and having health care. Why won’t Maine’s governor expand Medicaid and guide over 70,000 more Mainers and their families in the direction of health?
Sam Zager is a family physician and a resident of Portland.
Send questions/comments to the editors.
