When Maine’s medical marijuana law goes into effect I am hoping my doctor will say I qualify for a little therapeutic reefer. Then I can smoke it in the bathrooms of the state capital building to help me deal with stress when Maine’s state budget problems collide several months from now with Maine’s health care system.
We are not talking about a fender bender here; this has the making of two trains colliding head-on. Coming from one direction at express speed is the estimated $1 billion gap between projected expenses and revenues in the state budget that must go into effect in July 2011. Coming from the other direction is the freight train of ever-increasing costs for Maine Medicaid, the health insurance program for Maine’s poor and disabled. The problem is being faced in every state, but it is proportionately bigger in Maine than in many others.
Now, I won’t get all of this math right, but I think I will be close enough to make my point. Medicaid costs consume over $1 billion in state funds every two years, about 20 percent of the state’s biennial budget. (Together, health care and education consume almost two-thirds of the state budget.) That means there’s no way out of a billion-dollar budget hole without Maine Medicaid taking a shellacking. With 20 percent of the total budget, Medicaid’s proportionate share of cuts would be about $200 million.
That’s bad enough, but the Medicaid train carries a bomb on board that goes off when the two trains collide. Every dollar in state Medicaid spending cuts is matched by about $3 of cuts in federal spending for Medicaid in Maine. So a $200 million cut in state budget spending on Maine Medicaid means about $800 million in total Medicaid spending cuts over two years, or about 40 percent of the Maine Medicaid budget. Even a cut half that big over that short a period will shred large parts of the care system for Medicaid patients, and some patients with it.
There are many reasons these two trains got headed at each other on the same track in the first place, but it is the rails of the budget reality that have them unable to turn aside. One rail is a lousy economy with depressed tax revenues and state employee pension investments. The other is Maine taxpayers, who have given numerous signals in recent years they will not stomach a tax increase to close the projected gap in the next state budget. That means there is no getting these trains off the track, and no avoiding a crash; the only question is how big that crash will be and how many people will get hurt.
That may depend in part on when we start working with all stakeholders on the problem for the 2011 legislative session. If most of the multi-stakeholder work starts next January, with a new governor and Legislature having only three months to come up with a two-thirds majority budget, a blunt budgetary ax will be the only tool fast enough for the job and the collision of the trains will be at full speed. If, on the other hand, the current governor, and candidates to replace him, bring together wise heads now from around this state to find other answers, the trains might collide in a more controlled, less devastating fashion.
Such heads might, for example, agree to move rapidly to a managed care model for Medicaid enrollees that could reduce waste in their care. They might find ways to reduce enrollee benefits more slowly and carefully and with less harm, and prepare more cost-saving options for the new governor and Legislature. We could begin building more care management for Medicaid patients so we will have it in place when reducing avoidable utilization of services in order to control costs becomes more important.
Starting sooner rather than later may not make a difference, but it could and it’s worth trying. Otherwise, there’s nothing else to do but wait for the crash early next year, and we might as well just get high now and watch the show because train wrecks are like, wow, man, soooo far out!
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.