MaineCare rests on taxpayers’ backs

While the ideological debate about Maine’s Medicaid program — MaineCare — is likely to continue, the financial facts remain unchanged and the fiscal pressures will not go away without difficult decisions being made.

With that said, the Bangor Daily News recently published “MaineCare is not welfare” by Steve Bien and I must disagree with this sentiment. The reality is that Medicaid is a taxpayer-funded health service. For many, any benefit program that would not exist without taxpayer support is considered welfare.

There is no debating that Maine’s Medicaid program has grown to a point where it cannot be sustained. The program must find its way to firmer financial footing quickly, as funding is due to run out in April.

The age-old argument of those who endorse taxpayer-funded health care is that every state dollar is matched by nearly three federal dollars, so it is a “good deal” for Maine to leverage federal funds. The word “taxpayer” is conspicuously missing from the remarks of the ideologues who support bloated social service programs and overspending.

Whether it is state or federal funding, these dollars come from the working class taxpayer who often is struggling to make ends meet.

As a result of pursuing this ill-guided strategy of overleveraging federal funds and budget building, Maine Medicaid has moved away from its original intent, to be a true safety net for the neediest. Maine has expanded its coverage to many more people — nearly a third of Maine’s population — and offers far more services than required by federal law.

Over the last decade, the state’s desire to grab federal funds has helped Maine grow its Medicaid program by more than $1 billion. And in the last nine years, enrollment has reached record highs, with nearly 80 percent more members today than in 2002.

When the state looks at the current budget shortfall, it is clear that the Medicaid program must make structural changes. The Maine Department of Health and Human Services faces a $120 million shortfall in state fiscal year 2012 and estimates an additional $101 million gap in 2013.

As the budget deliberations gear up, it must be pointed out that if all of the proposals on the table are approved by the Legislature, more than one in five Mainers — or around 285,000 people — still will be receiving taxpayer-funded health care. All of the people and services required to be provided by the federal government will continue and Maine still will provide taxpayer-funded health care to more people than the national average.

We all can agree that more needs to be done to bring down the amount of expenses for the high-cost user, to better manage the care of Medicaid members and to hold providers and members accountable. It appears that DHHS is moving in that direction with value-based purchasing, performance-based contracting, patient-centered medical homes and other initiatives. These changes will not happen overnight and have no chance to erase a decade of reckless spending and unsustainable growth.

Maine’s Medicaid program must be reprioritized and resized to help close the gap and ensure that the safety net still will be there for those who are most in need for years to come.

Paula Sutton lives in Warren.