Coverage can remain, costs can be cut

An ideological battle has been brewing in Augusta. It’s the kind of battle that goes straight to the heart of our state’s priorities and values. For the last three months, lawmakers have been working to resolve a shortfall in the state’s health care program known as MaineCare.

Maine should be proud of the deliberate steps the state has taken over the last decade to expand access to health coverage for our families with children, seniors, people with disabilities and others. They have been a wise investment that has paid off. Our state now has one of the lowest uninsured rates in the country and is ranked as one of the healthiest states as a result. Our children have a better start in life and a brighter future. Our seniors no longer have to choose between paying for food or medicine. Our work force is healthier and more productive.

Democrats believe the solution to the current shortfall is to maintain this important investment while better managing the cost of health care. We have a prescription for the problem that addresses the true cost drivers in the program and provides a structure to bring about real change and long-term improvements in the program.

As in any health care system, a small number of individuals make up the majority of the health care costs, and MaineCare is no different. In fact, 5 percent of the population accounts for 55 percent of the cost. Better managing the care for these individuals will help lower the costs for the sickest people while improving the quality of care they receive.

So, what does it mean to better manage people’s care? The idea is to deliver care in a more cost-effective manner while producing better health outcomes. That requires health care providers to work collaboratively with one another and in closer partnership with their patients to better integrate treatment and care. We must pay health care providers based on better health outcomes rather than the number of procedures they perform. In short, we need to pay for quality, not quantity.

We can also lower costs fairly quickly by treating sick people early, through prevention measures, and helping those people with chronic health conditions manage their health to avoid expensive hospital stays. We know that a significant portion of the care provided in the emergency room would be more appropriately provided in a primary care setting.

A pilot project in one Maine hospital has already saved the state one-third of the typical cost for these individuals. This initiative should be expanded systemwide and fast-tracked immediately.

These are part of managed care solutions that have already saved millions of dollars in other states.

When the governor took office, his administration axed efforts that were under way to implement a robust comprehensive system of care management that would have saved the program tens of millions of dollars with increased savings over the years and better health outcomes for MaineCare members. The administration’s choice to end this initiative was part of a series of poor planning decisions and mismanagement that led us to the shortfall we are in today.

The governor and the Republicans in the Legislature believe the solution is to take health care away from 65,000 people to meet the budget shortfall. Republicans call this “structural change.” In reality, it is a shortsighted cost shift that will result in dramatic increases in hospitals’ uncompensated care which will translate into higher private health care premiums. People with low incomes, including seniors and parents working at low-wage jobs, cannot afford to lose their health coverage and those on private coverage cannot afford to absorb this cost shift.

Taking health care away from our parents, our grandparents, our neighbors and our fellow Mainers is morally wrong. It won’t save money and it will result in job losses, especially in our health care sector which account for one out of every four jobs in Maine.

We can better manage our health care delivery without dismantling the safety net. It is the right solution that makes the most sense and does the least harm. Throwing people off of health care won’t solve our budget problems. It is an unconscionable choice, and one that will cost us more in both human and financial terms — especially when we have alternatives that are proven to work.

Rep. Mark Eves, D-North Berwick, is the lead House Democrat on the Health and Human Services Committee.