Suspending MaineCare for migrants is shortsighted, unethical

Hans Bruns lives in Fort Fairfield and became a lawful permanent resident of the United States in 2007. Sadly, in February of 2010, he was diagnosed with a rare form of cancer known as adenoid cystic carcinoma. Late last year, changes made by the Maine Legislature took effect, and Bruns, along with roughly 500 other immigrants who had been U.S. residents for less than five years, were notified that they were no longer eligible for MaineCare, Maine’s low-income health-care program.

Currently, affected individuals retain eligibility only for emergency MaineCare benefits. Chronic debilitating illnesses that require ongoing treatment such as Bruns’ are not covered. These restrictions deprive low-income, lawful permanent residents of essential medical care. Furthermore, the measures make for bad policy and raise serious ethical dilemmas. As the first session of the newly elected 126th Maine Legislature gets ready to convene next month, it should strongly consider reversing its decision on restrictions.

Lawmakers in Augusta justified the restrictions as necessary cuts to a state program that has been chronically over budget. Maine Department of Health and Human Services spokesman John Martins said the cuts would result in $1.3 million in savings in 2012 alone. At a time of considerable economic strain, Maine’s efforts to tighten its belt are understandable. However, the state should take a more careful look at these “savings.”

For those with ongoing medical needs, such as Bruns, a last resort may be turning to hospitals for “charity care.” If individuals fall below a certain poverty level, non-profit hospitals are mandated by the state of Maine to provide minimal standards of care. In Bruns’ case, the charity care he receives is far short of what he needs to treat his cancer and improve his prognosis, yet it remains his only option.

Charity care incurs costs for these hospitals. A recent study by the Maine Hospital Association estimated that costs of charity care had more than doubled from 2007 to 2011. Maine Medical Center, for example, saw charity care increase from $11.2 million to $18.3 million. Mercy Health System went from paying $5 million in 2007 to $12.8 million in 2011. These expenditures translate into higher health-care costs for the rest of us. MidCoast Hospital Chief Financial Officer Robert McCue said, “You do your best not to pass that cost on, but at some point it becomes so large that taxpayers and insurance companies end up paying for it.”

Others may turn to the emergency room because they know MaineCare must pick up the tab. A recent Center for Disease Control report estimated that 79.7 percent of those seeking emergency care last year cited lack of access to other options as a reason. Or they may end up in the emergency room because basic health problems that would have been remedied by regular doctor visits end up as health crises. Here, too, the taxpayer bears the costs — often significantly higher than if routine medical care had been available.

However, such restrictions also raise serious ethical questions. Are we willing to let a human being die because his or her residency falls short of state requirements by a few months? Should lawful permanent residents, who pay taxes just as citizens do, be deprived of lifesaving medical care in the event of disability or illness? In the case of Bruns, the state of Maine is saying yes on both counts.

The American Civil Liberties Union of Maine and Maine Equal Justice Partners have filed a suit against the health and human services department on behalf of Bruns. They claim that the changes violate the Equal Protection Clause in the 14th Amendment of the Constitution. In the past, the Supreme Court has established a precedent that denial of equal treatment because of immigration status is “inherently suspect and subject to close scrutiny.” For Bruns and others like him, the decision in this case could very well mean life or death. Action by the Maine State Legislature could prevent this protracted legal battle and provide rapid assistance to those like Bruns.

In the 18th century, Samuel Johnson said, “A decent provision for the poor is the true test of civilization.” That test remains as paramount today as it was then. This is a metric of our worth as a people, one that extends not only to those of us who were born here, or who are citizens, but to those of us who come to Maine from away.

Robert W. Glover is the CLAS-Honors Preceptor of Political Science at the University of Maine, where his research focuses on the politics of immigration in the United States. He is a member of the Maine Regional Network, part of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.