A 10-point health care plan unveiled this week by Rep. Mike Michaud sets the right priorities by taking a holistic view of health and medical care. It aims to integrate health and wellness with education, workforce development, law enforcement and other areas of government.
On a more tangible level, it encourages the treatment of mental health, substance abuse and dental disease as part of physical health care, not as a separate type of care. This is overdue.
Not surprisingly, the first item in the Democratic gubernatorial candidate’s plan is to expand Medicaid under provisions of the Affordable Care Act. Independent Eliot Cutler also supports Medicaid expansion. Gov. Paul LePage is in stark opposition and has five times vetoed bills passed by the Legislature to expand Medicaid by using mainly federal dollars to extend the coverage to more low-income Mainers. LePage considers Medicaid welfare, and his administration has worked hard to pare back welfare benefits and has demonized those who receive government assistance.
Michaud would expand Medicaid coverage to 70,000 Maine residents who are uninsured and living in and near poverty. Currently, when these people visit a doctor or emergency room, the cost of their care is shifted to those with insurance.
Twenty-seven states and Washington, D.C., have opted to expand their Medicaid coverage and four are in the process of doing so or strongly considering it.
What is unusual in Michaud’s plan is the strong focus on preventive care and and the comprehensive view of what that includes. The centrality of health care is highlighted in the first sentence of the plan: “Poor health makes it harder for children to learn and develop and for adults to work and be fully engaged in their families and communities.
“But health care reform isn’t enough,” it continues. “We need comprehensive policies to address poverty, food, the environment, housing, education and a job — things that matter as much to good health as medical care.”
This recognition that health care, education, poverty, substance abuse, unemployment and underemployment are all interconnected is not new, but addressing these problems in such a comprehensive way at the state level would be.
The plan, as expected from a Democrat, relies heavily on government agencies to coordinate and carry out much of the work detailed in the plan, although it also builds on partnerships with private entities. It also calls for an audit, but not restructuring, of the unwieldy Department of Health and Human Services. The call for a public workplan with specific goals makes sense, especially given the ongoing chaos within the department now, but it’s unclear how shortcomings would be addressed.
While it is possible to do much of the work envisioned in the plan, especially the coordination among agencies, without spending more money, many tasks will require additional spending. Michaud did not say where such funds would come from.
The broad nature of the plan makes it attractive but also difficult to implement when lawmakers and voters tend to focus on short-term, modest changes. This is also true of encouraging fellow lawmakers to commit to spending and policies that won’t pay dividends for years to come.
For example, expanding access to comprehensive dental care — which Maine’s Medicaid program does not cover for adults — is critical. Dental problems are the primary reason for hospital emergency room visits in Maine among those with Medicaid and the uninsured. But ER doctors often cannot resolve patients’ underlying dental problems; nationwide, according to the American Dental Association, 39 percent of these patients return to the ER for expensive, repeat visits. Oral health and physical health are one and the same, so it makes no sense for dental insurance to be separate from medical insurance.
Wellness is also crucial to economic growth. In the workplace, helping employees deal with substance abuse and physical or mental health illness can increase productivity and reduce absenteeism — an advantage for employees and businesses.
Michaud’s plan is far from perfect, but it outlines a comprehensive framework for rethinking health care that the state has long needed.