Gov. LePage’s bizarre campaign to protect Maine people from federally funded programs lurched forward last week with his embrace of the Graham-Cassidy health care reform bill.
Why the governor of a state with a high number of low-income residents who are elderly or disabled would back a bill designed to cut federal support for their health care costs might someday make an interesting problem for political scientists.
But it should not take Mainers much effort to figure out that virtually everything Gov. LePage says about this bill is false, and that its passage would hurt the people who even he says need help most.
The governor went on the airwaves last week urging Mainers to deluge the offices of Sens. Susan Collins and Angus King to vote for the latest attempt to gut Medicaid and put affordable health insurance out of reach for thousands of working Maine residents, saying, “We have one last shot to get the votes in the United States Senate to save the health care system from total collapse or a big government takeover.”
Fortunately, Collins and King don’t rely on LePage for guidance on policy matters, but before Mainers send off an email to a Senate office, they should take a good look at what LePage has asked them to support.
This is a massive cut to federal health care spending disguised as reform, and, according to multiple analyses, would result in millions of Americans losing health insurance, including 161,000 in Maine.
Supporters of the bill say that they would be giving states flexibility to run the health care programs that work best for them. Under Graham-Cassidy, individuals and businesses would no longer be required to buy health insurance, and the federal government would stop helping people pay for coverage through expanded Medicaid or tax credits for the middle class. In the place of those subsidies, each state would get a block grant to spend how it wants.
But like everything in health care policy, it’s not that simple. All together, the money distributed in block grants would add up to less than what the federal government now spends on the ACA, and passing the bill would pull billions of federal dollars out of the health care system each year, which would have to be made up by other payers.
The block grants would end completely in 2027, dumping the whole cost of these programs onto the states unless a future Congress decides to get back into the health care game.
The impact of block grant funding has been the subject of deceptive messaging from the bill’s backers.
In a photo opportunity with Vice President Mike Pence on Friday, LePage claimed that Maine would see “a 44 percent increase” in federal support if the bill were approved. That’s consistent with a Graham-Cassidy spreadsheet that calculates what states would receive on a per-enrollee basis if the bill were to pass.
But that data set is very misleading. It looks at a very specific population: people with incomes between 50 percent and 138 percent of federal poverty.
Many of them would have been covered by Medicaid expansion if LePage had accepted the federal funds, but they are currently not receiving anything. Another group – people who earn up to 400 percent of poverty – are receiving tax credits but were not counted as enrolled in the Graham-Cassidy calculation.
A more accurate comparison shows that what Mainers collectively receive now in subsidies under the ACA is 8 percent less than what the state would get in a block grant under Graham-Cassidy, according to the Kaiser Family Foundation.
But even that calculation does not take into account the full impact of Graham-Cassidy, which would cap the federal contribution to Medicaid, known here as MaineCare. By putting a limit on how much the federal government would pay to care for low-income parents and children, low-income elderly including nursing home patients and people with disabilities, Maine would have to raise the difference in taxes or cut services to the most needy as the federal share gets relatively smaller over time.
Whatever small gains Maine would get from the block grant would be more than offset by cuts to MaineCare. And if the block grants disappear in 2027, Maine would be even further in the hole.
There are better ways to look out for Maine’s interests. If LePage wants an increase in federal health care spending, he should expand Medicaid eligibility. If he wants to lower premium costs, he should join Sen. Collins’ bipartisan efforts to stabilize insurance markets.
But if he’s looking for a job in the Trump administration, he should resign from the one he’s got now, and let someone else run things.
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