Maine was sliding into a public health crisis in 2010, although most people didn’t know it.
We were focused on the Great Recession and a gubernatorial campaign in which the state’s budget shortfall was the most important issue. The candidate that talked the loudest about cutting the most ended up winning the race.
So when Paul LePage took the oath of office in 2011, more attention was paid to his proposed Medicaid cuts than the 155 drug overdose deaths that year. Those cuts went into effect in 2013, by which time the annual overdose tally had climbed to 208. It jumped to 272 the next year, 376 in 2016 and last year reached 418.
Twelve-hundred-and-seventy-four deaths later, the administration’s policy of dumping people off Medicaid (known here as MaineCare) and refusing federal funds to expand eligibility for others has made drug treatment unaffordable to thousands of Mainers who desperately need it.
In hindsight, it looks like a terrible error in judgment. But if you want remorse, don’t look to Mary Mayhew, LePage’s commissioner of health and human services and current Republican candidate for governor.
She’s not trying to hide her role – she’s campaigning on it. In a Facebook post last week, Mayhew wrote: “I fought to make millions of dollars in savings under the LePage administration and I intend to continue finding ways to streamline our health care system.” Attached was a 2013 Press Herald story that outlined Medicaid cuts for 27,000 Mainers.
Streamlining sounds good, as long as you are not one of the 25,000 Maine people who have unsuccessfully tried to get drug treatment, according to the Substance Abuse and Mental Health Services Administration. We tend not to judge health care on cost alone.
Mayhew designed the cuts to Medicaid and she opposed Medicaid expansion, which was passed five times by the Legislature but could not overcome LePage’s veto. She is still against expansion, which was approved by voters last year in a referendum, drawing nearly 60 percent of the vote. And she travels the country to convince other states not to expand their programs.
When a columnist in Utah asked why, she responded flatly, “It’s a government program.”
The same could be said about Social Security and Medicare, but don’t expect Mayhew to get any flak from the other Republicans competing with her anti-government campaign for governor. The primary has turned into a contest of who can out-LePage LePage.
In her defense, Mayhew is right that Medicaid is no magic wand for the opioid crisis. The nine states that have higher overdose death rates than Maine all have expanded eligibility (and they all had high opioid problems before they expanded).
If this were a problem that money alone could solve, she said from the campaign trail Tuesday, “you wouldn’t see overdoses in Hollywood.”
Mayhew said she had no regrets about policies she advanced, and that she does not believe they shortchanged anyone who needed help. “Because I believe that Medicaid has significant priorities that need to be fulfilled on behalf of our elderly and disabled,” she said. “And when it comes to substance abuse, there are other resources available.”
But there is a different health care system for people who don’t have insurance. An uninsured heart attack patient can be treated in an emergency room, but he probably won’t be able to see a doctor for regular follow-up visits to monitor his weight and medications.
The same is true for someone without insurance who overdoses. She can be revived at a hospital, maybe even get a bed for a week in detox, but that’s it. Without insurance, it’s unlikely that she will be able to get medication-assisted treatment, the acknowledged “gold standard” for care.
And overdose deaths are just part of the problem. Suicides by drug users are not typically counted, but they also result from the epidemic. Drug-affected babies are being cared for in neonatal intensive care units at great cost to the public. Maine is one of seven states in which the rate of hepatitis C, a disease spread by intravenous drug use, is twice the national average.
Doctors here say that endocarditis, infections of the heart lining, are also appearing more frequently in Maine hospitals, often because people inject drugs in unsanitary conditions.
When you add $55,000 a year to keep a drug user in jail, trying to care for children who were abandoned by addicted parents, and lost years of productive work by tens of thousands of people, the Medicaid savings don’t look quite as good.
Maybe we should have known better eight years ago, but we didn’t. Now we know, and the candidates for governor ought to know too.
Greg Kesich is the editorial page editor. He can be contacted at:
Twitter: gregkesich
Send questions/comments to the editors.
