Listening to Mainers debate health policy, some seem to talk only about finances. They focus on what care costs, whether the state can afford it and the impact of decisions on hospitals’ bottom lines.
But others contend that, while medical coverage is a financial matter, it’s also about improving health, preventing disease and keeping people alive.
Truth is, Maine can save money and lives. Here are three ways to do both.
1. Increase attention to people with chronic illnesses
Certain people generate most health care costs. For instance, 95 percent of Medicare spending goes to people with at least one chronic condition.
Some have heart disease, even heart failure. Others have diabetes, asthma, high blood pressure or high cholesterol.
A study of a Pennsylvania project called Health Quality Partners found a whopping 25 percent reduction in deaths between two groups to which people were randomly assigned. One group was given intensive attention.
Financial savings were also stunning. Medicare costs declined by 22 percent as hospitalizations fell by 33 percent.
What HQP did wasn’t high-tech. They sent a nurse to see people once a week or month. A reporter who tagged along some visits “asked a half-dozen seniors what difference Health Quality Partners made in their lives. Every one of them began the same way: They could ask their nurse questions, they said with evident relief. They could get help understanding and navigating their doctor’s orders. They didn’t feel like they were being a burden if they needed to ask one more thing, or have their medications explained to them again.”
Visits saved a lot of money and extended lives. Maine could implement it for people on MaineCare.
2. Help Maine’s insurance marketplace enroll everyone who qualifies
Health insurance marketplaces get much less attention than other aspects of the Affordable Care Act (Obamacare).
Each state will have one, and people in the individual insurance market will buy coverage through it. Depending on family income, citizens may receive subsides to help pay their costs.
Massachusetts, under Romneycare, has had one for awhile. Like the coming state marketplaces, it offers different levels of coverage from various insurers.
Gov. Paul LePage decided that Maine would not build its own, leaving it to the federal government. But recently he spoke positively about the subsidies available to people using the online marketplace.
Getting more people coverage will improve their health. And if Maine, like Massachusetts, can get near-universal coverage, there will be less unreimbursed charity care. This prevents shifting health care costs to others, including taxpayers.
Marketplaces open enrollment on Oct. 1. Studies show that many lack information and need assistance to sign up. Colorado is running ads and will train people to help others choose insurance, as other states are about to start. Maine needs to do the same.
3. Expand Medicaid, one way or the other
Expanding Medicaid would cover more working people with low incomes.
Research has repeatedly shown that including more people in Medicaid helps improve mental, medical and financial health and saves lives.
Because Maine previously covered more than the federal government required, the state can benefit financially. As the non-partisan Kaiser Family Foundation revealed, if Maine expands Medicaid, it will save $690 million in the next 10 years.
But there’s more than one way to expand Medicaid. Maine could follow the Arkansas model. Adopted on a bipartisan basis and supported by the business community, Arkansas wants to use the “private option.” Medicaid recipients will get coverage through the marketplace, with insurance purchased by the state. And if income fluctuates, people can keep the same policy.
Given how the issue has evolved, expanding Medicaid could be part of a package that improves Maine’s economy, leading to hospital debts retired more quickly and bond funding released. This opportunity should not be missed.
If we expand Medicaid, promote the exchanges and intensify care for people with chronic conditions, we can save money and lives and boost our economy.
Many fewer Mainers will risk bankruptcy because they lack health coverage and can’t pay the bills. Bake sales, lovely as they may be, are inadequate to cover the cost of cancer treatment or care following a serious accident.
As taxpayers and health providers benefit, Maine people will be treated sooner and better, helping them, their families and communities.