After giant theatrical checks, reality check needed for Maine health care

Health politics is getting increasingly theatrical even as health policy has serious consequences.

Some of the theater is great fun. For instance, in Maine last week, an event included not one, but two giant checks.

One giant check was being delivered by Gov. Paul LePage to pay all state debts owed to hospitals in one fell swoop. Rather than simply having the funds transferred, the governor’s staff created an event aimed at producing an attention-grabbing image.

The governor’s giant check had been in the works for a long time. Before LePage took office, his incoming communications director, Dan Demeritt, wrote a December 2010 memo that created a bit of an uproar largely because he said, “Once we take office, Paul will put 11,000 bureaucrats to work getting Republicans re-elected.” But Demeritt also proposed events with “a big symbolic check.”

Demeritt’s smart plan for a bit of political theater came to pass, although a second oversized check appeared, delivering a different message. Uncle Sam held this one, symbolically paying Maine for covering health care for 70,000 Mainers via Medicaid expansion. The Maine People’s Alliance’s photo-bomb won attention, as LePage, to his credit, appeared to find the whole scene exceedingly amusing.

With these theatrics behind us, Maine still has health policy decisions to make.

Those tens of thousands who would have received health coverage through expansion will suffer if they lose coverage or can’t get insurance. Studies consistently show that people without insurance suffer preventable deaths and illnesses. Hospitals support the expansion. Recently, when the ACA enabled young adults to stay on their parents’ plans, hospital debt decreased.

And so policy questions on Medicaid expansion won’t go away. Not only will it be an election issue next year, but the Maine Legislature will surely take up another bill to expand it. Expansion is very popular nationally, as most people who would benefit have low incomes and work for a living.

Legislators and LePage should consider a range of options. Standard, traditional Medicaid is one possibility, but there are others.

Recently Republican Gov. Tom Corbett of Pennsylvania agreed to an expansion, while proposing including incentives for patients to seek care from doctor’s offices and medical clinics rather than emergency rooms. People on Medicaid can save money if they participate in health and wellness programs and, if unemployed, are involved in job training programs.

In April, Gov. Mike Beebe of Arkansas, a Democrat in an increasingly Republican state, signed a bill expanding Medicaid via a “private option.” Arkansans with Medicaid will get state support for choosing private insurance from the state’s health insurance marketplace.

Closer by, Vermont is going a different direction. It’s creating a single-payer option that will use funds from the Affordable Care Act.

Policy creativity is possible. Maine could use more of it.

But even if LePage absolutely refuses to expand Medicaid, no matter what, he could do more to help Mainers get health insurance through the insurance marketplace.

Research shows that many people who will be eligible for subsidized coverage through the marketplace don’t know and don’t understand the system. But when they learn about their options, they will like what they hear and want to sign up.

While LePage hasn’t actively sabotaged the insurance marketplace like Republican governors in Texas, Florida and Missouri, he hasn’t publicized them. The governor could start by urging the uninsured to sign up and by explaining that nearly all will get financial aid to buy insurance.

Unfortunately this wouldn’t help Mainers eligible for Medicaid, since they don’t qualify for subsidies to buy insurance.

Nationally a different kind of theatrics is in full flower. House Republicans and some senators, like Ted Cruz of Texas, are trying to defund the Affordable Care Act and threaten to stop government operations.

Pragmatic conservatives and business groups, such as the Wall Street Journal editorial board and the U.S. Chamber of Commerce, have told Sen. Cruz and the tea party faction that it’s not possible to end funding for health care and that a government shutdown would hurt them politically.

As the Wall Street Journal’s Paul Gigot reports, Cruz privately admits his plan can’t work. This makes Cruz’s plan sound like an attempt to deceive his own supporters, thus a rather dishonest bit of political theater.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.