Costs down and benefits up for Obamacare, but Maine lags

As Obamacare begins to make a difference, Maine is lagging.

Remember when people said that the Affordable Care Act doesn’t do anything to lower costs? That’s already been proved wrong — and in a big way.

According to the highly respected Congressional Budget Office, compared with its 2010 estimate, projections for Medicare spending in 2020 are 15 percent lower, and projections for Medicaid are 16 percent lower. Taken together, those add up to $222 billion dollars.

In addition, costs will be billions less for Obamacare subsidies for people getting aid to buy private insurance through the insurance marketplace. Those cost decreases will also affect people not receiving subsidies, as the CBO revised its “projection of private health insurance premiums per enrollee in 2020 by about 9 percent.”

These lower costs are, of course, excellent news for the federal budget and decrease expected levels of debt and deficit.

But they also reflect better health for more people. That’s because drops in cost have been achieved smartly.

For instance, the Affordable Care Act encourages the development of Accountable Care Organizations. Health care providers work together to share information and avoid unneeded medical procedures and tests. If they can avoid unnecessary hospitalizations and deliver quality health care, the ACOs are rewarded. ACOs move away from the way most hospitals are paid for health care — exam by exam, test by test, procedure by procedure. It’s better for patients and costs less.

As independent Sen. Angus King reported, after visiting MaineHealth and a school-based program promoting exercise and good eating habits, “I saw firsthand at MaineHealth how the new law is supporting improved care practices through innovative Accountable Care Organizations, and at East End Community School I saw a nationally-recognized example of preventive and wellness care with the Let’s Go! program, which the ACA is bolstering through a $2.4 million Community Transformation Grant. These ACA-supported developments will go a long way in helping Mainers to not only live healthier lives, but to also save more money in the long-run.”

But not all Mainers are benefiting, as our state suffers from Gov. Paul LePage’s decision not to expand Medicaid.

About 70,000 Maine people will either not receive or will lose Medicaid, leaving them more vulnerable to illness, deaths and medical bankruptcies.

Take a young family, with two parents and two small children making $27,000 a year. The parents qualify for Medicaid under federal rules but not for subsidies for buying insurance through the exchange. Until the Supreme Court ruled that states could turn down Medicaid, they would have been covered.

Now it’s LePage and some Republican state legislators who are standing in their way. The result: Families that are working hard but not making much money won’t get health coverage

LePage’s decision hurts women more than men. As a study by the nonpartisan Kaiser Family Foundation finds, “Women are consistently more likely than men to report a wide range of cost-related barriers to care for themselves and their families, such as skipping needed care and forgoing prescription medicines because of the out-of-pocket costs.” Under Obamacare, coverage includes mammograms, pap smears, birth control and maternity care, helping women and their children.

Turning down Medicaid leads to cost shifting. Health economist Jonathan Gruber estimates that premiums will be 15 percent higher in states that don’t expand Medicaid because more people will use higher cost health care. Instead of catching problems early in a medical office, they’ll get sicker and go to an emergency room. Higher, non-reimbursed costs will be passed along to everyone with health insurance.

Meanwhile, LePage is wasting taxpayer money that could be used for people’s needs by giving the Alexander Group a no-bid contract to analyze Medicaid and produce a study that will simply support pre-existing views.

The nearly $1 million report will come from a consultant who has left a trail of problems where he previously worked and whose idea of reform is throwing children off health insurance. Its greatest use will be in the governor’s re-election campaign, as it will undoubtedly show up in campaign advertising. Campaign surrogates and strategists will claim it provides evidence of LePage’s pragmatism and care in looking after the state’s taxpayers.

But instead Maine people will have been left behind, even as, nationally, Obamacare is increasingly delivering better care with cost restraints.

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.