Some really bad advice from Medicaid expansion foes

Sen. Michael Thibodeau of Winterport, the Senate Republican leader.

Sen. Michael Thibodeau of Winterport, the Senate Republican leader.

So many odd things have happened in Maine’s debate about expanding Medicaid, like the no-bid contract for a report that had an arithmetic error of over half a billion dollars.

But the oddest by far might be the claim from expansion foes that some should declare they will make a different income next year so they can get coverage. As expansion opponent Sen. Michael Thibodeau, the Republican Senate leader, put it, “qualifying is a self-declaration of intent.”

Whom is Thibodeau advising to report a different income to be eligible for government assistance? Maine people who earn too little to qualify for subsidized insurance through the Obamacare marketplace.

Among them are farmers and fishermen, artisans, people working part-time and students who are finishing school. I’ve heard from a man whose wife falls into this category. She is 62, has a heart condition and can’t work more hours.

Effectively, they’ve been counseled to report to the federal government a higher income than they made this year so they can get subsidies for insurance.

You may wonder how anyone can end up without insurance because he or she earns too little. Well, the Affordable Care Act was designed to cover the lowest-income people with Medicaid. The law expanded eligibility for Medicaid coverage.

However, when the Supreme Court ruled that the Affordable Care Act is constitutional, a majority of justices decided that states can decide not to expand Medicaid.

If Maine expanded, people who make up to 138 percent of the federal poverty limit will get coverage through MaineCare. Every state in New England besides Maine has chosen to or is on track to expand.

Most Mainers and state legislators support an expansion, but because Gov. Paul LePage will veto any bill doing so, getting this passed needs two-thirds of legislators’ support. While the Legislature is considering two Republican senators’ expansion plan, there might not be enough votes to override the governor’s veto.

Now, Thibodeau and other expansion foes say there is an alternative, and they note that people who make between 100-138 percent of poverty qualify for subsidized insurance. But the deductibles and copays for them, while not a lot for middle-class people, are costly to them.

And there’s a gap. If Medicaid isn’t expanded, a group of Mainers will be left behind without any coverage. Those people make less than 100 percent of the federal poverty level and have no children under 18. And they would get no subsidies to obtain insurance. None. Zippo.

Maine can’t choose to cover these very needy people with Medicaid and have others eligible under expanded Medicaid just go ahead and buy subsidized insurance through the marketplace. States can’t choose to partially expand Medicaid under the Affordable Care Act and still receive full funding.

The Mainers left behind — who make less than $1,000 a month — make too little to qualify for subsidized insurance. It’s literally MaineCare or nothing for them.

But, wait! Didn’t Thibodeau say even these very poor Mainers can get coverage after all, that “qualifying is a self-declaration of intent?” With this, Thibodeau is saying that people should say they will make more money in the future in order to become eligible for subsidies now.

This advice comes after some Maine Republicans backed a bill that would have jailed state and federal officials for enforcing any part of Obamacare.

Asked about this guidance on Maine Public Broadcasting’s “Maine Calling” show, health care navigator Jacob Grindle called it, “very dangerous, very concerning advice.” Grindle pointed out that there are “civil and criminal penalties” for misstating income.

Moreover, MaineCare expansion opponents have called Medicaid and many other government programs “welfare” and claimed that welfare fraud is rampant. Yet they are telling people to say they make more money so they can qualify for government subsidies.

Now, these expansion opponents also say that declaring higher income would be an incentive to make more money, but keep in mind that people in this category often have health problems or have some other reason why they are earning little and can’t just make a bit more.

As members of Congress consider tightening up income verification, expansion opponents tell needy Mainers to try to slide in though they don’t currently qualify.

People taking Thibodeau’s advice could be prosecuted. They could become illustrations of fraud. Now that would really make them sick — and they would still lack coverage.

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.