Earlier this month, the Maine House sustained the governor’s veto of LD 837, the Medicaid expansion bill, by a vote of 85-58. While I have opposed efforts to expand Medicaid in the past and remain concerned about what it will eventually cost Maine taxpayers, I voted to support this funding bill. Last year’s referendum passed overwhelmingly in Gorham, Scarborough and Buxton so I felt it was important to respect that ballot decision.
While this funding bill is now dead and the expansion is in limbo, I believe it represents a missed opportunity for this administration. Expanded Medicaid is now law in Maine. Implementing what voters passed, using conservative ideals that are working in other states, could have been a priority over the last several months.
In January, the Trump administration announced its flexibility in how states administer their Medicaid programs, prompting Maine and 10 other states to submit waivers requesting permission to institute guardrails around the program in an effort to break the cycle of poverty. Of the 11 waivers applications, four states have received approval (AR, IN, NY, KY).
Had this administration submitted the necessary paperwork to begin our expansion (and had the legislature funded it), we could have included many of these conservative proposals in our application, resulting in a much more palatable program than what is currently on the books.
The first and most popular proposal that I would like to see implemented is work requirements for able-bodied adults. As of January, 36 percent of the 100,000 non-elderly, non-disabled adults on Medicaid in Maine were not employed. The referendum which passed last year will add another 70,000 able-bodied, childless adults; we need to make sure that they are contributing to their communities for this benefit.
Having a job is about more than monetary compensation. Work provides individuals with a sense of accomplishment and self-worth, as well as daily structure and skill development that no government program can provide. For those without a job, this requirement could also be fulfilled by volunteering a few hours a week within the local community or pursuing higher education.
Work-oriented activities help end isolation, build relationships and improve the quality of life for recipients. We have already implemented similar requirements to our TANF program for able-bodied adults and the results were incredible. Within one year, these individuals were earning 114% more than they were before these requirements existed.
Income growth and self-sufficiency is critical for Maine families and for our economy. It also improves overall mental and physical health. The goal of all government programs that serve able-bodied, non-elderly adults should be self-sufficiency, not perpetual dependency.
Other proposals that were included in Maine’s waiver request included cost sharing of premiums and co-insurance.
The theory behind cost-sharing is that recipients with the ability to earn an income would be responsible for a small premium based on their capacity to earn, likely $10 – $40 per month. These small premiums would give recipients a level of personal responsibility or “skin in the game” for their coverage, much like privately insured members who obtain insurance either through their employment or on the exchange. In addition, this policy would help remove some of the burden of the program from Maine taxpayers.
The idea of co-insurance isn’t new to anyone who holds a private insurance policy. Under the waiver request that was filed, there would be a $20 co-insurance fee to use the emergency room. Under the current program, there is no incentive for participants to keep up on their own health through a primary care provider or walk-in clinic. As a result, taxpayers pay for many non-emergency visits to the ER through the Medicaid program.
It appears that this administration may continue to resist implementing Medicaid Expansion. However, I remain hopeful that the Trump administration will work closely with Maine Department of Human Services to approve our waiver under the existing program.
Amy Volk is serving her second term in the Maine Senate and represents the people of Senate District 30 which includes Gorham and parts of Scarborough and Buxton. She is the Senate Assistant Majority Leader, the Chair of the Labor, Commerce, Research and Economic Development Committee and is also a member of the Environment and Natural Resources Committee.
(207) 287-1505 | (800) 423-6900 | amy.volk@legislature.maine.gov