Governor LePage’s proposed MaineCare cuts have the social services community in an uproar. And this makes sense – no one wants the least fortunate among us to be left out in the cold. As legislators dig in to find a solution to the DHHS budget shortfall, everyone is focused on how to solve the problem without eliminating critical services. Unfortunately, over-the-top rhetoric and unsubstantiated claims are blocking the road to real solutions.
One of the most deceptive of these claims is that, if 60,000 Mainers are cut from MaineCare, they will drive costs up for everyone by over-utilizing emergency rooms.
Here are some examples of this argument in action:
- “The proposed cuts will also result in tremendous cost shifts as those who lose health care coverage show up at emergency rooms for more expensive treatment…”
Garrett Martin, Executive Director, Maine Center for Economic Policy
- “They will end up in emergency rooms with their care paid for by hospitals…”
Bangor Daily News Editorial
- “Mentally ill people who now go to case managers to help them to deal with their disease would be forced to go to emergency rooms”
Betsy Sweet, progressive lobbyist
- “I see a lot of these health care costs being transferred to our emergency rooms and hospitals.”
Justin Alfond, Democrat Senator, Portland
And it’s not just liberal activists that have trumpeted this claim. Jeff Austin of the Maine Hospital Association proclaimed, “Those who have been axed from coverage no doubt will wind up in hospital emergency rooms, they find that emergency room door in the middle of the night.”
Parroted without substantiation from activists to legislators to editorial pages, this claim has enabled the debate on Maine’s over-generous social services eligibility to shift into the upside-down argument that cuts will hurt the economy, and taxpayers, as well. The problem with this argument is that the limited amount of empirical data available about emergency room utilization among the Medicaid/non-Medicaid population shows just the opposite is true- Medicaid enrollment does not impact emergency room usage.
Patterns of Medicaid’s impact on participants has been extremely difficult to measure, but a study conducted in Oregon by the Harvard School of Public Health, MIT, and the National Bureau of Economic Research, released last June, was a breakthrough. Oregon used a lottery system to bring in an additional 10,000 participants to the state’s Medicaid system, and this created a controlled study group for the first time ever. The first year’s results yielded some interesting information, some that showed a positive impact from Medicaid enrollment, and some that didn’t. One of the findings was that Medicaid enrollment did not affect emergency room utilization.
Opponents of the Governor’s proposal have tried to argue a two-front war. On one hand, they argue, limiting access to free health care is bad for those who face cuts. On the other hand, those facing cuts will not really be denied health care, but their over-utilization of emergency rooms for care makes it a greater public burden than simply extending free benefits. The results of this study show clearly that the latter argument is entirely without merit.
Another argument pushed by the Bangor Daily News and others opposed to LePage’s cuts is that, as Eric Russell of the BDN reported a Democrat insider saying, ‘people will die’. The Oregon study puts this notion to bed as well. According to the authors, their research “shows that we do not detect any statistically significant improvement in survival probability” for those enrolled in Medicaid.
Moving these two false arguments off the table will be a useful development in the ongoing effort to solve the MaineCare problem. Combining false economic arguments with scare tactics like ‘people will die’ is a shameful way to approach a problem that all sides agree needs thorough and serious review. Opponents of cuts should stay focused on their core argument – that they favor broadened socialization of Maine’s medical system – and not pretend they are seeking cost efficiencies or saving lives.
A strong debate over the role of government in health care is long overdue, and the first step is a stipulation of honest facts.
The Oregon study can be read here: