Maine commissioners say Medicaid spending threatens natural resource agencies

AUGUSTA – Members of Gov. Paul LePage’s cabinet gathered at the State House on Wednesday to deliver a message to the public: Expanding Medicaid will undermine funding for natural resource management and environmental protection.

The cabinet members, surrounded by LePage supporters and Republican lawmakers, delivered the message one day after Assistant Senate Minority Leader Roger Katz (R-Kennebec) and Sen. Tom Saviello (R-Franklin) unveiled a new effort to push Medicaid expansion legislation as an amendment to a bill that would establish state contracts with managed care service providers.

Many Republicans fear the purported compromise legislation will undermine attempts by conservative lawmakers to thwart the Democrat-sponsored expansion of Medicaid – a key provision of the Affordable Care Act a.k.a. Obamacare.

Department of Health and Human Services (DHHS) Commissioner Mary Mayhew began the press conference by stating the problem: state spending on Medicaid has grown tremendously over the past decade, and this increase has come at the cost of other state agencies and priorities within DHHS.

“Democrats have said that adding 100,000 people to Medicaid is somehow free, but we all know better,” said Mayhew. “Don’t be fooled with efforts to combine expansion with fancy new managed care legislation,” she said.

Mayhew repeated the administration’s view that expanding Medicaid to cover able-bodied young adults will prevent the state from funding services for more vulnerable populations, including intellectually disabled individuals and elderly in nursing homes.

“We do not live in a world of unlimited resources. If the state expands Medicaid our elderly and disabled will wait longer for services. That is a price we cannot afford to pay,” said Mayhew. “Efforts to contain spending in the Medicaid program should be focused on meeting the needs of our most vulnerable and addressing other critical needs in state government.”

“Government simply cannot be all things to all people,” she said. “We must put the needs of our most vulnerable citizens at the front of the line and ensure that state government is effectively prioritizing our limited resources in the best interest of the future of this state.”

Department of Marine Resources (DMR) Commissioner Patrick C. Keliher said the prospect of Medicaid expansion jeopardizes his agency’s ability to care for coastal natural resources.

“The biggest example would be the Maine lobster,” he said. “The health of this population is very strong, but we now have three years of survey information on juveniles that leave us very concerned.”

“Our ability to do additional research, to make those determinations, to ensure that the information that we have right now is accurate, to be able to make future management decision is jeopardized, jeopardizing 5,000 license holders and an industry that is worth likely upwards of $900 million to our coastal communities,” he said.

The shrimp industry and the clam industry would also suffer from a lack of effective oversight and management should Medicaid expansion become law, Keliher said. He also said that DMR’s ability to enforce state laws and regulations will be diminished if resources continue to flow away from DMR to social services.

“We will not have the means available to adequately enforce our laws,” said Keliher.

He said Medicaid expansion would “severely impact” DMR’s ability to manage coastal resources in the coming years.

Walter E. Whitcomb, commissioner of the Department of Agriculture, Conservation and Forestry said Medicaid expansion would also threaten the state’s forests, farmers and public parks, as shifting funding to social services means natural resource agencies continue to go without proper funding.

“We’re considered the small natural resource agencies,” said Whitcomb, “But in a sense we represent what Maine is widely known for – our iconic image.”

“Unfortunately, because of the constraints, particularly over the last ten years, of the incessant shift toward social spending, the natural resource agencies have taken it on the chin financially,” he said.

He cited a 13 percent cut in General Fund allocations the agency took in 2009 and said such decreases hamstring his ability to promote Maine made products through the world. The lack of funding also prevents much needed technology upgrades, he said, keeping his department stuck with antiquated “dinosaur technology.”

Department of Inland Fisheries and Wildlife Commissioner Chandler E. Woodcock, who served in the state senate for six years, said that despite his department’s unique constitutionally guaranteed revenue stream, he is still concerned about the impact Medicaid expansion would have on the future of his agency and the state.

“Maine cannot afford to continue on this pathway,” said Woodcock. “The future of Maine is at risk in this discussion.”

“Fifty years from now we will be impacted by this moment,” he said.

Woodcock reiterated his fellow commissioners’ message, that drastically increasing Medicaid funding has a necessary tradeoff for other priorities. He cited specifically Maine’s fish hatcheries, which the department would like to expand but cannot due to limited funding.

“Our ability to maintain Maine is being threatened,” said Woodcock.

Department of Environmental Protection Communications Director Jessamine Logan spoke on behalf on DEP Commissioner Patricia Aho, who, she said, was in Boston testifying on federal wood stove regulations.

Logan highlighted the impact growing social services spending places on DEP’s efforts to protect the environment and address instances of pollution.

“The last expansion [of Medicaid] came at the cost of natural resources,” said Logan. She said funding restraints mean contamination cleanup sites cannot be addressed as quickly as possible and must instead be placed on waitlists.

In the past ten years, she said, nearly $3 million has been diverted from ground water and surface cleanup funds in order to accommodate the growing funding appetite at DHHS.

All told, the commissioners of the natural resource agencies delivered a message tailor-made for the left-of-center public.

The administration’s previous messaging efforts have focused on the cost to taxpayers of growing Maine’s welfare rolls. And talking points addressing the crowding-out effect of Medicaid spending has centered on education, transportation and public safety. But today’s message highlighted the fundamental tradeoffs with regard to natural resource management that will become necessary with another expansion of Medicaid.

At the conclusion of the press conference, Mayhew addressed the Katz-Saviello expansion bill head on.

She said bringing in for-profit, out-of-state managed care service providers — a key provision of the bill — will duplicate local efforts already underway in Maine’s communities while failing to produce predicted savings. Managed care providers, she said, typically produce cost savings by reducing services or cutting reimbursement rates – something which may work in states with high levels of services or high reimbursement rates, but which cannot work in Maine.

“For-profit managed care companies are unproven,” she said. “We cannot afford to have companies coming in here to cut rates to nursing homes,” adding that Medicaid programs already do not pay their “fair share” to medical providers.

“It’s unfortunate,” said Mayhew, “that we’re going to try to fool people into believing that these two issues [Medicaid expansion and managed care service providers] are linked… It’s nonsensical.”

Gov. LePage, who did not attend today’s press conference, delivered a statement to media beforehand via email.

“Everything the State of Maine does is adversely impacted by Medicaid spending,” said LePage. “Now liberals want to expand welfare again.”

Steve Robinson
Editor, Maine Wire