At an event last week in Falmouth hosted by a conservative women’s group, Governor Paul LePage had a few words to say about honesty and how far he was willing to go to back up his claims.
“I told the President of the Senate and the Speaker of the House I believe that expanding Medicare, expanding Obamacare, was going to increase the cost to the State of Maine, and I made a deal with them. I told them – if it doesn’t and you prove to me it’s going to lower the cost in health care, I’ll resign and I won’t run again, but if it raises the cost of health care by one dollar, you’ll both resign,” said LePage. “Because that’s honesty. That’s what it takes. You’ve gotta put it on the table and they don’t want to. Because it’s $150 million a year, plus that’s not even counting the 35,000. It’s another about 8 million just in new personnel. It’s crazy, it’s so out of control it’s unbelievable. So don’t let ’em fool you on healthcare.”
First of all, according to the House Speaker’s office, no crass wager like this was ever offered by LePage.
Second, if he had made this bet, he would now be out of office. There have been a number of independent studies of the effects of accepting federal funds to expand health care coverage in Maine and all have shown that the state would save money by expanding care to 70,000 more Mainers.
The most simple is the fiscal note prepared by the non-partisan Office of Fiscal and Program Review for LD 1066, the bill to accept federal funds. They find no cost to the state at all for the first three budget cycles. In fact the unknown here isn’t the cost, but the savings – they note that there will likely be additional savings that will be realized that aren’t part of their estimate. The bill, as modified by an amendment from Republican Senator Roger Katz, would end after these first three years.
One area of savings was examined by the RAND Corporation in a study (PDF) of 14 states that could choose not to expand coverage. They found that, not only would they lose out on federal funds, but they would also have to continue to pay the high costs of uncompensated care for these populations. (When people without insurance get sick or injured, they often still get emergency care. This costs them, hospitals and the state much more in the long run.)
“If a state chooses not to expand Medicaid, the decrease in DSH payments could shift the cost for uncompensated care from the federal government to states, localities, and hospitals,” note the authors of the RAND study. “The fourteen states that did not expand Medicaid would see their federal transfer payments decrease by $8.4 billion, relative to full implementation of the act. Additionally, these states would spend about $1 billion more on costs associated with uncompensated care.”
The Kaiser Family Foundation conducted perhaps the most comprehensive state-by-state examination of these effects and others, including higher federal reimbursement rates for Mainers already covered through MaineCare, on state budgets. They estimate that over ten years, by accepting federal funding, Maine would save a total of $690 million over current costs while providing care for tens of thousands. You can see their results in graph form, courtesy of the conservative Heritage Foundation.
These studies don’t even begin to describe the additional positive effects of this new health care spending on the Maine economy or the economic advantages of a healthier workforce.
There is no contention that health care expansion would be an overall net cost to the state, much less the $150 million figure LePage cites. Even the brief for the Informed Women’s Network written by Republican House spokesperson David Sorenson only projects a cost in fiscal year 2018-2019, which doesn’t take into account the savings in other areas that would more than cancel it out and only occurs after the compromise expansion bill has already sunset.
What concerns me the most about this statement from LePage, however, isn’t his willful ignorance of the facts, or even his reference to the importance of honesty in a speech filled with misinformation. It’s the way in which he cavalierly dismisses the health and lives of tens of thousands of Maine people.
According to a Harvard study on the effects of expansion, Maine could prevent around 395 deaths per year by accepting federal funds, in addition to ending and preventing untold human suffering. In his statement, LePage turns what is a life or death issue for thousands of Mainers into a false anecdote about a tasteless wager and says quite clearly that if he had to pay a single dollar to save all these people, he wouldn’t do it.
Health care expansion will be voted on again when the Legislature reconvenes in January. Mainers will begin losing and being denied coverage on January 1st. It will take two more Republican votes in the House to overturn LePage’s veto.
Download the audio here. More to come.