Maine, Medicaid, and the Gruber Principle
David Catron
by

An aphorism much favored by my fellow dipsomaniacs goes thus: “Dogs are smarter than people. A dog won’t eat or drink anything that has made him sick in the past.” In other words, fill up Fido’s water bowl with Booker’s, let him slurp down enough to induce vomiting, and you’ll not get him near booze nor bowl again. What has this to do with Maine or Medicaid? Well, Maine experimented with Medicaid expansion 15 years ago, and it took the state a decade to recover from the hangover. Nonetheless, a majority of Maine’s voters approved another Medicaid expansion last Tuesday.

And it is no exaggeration to say that it took Maine 10 years to recover from its last Medicaid expansion. That debacle, initiated in 2002 by former Governor Angus King — who has since fled to D.C. where he now “serves” as a U.S. Senator — damaged Maine’s finances so badly that there was no money to pay hospitals for services rendered to Medicaid patients. It wasn’t until 2013 that the state was able to pay off that debt, whereupon Obamacare advocates began pimping expansion again. At the time, perhaps thinking of the above-quoted aphorism, Republican Legislator Ken Fredette observed:

I think it’s interesting that here we are talking about Medicaid expansion, when quite frankly, Medicaid expansion… is really what caused us to be in a decade of deficit that we are now just finally paying off. I find that ironic.

Fredette was by no means the only Maine Republican to find it ironic. Two-term GOP Governor Paul LePage, having excavated the state from beneath the fiscal wreckage created by the original expansion boondoggle cobbled together by former governor King and his accomplices in the legislature, has since vetoed no fewer than six attempts by the state legislature to expand Medicaid under the auspices of Obamacare. And, even after last Tuesday’s referendum, he announced in a statement that he still has no intention of implementing expansion until the legislature fully funds the scheme:

The last time Maine experimented with Medicaid expansion in 2002 under then-governor Angus King, it created a $750 million debt to hospitals, resulted in massive budget shortfalls every year, did not reduce emergency room use, did not reduce the number of uninsured Mainers.… Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families.

If the last Medicaid expansion was such a disaster, what could possibly have convinced Maine voters that it would be any different this time? Unlike Fido, whose memory of that bowl of bourbon will remain forever green, the voters of the Pine Tree state evidently have short memories. The Democrats rely heavily on “the stupidity of the American voter,” as Obamacare architect Jonathan Gruber famously phrased it. And the “news” media certainly cannot be counted upon to remind forgetful Mainers that none of the claims made 15 years ago on behalf of expansion were ever fulfilled.

As it happens, the program and the promises were virtually identical to the bill of goods sold to the voters this time around. Last time, the state expanded Medicaid eligibility to adults earning up to 125 percent of Federal Poverty Guidelines (this time it’s 138%). Maine’s voters were promised that expansion would lead to augmented economic growth, reduce the uninsured rate, and bolster the state’s medical infrastructure by reducing the amount of uncompensated care borne by its 39 hospitals. It goes without saying, of course, that not one of these implausible outcomes ever materialized.

According to the Maine Heritage Policy Center Foundation, the actual results of Medicaid expansion were the precise reverse of those promised by its advocates. The state’s annual economic growth, for example, actually shrank from about 6 percent annually to about 4 percent annually after implementation. Likewise, the uninsured rate remained unchanged, hovering around 12 percent from 2000 to 2010. Nor was there any positive benefit for the hospital system. The amount of uncompensated care provided by Maine’s hospitals grew apace. By 2006, charity care had more than doubled its 2002 rate.

The only new item added this time around to the 2002 list of pie-in-the-sky promises was the claim that Medicaid expansion will somehow ameliorate the opioid epidemic. Erika Lynn-Green and Howard P. Forman make this very claim in the Bangor Daily News: “Nationally, Medicaid covers 30 percent of nonelderly adults with opioid addiction, making it a crucial tool in fighting the worsening epidemic.” There is one problem with that claim. There is evidence that Medicaid expansion may actually be exacerbating the opioid crisis. The Centers for Disease Control describes the findings of one analysis thus:

The age-adjusted rate of death was 30.8 per 100,000 in the Medicaid-enrolled population, compared with 4.0 per 100,000 in the non-Medicaid population.… Efforts to minimize this risk should focus on assessing the patterns of opioid prescribing to Medicaid enrollees and intervening with Medicaid enrollees who appear to be misusing these drugs.

Additional studies on that issue will be continued by serious researchers. Until more definitive answers concerning the real causes of the crisis are forthcoming, it’s irresponsible to claim that Medicaid expansion is a panacea for the opioid epidemic. But the advocates of expansion show little inclination to behave responsibly. Groups in several states, including Idaho, Utah, Kansas, and North Carolina, hope to initiate similar referenda. One hopes the voters of those states are less susceptible to the Gruber principle than are those of Maine, where the dogfight rages on between LePage and the Legislature.

The Speaker of the Maine House of Representatives, Sara Gideon, vows that “Any attempts to illegally delay or subvert this law will not be tolerated and will be fought with every recourse at our disposal.” Governor LePage vows to do nothing at all on Medicaid until the legislature fully funds the expansion. The “news” media is predictably promulgating the claim that Governor LePage is flouting the will of the voters.

Bark. Bark. Woof. Woof.

David Catron
David Catron
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David Catron is a health care consultant and frequent contributor to The American Spectator. You can follow him on Twitter at @Catronicus.
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