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MaineCare system was allowed to expand to a Cadillac budget

The governor has more logic going for him with his proposed cuts than he is being given credit for.

Gov. LePage, no shrinking violet when it comes to controversy, is at it again with his proposal to address a $120 million shortfall in the Department of Health and Human Services budget.

The governor is proposing to eliminate MaineCare (Maine's term for Medicaid) coverage for approximately 65,000 of the 361,000 Mainers currently receiving benefits.

Most of those losing coverage under the governor's proposal would be childless adults, 19-year-olds and 20-year-olds, and some parents.

In addition, the governor proposes to reduce or eliminate services covered by MaineCare, generally those where Maine's coverage exceeds national norms.

All of this sounds draconian and was so viewed by almost all of those who packed the hearing on the governor's proposals in mid-December.

The governor, however, has more logic going for him than he is being given credit for.

First, a bit of history. Medicaid was developed in the mid-1960s to provide medical assistance to low-income Americans.

In particular, the program was designed to cover health insurance for families with children under age 19 at or near the federal poverty level.

The statute generally uses 133 percent of the federal poverty level as an upper limit of eligibility for a family of four. This translates into an annual income of just over $27,000.

In Maine, the Democratic-controlled legislatures of the past 30 years, up to the 2010 election, significantly expanded MaineCare eligibility to include childless adults, for example, and also to include income levels up to 200 percent and, in some cases, 300 percent of the federal poverty level.

In addition, Maine significantly broadened MaineCare coverage to a range of so-called "soft"services including chiropractic, mental health counseling and many others.

These are the kinds of services that are notoriously difficult to control or even to judge how much is enough.

The state policy pursued by the Democratic majorities in these years was to extend MaineCare coverage well beyond what was originally envisioned for the program and well beyond coverages offered in many other states.

The logic was this: Mainers needed health coverage, so why not use MaineCare to provide it, particularly as federal dollars more than matched whatever the state paid?

This made sense as long as the state could afford its share.

What was not expected was the escalating growth of MaineCare expenditures that followed. The expansion of coverage in Maine drove substantial growth in both numbers of people covered and the cost of the services provided.

In his news conference announcing his proposals, the governor noted that MaineCare enrollment had increased by 80 percent in the past 10 years.

According to a 2010 DHHS briefing, 22 percent of Maine's population was covered by MaineCare, compared to a national average of 16 percent and 8 percent in neighboring New Hampshire.

Moreover, the highly regarded 2010 report "Reinventing Maine Government," by Alan Caron and David Osborne, documented that Maine's spending on welfare and Medicaid was 69 percent above the national average and 101 percent (double) the rural state average.

One of their principal recommendations for an "Action Plan for the Decade" was "slowing the climb of health care costs."

When Gov. LePage points out that childless adults are covered by Medicaid in only 18 states, and that Maine can no longer afford such coverage, he has a point. This is an uncomfortable point, of course.

No one likes to take away a benefit.

Nonetheless, this is a trade- off the Legislature needs to examine. Early indications are that the Legislature is considering ways to temper some aspects of the governor's proposals.

Republican leadership has already said they do not support his proposal to end aid for residential care facilities for the mentally and physically disabled. Other avenues of savings will need to be found.

I do not envy the Appropriations Committee or the Legislature as lawmakers consider the governor's proposals and alternative ways to address the DHHS shortfall.

With all good intentions, we have developed a Cadillac MaineCare system that we are trying to finance with a Chevrolet budget.

Something has to give.

One may view the governor's proposals as too harsh, but, give him credit, he gets to the heart of the tough issues.