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Here is a list of misconceptions about Medicaid Expansion for Maine

(with links)

1) There are no alternatives to ObamaCare’s medical welfare expansion.
 NEW! Sent from a constituent to a Republican member of the HHS Committee recently:
- “I just completed paperwork from the ‘marketplace’. I earn about $16k/yr. and can
buy a silver plan for about $5/month. I am writing you because you need to know
that we don’t need to expand Maine’s medicaid system when low income people can
get covered for less than five dollars a month. So when the democrats rant and rave
about denying poor people healthcare – remember me.”
 Data Says Maine [state GOP-led] Health Reform Working
- “Small businesses in Maine have seen continued improvement in the cost of their
health insurance policies since Maine’s health reforms were implemented in 2011.”

2) Congress can be trusted to sustain its Medicaid funding promises.
 Top Republicans say broken Obamacare promises show Medicaid expansion is a bad
- “The proposed $18 billion reduction over ten years would, in the words of two
Republican members of Congress, ‘have a dramatic effect on how much a Medicaid
expansion could cost State governments after 2014.’”
 NEW! US House Budget Chair on Expansion: “No way fed funding will be there after
three years.”
- “It doesn’t matter if Republicans are running Congress or Democrats are running
Congress. There’s no way we’re going to keep those match rates like that.”
 NEW! US government seeks to cut Medicare payments to insurers
- “…appeared to cut payments by more than the 6 to 7 percent the insurance industry
had expected, one Wall Street analyst said.”

3) Medicaid expansion doesn’t take funding away from other important
 NEW! Maine is underpaying nursing homes $30 million. Will the Legislature bring them
- “Over time, those payments haven’t kept pace with the costs of operating a nursing
home. Combined, the state’s nursing homes were underpaid $29.4 million by
MaineCare in 2011, according to the Maine Health Care Association.”
 NEW! Rep. Willette’s Tough Love to the Maine Municipal Association
- “[Medicaid expansion] is unsustainable. We must have the financial flexibility to
respond to the needs of our towns and our cities. We must keep our existing
promises before we make new ones. That is why I encourage every local leader to
speak out in opposition to a new record expansion of our Medicaid program.”
 No Help In Sight For “Lost Group” On Wait List For MaineCare Services
- “But that expansion of MaineCare would do nothing to help people like Bradley.
Republican lawmakers have argued that it would be unfair and morally wrong to
pass over the elderly and disabled people of the state who are languishing on these
wait lists to take care of those people who they describe as ‘able bodied.’”
 Perennial Raiding of Oil Cleanup Fund Symptomatic of Budget's Crowding-Out Effect
- Rep. Fredette: “The more welfare spending grows, the harder we have to look to
find the money to pay for it, and too often, essential governmental services like oil
cleanup pay the price.”
 NEW! WLOB’s Ray Richardson to Speaker Eves this morning (4
clip): “Every dollar you
spend affects every dollar you want to spend.”

4) Medicaid expansion is “free”
 State budgets are written by state departments and the legislature’s nonpartisan budget
office, the Office of Fiscal and Program Review (OFPR), not Kaiser or the Urban Institute.
 Maine’s Department of Health and Human Services estimated months ago that
expansion would cost state government $75 million per year long-term, when the
federal matching rate drops to 90 percent in 2020.
 The legislature’s nonpartisan budget office, OFPR, has produced estimates showing
that Medicaid expansion would cost over $40 million per year by 2020.
 If Maine’s historical experience with Medicaid has taught us anything, it’s that
expansion always costs more than we expect it to. In 2001, childless adult enrollment
more than doubled projections and had to be capped at 25,000.
 The Alexander Group has projected a cost of $125 million per year by 2023, or $807
million over 10 years.

5) Medicaid expansion would boost Maine’s economy
 Federal money is coming into the state regardless of whether we expand.
- Democrats talk about “$1 million per day” coming into Maine’s economy with
expansion, but they don’t mention that federal money will come into the state
regardless of whether we expand. Half the expansion-eligible population is already
eligible for heavily subsidized private plans on the exchange, and those plans pay
providers significantly more than Medicaid does.
 The state’s cost of expansion would kill thousands of jobs.
- When the state was facing a $121 million DHHS shortfall in 2011, a study estimated
that raising taxes to pay for that increased Medicaid spending would kill over 6,400
private sector jobs.

6) We’ll lose money to other states if we don’t expand
 Medicaid expansion dollars turned down by states go back to the feds’ bottom line
- From health policy expert Joel Allumbaugh: “Expansion states will not receive
additional expansion dollars because other states opt out, rather the total cost of the
ACA will decrease.”
 Declining expansion will actually reduce the federal deficit.
- According to the Congressional Budget Office (CBO), states opting out of welfare
expansion will reduce the federal deficit by $84 billion.

) The “Sunset Clause” means we can just take the “free” introductory
offer and run!
 Democrats shouldn’t approach governance like an infomercial.
 It is disingenuous to say that the legislature will repeal welfare expansion once
begun. Liberal politicians’ years of addiction to welfare spending stands in stark
contrast to their cynical and duplicitous bait-and-switch offer to yank funding from
70,000 people in three years.
 The News Virginian Editorial Board: “Don’t offer people a service and then pull it
back. To us, that seems worse than not providing it in the first place.”
 Aside from being politically impossible, a state sunset clause is also legally impossible.
 Attorney Robert Alt of the Buckeye Institute, in testimony before the Ohio
Legislature: “While the Supreme Court stated that the federal government cannot
condition the first dollar of existing Medicaid coverage upon a state’s decision of
whether to opt into the expansion, it did not say that those requirements of federal
law would not apply after a state has opted into the expansion. As such, if Ohio
were to seek to exit from the expansion at some point in the future should the
funding terms become less favorable, it is entirely likely that a court would find that
the Secretary of Health and Human Services has the legal authority to condition first-
dollar federal Medicaid spending on Ohio’s continuation in the expanded program.
 Wall Street Journal Editorial Board: “The logic of Justice Roberts's opinion suggests
that once states adopt new Medicaid, the program immediately becomes the old
program for the purposes of the law and then states can't leave. The Bricker memo
also cites ‘guidance’ from the federal Health and Human Services Department that
states ‘may decide later to drop the coverage.’ But these informal documents on the
HHS website lack the force of law or even of regulation; they aren't part of the
Federal Register. In any case, HHS doesn't have such authority. We wouldn't be
surprised if HHS is promising flexibility now only to revoke it later as a deliberate bait
and switch.”
 Bangor Daily News Editorial Board: “…there are reasonable legal questions about
whether a state can take 100 percent funding and then run.”

8) Expanding Medicaid will reduce ER usage in Maine hospitals!
 Harvard/MIT “Oregon Project”: Found that emergency room usage among Medicaid
recipients was actually 40 percent greater than among the uninsured after Medicaid
expansion in Oregon.
 Democrats like to say, “But the Oregon study reflects new enrollees with a pent-
up demand for health services!” OK, but not so fast. . .
 Look at what happens when you study static populations of Medicaid enrollees that
include long- and short-term enrollees:
 CDC National Center for Health Statistics: “Medicaid beneficiaries were more
likely to have had at least one ER visit in a 12-month period than persons with
private insurance and the uninsured.”
 The Muskie School at USM: Analysis of Emergency Department Use in Maine
(Page 2): “There was no discernible pattern associating high or low ER use with .
. . insurance status.”

9) We can contain costs! Our history with Medicaid isn’t so bad!
 Medicaid has increased in cost nationwide by more than 31,212 percent since its
 Medicaid costs have even outpaced enrollment by about 30-to-1.
 US Sen./M.D. Tom Coburn: “In light of the reality of past trends, concern about
the trajectory of the future health-care spending – whether in the ACA,
Medicare, Medicaid, or other programs — is well placed.”
 Cost and enrollment estimates for Maine’s past expansions were thoroughly smashed.
 In 2001, DHHS estimated 11,000 would “gradually” enroll out of 14,800 eligible
childless adults (74% enrollment rate).
 Instead, enrollment reached 17,000 within 14 months.
 To stop the budgetary bleeding, the Legislature had to cap childless adult
enrollment at 25,000 within two years (227% enrollment).
 Maine’s Medicaid program has roughly doubled in size in recent years.
 Enrollment has more than doubled, from 164,000 to 340,000, in just 13 years.
 Annual spending has grown by $1 billion since 2000 alone.
 The percentage of the state General Fund budget consumed by Medicaid
spending has doubled—from 13 to 25 percent—in 15 years, and is expected to
reach 36.2 percent in the next 10… even if we don’t expand.
 Maine now ranks third in the nation for Medicaid spending as a percentage of
all state spending.