Study: Most MaineCare adults are older, ill

Posted Wednesday, January 11, 2012 in News

Study: Most MaineCare adults are older, ill

by Gina Hamilton

A new study, released by Maine Equal Justice Partners, has determined that one of Gov. Paul LePage's assertions — that childless adults covered by MaineCare tend to be young and healthy — is simply untrue.

Although LePage's spokeswoman, Adrienne Bennett, insisted the average age of a childless MaineCare recipient was 40 years old, the data seem to contradict that assertion. 

Members of this group tend not only to be older, but chronically ill as well. Sixty percent of the members are age 35 or older; 43 percent are age 45 or older.

Disease, including cancer and mental health conditions, account for most of the services used by this group. Forty-seven percent of members getting services fall into a major diagnostic grouping of disease or cancer (e.g., a disease of the nervous system, the circulatory system, digestive system); 24 percent had a diagnosis categorized as a mental disorder; 11 percent were treated for an injury or poisoning.

"People with chronic illness who lack access to care forgo needed health care, often with severe consequences. Uninsured adults with common chronic conditions (diabetes, hypertension, arthritis-related conditions, high cholesterol, asthma and heart disease) suffer serious, identifiable gaps in needed medical care. Almost half of these adults do not access needed medical care or prescription drugs due to cost and, as a result, are at higher risk of mortality," the report asserted.

The report also made the point that Maine is by no means alone in offering Medicaid to these groups. Twenty states offer health-insurance  assistance to poor, childless adults, especially to cover catastrophic health issues and chronic disease. Beginning in 2014, all states will be required to provide this care anyway, under the Affordable Care Act, so removing it for a year and a half, with the health issues likely to be caused during that period, is counterproductive.

Dr. Laurel Coleman, who worked on the report, said that the impact on those who will lose health coverage for that short period could be devastating. "For several of the people we interviewed [the loss of coverage] will result in deteriorating health; early, preventable disability; and significant increases in high-cost emergency-room services. In some cases, deteriorating health likely will bring on misery, in others an unnecessarily shortened life."

The report also made the point that for the majority of MaineCare recipients, MaineCare is a temporary step — less than two years — until they become healthy enough to return to work. Cutting them off could cause them to remain unemployed and unproductive. More than half of all MaineCare members ever enrolled in this program were enrolled for less than one year; three-quarters were enrolled for less than two years.  However, 10 percent of members using services accounted for 60 percent of the program's cost. These individuals have serious conditions that require longer-term care.

The federal government matches MaineCare to a high degree. If Maine eliminates coverage for low-income adults, the state will forgo $37 million in federal funding, while shifting that cost to the private sector. "People who are chronically ill and uninsured eventually will access the health care system — they just won’t be able to pay for their care. Although doctors and hospitals will absorb some of these costs, they will be forced to increase their fees as a cost of doing business, and these higher fees will drive health insurance premiums up. Fewer employers will be able to afford to offer coverage. More people will become uninsured. And so the cycle goes," the report read.

The report went on to make the case that a healthier population results in a healthier economy, giving Maine a competitive edge against other states. During the period of time when Maine offered MaineCare to childless adults, the uninsured rate fell from 40 percent to 29 percent for that demographic.

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