Medicaid compromise drafted by two GOP senators to hit State House this week
Posted Feb. 25, 2014, at 9:48 a.m.
AUGUSTA, Maine — A bill drafted by two moderate Republican senators, meant to be a compromise on the divisive issue of Medicaid expansion, is slated to be unveiled to lawmakers as soon as today.
Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton drafted the proposal, which they hope will sway enough of their GOP colleagues to make expansion happen. It accepts federal funds in exchange for expanding Medicaid — a top Democratic priority this legislative session — and incorporates several other proposals meant to alleviate concerns by Republicans wary of expanded welfare costs.
Katz has proposed an amendment that would implement aspects of “managed care,” under which the state would contract with a handful of managed care organizations — both for-profit and nonprofit — that would take over care of the entire Medicaid population. The organizations would be paid a flat rate per patient served, rather than the current model, in which the state pays providers on a per-procedure basis.
The framework of Katz’s managed care amendment is expected to form the core of the two Republicans’ Medicaid expansion compromise scheme.
Democratic lawmakers are expected to support the proposal. The Maine Hospitals Association and state Chamber of Commerce were involved, to one degree or another, with crafting the plan, and so are also expected to throw their weight behind it.
However, many Republicans — especially in the House — are sure to oppose any proposal that accepts federal money in exchange for expansion. Gov. Paul LePage and others in recent weeks have turned to increasingly dire rhetoric in their opposition.
On Saturday, House Minority Leader Ken Fredette, R-Newport, called the compromise a “fool’s errand.”
“I suspect they will throw everything and the kitchen sink to make this look acceptable to Republicans, but it’s Medicaid expansion. That’s the bottom line,” Fredette said.
The official line from House Republicans and the LePage administration is that MaineCare spending — which represents 25 percent of General Fund expenditures and is expected to grow by about 1 percent each year for the next two years — is crowding out other state programs. LePage says that situation will only worsen if the state accepts Medicaid expansion.
On Monday, LePage released a statement decrying the way Medicaid spending is “cannibalizing” other state programs. Attached were statements from communications directors of many state departments, outlining where budget shortfalls — which LePage attributes to ever-growing costs of MaineCare — had left their programs wanting. The missive was a response to a coordinated campaign by LePage’s administration to solidify every state department behind the governor’s “cannibalization” message.
“My challenge as governor and our challenge as a state is to find ways to help Maine families prosper, improve the business climate, foster better educational opportunities, while still protecting those most in need with limited resources,” LePage wrote. “We cannot do that while Medicaid is consuming an inordinate amount of our finite financial resources.”
Katz and Saviello are expected to present their proposal to the Legislature’s Health and Human Services Committee sometime this week.
Support managed care, expand Medicaid, keep patients front and center
Posted Feb. 25, 2014, at 2:45 p.m.
Republican Maine Sens. Roger Katz of Augusta and Tom Saviello of Wilton rolled out legislation Tuesday that would overhaul the state’s health insurance program for low-income residents. It would permit the state to expand Medicaid under the Affordable Care Act for three years, and it would fundamentally change the way Maine administers Medicaid for all recipients by contracting the program out to private companies or nonprofits, a model known as managed care.
As with any complex change, a successful managed care system would depend on how it’s organized and overseen. As the bill makes clear, the change would require years of work and effort, sustained collaboration, expert help, and buy-in not just from both political parties, physicians and patients’ groups but the public.
As long as rulemaking resulting from the bill ensures greater access to care for Maine’s low-income patients and fair rates for providers, there’s no reason not to pursue the new health care delivery system. Maine’s Medicaid program, MaineCare, has been plagued for years with cost overruns and inadequate oversight. Having organizations coordinate and finance care for Medicaid recipients has been done successfully elsewhere, and it can be done in Maine. Katz and Saviello have set up a way to pursue the process thoughtfully.
The managed care model is by no means new. In some form or another, organizations are now charged with coordinating care for 74 percent of Medicaid recipients across the country, up from 58 percent in 2002 and 10 percent in the early 1990s.
Maine is now discussing implementing the most common arrangement, called comprehensive risk-based managed care. It would have the state pay three or four successful bidders a fixed, per-enrollee payment each month — based on actuarially sound numbers — in exchange for furnishing a range of health services. Medicaid recipients would be able to get those services through a network of participating providers. One benefit would be having more predictable Medicaid costs for the state.
Some say that managed care will save the state money, as managed care organizations will have an incentive to contain costs and keep patients healthy. While it is possible, and the bill currently builds in a 5-percent cost savings, one study by the National Bureau of Economic Research found that managed care plans do not always reduce Medicaid spending — and that when they reduce Medicaid spending, it’s not always because of improved health among Medicaid enrollees and reduced health care use.
That doesn’t mean Maine shouldn’t pursue managed care or even that the state can’t find a way to save money. It does mean managed care shouldn’t be reduced to a soundbite touting it will save money no matter what. How well a managed care system works depends on how it’s set up.
Setting up an effective system would require expert guidance from other states that have been using the model well for years, such as Michigan or Wisconsin. Maine would need direction on the best ways to analyze data and measure the results of managed care. It would need to determine the problems it wishes to address: Reduced emergency room use? More flexibility on when patients can get help? Improved birth outcomes? The bill allows for all these issues and questions to be addressed by a stakeholder group, rulemaking and the contract process itself.
A managed care model has great potential to benefit Medicaid recipients, especially the 70,000 newly eligible with expansion, as they would have defined provider networks to turn to for care, and more services would likely be covered. Switching to a managed care system should not only be about money but about ensuring that people in need get quality care delivered in ways that are monitored and improved over time. Maine hasn’t done this well with its current fee-for-service system.
Expanding Medicaid and switching to a managed care model are changes that could substantially improve the lives of thousands of Maine residents. Those residents deserve to have their lawmakers put aside philosophical differences, come to an informed decision and support the efforts of Katz and Saviello.
Republican Maine Sens. Roger Katz of Augusta and Tom Saviello of Wilton rolled out legislation Tuesday that would overhaul the state’s health insurance program for low-income residents. It would permit the state to expand Medicaid under the Affordable Care Act for three years, and it would fundamentally change the way Maine administers Medicaid for all recipients by contracting the program out to private companies or nonprofits, a model known as managed care.
As with any complex change, a successful managed care system would depend on how it’s organized and overseen. As the bill makes clear, the change would require years of work and effort, sustained collaboration, expert help, and buy-in not just from both political parties, physicians and patients’ groups but the public.
As long as rulemaking resulting from the bill ensures greater access to care for Maine’s low-income patients and fair rates for providers, there’s no reason not to pursue the new health care delivery system. Maine’s Medicaid program, MaineCare, has been plagued for years with cost overruns and inadequate oversight. Having organizations coordinate and finance care for Medicaid recipients has been done successfully elsewhere, and it can be done in Maine. Katz and Saviello have set up a way to pursue the process thoughtfully.
The managed care model is by no means new. In some form or another, organizations are now charged with coordinating care for 74 percent of Medicaid recipients across the country, up from 58 percent in 2002 and 10 percent in the early 1990s.
Maine is now discussing implementing the most common arrangement, called comprehensive risk-based managed care. It would have the state pay three or four successful bidders a fixed, per-enrollee payment each month — based on actuarially sound numbers — in exchange for furnishing a range of health services. Medicaid recipients would be able to get those services through a network of participating providers. One benefit would be having more predictable Medicaid costs for the state.
Some say that managed care will save the state money, as managed care organizations will have an incentive to contain costs and keep patients healthy. While it is possible, and the bill currently builds in a 5-percent cost savings, one study by the National Bureau of Economic Research found that managed care plans do not always reduce Medicaid spending — and that when they reduce Medicaid spending, it’s not always because of improved health among Medicaid enrollees and reduced health care use.
That doesn’t mean Maine shouldn’t pursue managed care or even that the state can’t find a way to save money. It does mean managed care shouldn’t be reduced to a soundbite touting it will save money no matter what. How well a managed care system works depends on how it’s set up.
Setting up an effective system would require expert guidance from other states that have been using the model well for years, such as Michigan or Wisconsin. Maine would need direction on the best ways to analyze data and measure the results of managed care. It would need to determine the problems it wishes to address: Reduced emergency room use? More flexibility on when patients can get help? Improved birth outcomes? The bill allows for all these issues and questions to be addressed by a stakeholder group, rulemaking and the contract process itself.
A managed care model has great potential to benefit Medicaid recipients, especially the 70,000 newly eligible with expansion, as they would have defined provider networks to turn to for care, and more services would likely be covered. Switching to a managed care system should not only be about money but about ensuring that people in need get quality care delivered in ways that are monitored and improved over time. Maine hasn’t done this well with its current fee-for-service system.
Expanding Medicaid and switching to a managed care model are changes that could substantially improve the lives of thousands of Maine residents. Those residents deserve to have their lawmakers put aside philosophical differences, come to an informed decision and support the efforts of Katz and Saviello.
Maine lawmakers give initial approval to wider use of overdose-halting drug
Posted Feb. 24, 2014, at 4:34 p.m.
AUGUSTA, Maine — A legislative committee has approved a bill to put medication that counteracts the life-threatening effects of opiate overdose into the hands of police, firefighters and drug users’ loved ones.
In a party-line vote, members of the Legislature’s Health and Human Services Committee backed LD 1686, An Act to Address Preventable Deaths from Drug Overdose, sponsored by Rep. Sara Gideon, D-Freeport. The vote followed passionate testimony on the bill on Feb. 12 by lawmakers, medical professionals, law enforcement officers and those who have lost friends and relatives to heroin.
Last month, Maine Attorney General Janet Mills sounded the alarm about a startling increase in fatal heroin overdoses in Maine, which jumped from seven in 2011 to 28 in 2012.
The bill would expand the availability of naloxone, a prescription medication that blocks opioid receptors in the brain, halting the euphoria and effects of heroin or other opiates and triggering an immediate and severe withdrawal.
Also known by the brand name Narcan, naloxone is already used in Maine hospitals and ambulances. The legislation would put the medication into the hands of police, volunteer firefighters, drug users and their friends and families, freeing doctors to dispense the medication not only to a drug user at risk but also to anyone likely to witness their potential overdose.
An overdose of heroin or other opiates such as prescription painkillers and methadone can depress breathing and the body’s nervous system, leaving users unconscious. Naloxone restores breathing, allowing users to potentially survive an otherwise fatal overdose. Administered through a nasal spray or injection, naloxone does not provide a high. Drug abusers still must be hospitalized after the medication is administered.
In a work session on the bill Monday, Republicans on the committee voiced concerns about laypeople without medical training administering the drug, which results in sudden and violent withdrawal and can cause vomiting and aspiration. Republicans supported distribution and use of the drug among police, firefighters and other first responders, however.
Last year, Gov. Paul LePage vetoed a similar bill, saying that widening access to naloxone would provide “a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby.”
“I just think it sends a message that I’m not comfortable with, to have other than first responders with this medication,” said committee member Rep. Heather Sirocki R-Scarborough.
Democrats argued in favor of putting naloxone into the hands of drug users’ friends and loved ones, noting that other states have found success expanding naloxone’s availability.
“The alternative is that people are dying. … There is a way to save those people’s lives,” Gideon said.
Lawmakers have expanded access to the medication in 17 states and Washington, D.C.
Naloxone already can be prescribed to drug users in Maine, but proponents of the bill argued that addicts in the throes of an overdose can’t administer the drug to themselves. LD 1686 would allow a drug user’s friends and family members to obtain, possess and administer the drug.
The original bill would have provided civil and criminal immunity for those who administer naloxone to someone they believe to be experiencing an opiate overdose. Committee members adjusted that language to authorize individuals to possess and administer the medication.
In an amendment, the committee voted to require pharmacies to provide instructions about naloxone’s use and effects to inform drug users and their loved ones about the medication.
The bill now heads to the Maine House of Representatives for further votes.
http://bangordailynews.com/2014/02/24/health/maine-lawmakers-give-initial-approval-to-wider-use-of-overdose-halting-drug/print/
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