Medicaid Expansion – Unintended Consequences

January 7, 2014

A perpetual battle in the Maine Legislature is over Medicaid Expansion. Writing at the end of last year, State Rep. Lawrence E. Lockman, R-Amherst, stated, “When we return to the State House next month, Medicaid expansion under Obamacare will be up for another vote, despite legislative rules that prohibit the introduction of bills that were voted up or down in the first session.”

This is a critical issue. Not only does it affect our state’s debt and tax structure, but it affects the quality of care the poor actually receive. We are often asked: How can anyone with a heart object to providing Medicaid to those who truly need it? Can anyone be against maintaining that safety-net that the poor rely on for the basic needs of life? And if it is such a benefit, who could be against expanding it? The simple fact is, Medicaid expansion means the most vulnerable populations may have less, not more, access to quality care. And that is not compassionate. No one wants to deny help to the truly needy. But Medicaid expansion will create the exact opposite effect.

Medicaid is a top of the line Cadillac health care plan offered free to the poor. It covers 100% of doctor visits, and 100% of prescriptions for children ($3.00 co-pay for adults). But for many, the promised benefits are an illusion.

For so long, the state of Maine was a deadbeat debtor to the hospitals and doctors. At one time, the state was as much as five years behind in payments. As a result, fewer and fewer doctors would take new Medicaid patients. Someone would sign up for Medicaid and be given a list of doctors who were supposedly part of the program. They would start looking for a primary care doctor from the list, but over and over they would hear, “We’re sorry. We are not taking any new Medicaid patients.” For those who somehow snagged a doctor, the length of time it took to get an appointment was extremely long. If a parent had a child on Medicaid who came down with the flu, they would call and be given an appointment three weeks out. By the time they finally got to see the doctor, the child would be cured or dead.

So what option do they have? Off to the emergency room they go. After all, emergency rooms can’t refuse service. So if they endure the long hours of waiting, they finally get to see a doctor. The state is now on the hook for a thousand dollar bill instead of a hundred dollar bill. And no one is happy.

John C. Goodman, President and Kellye Wright Fellow in Health Care at the National Center for Policy Analysis, states:
“When people cannot find a primary care physician who will see them in a reasonable length of time, all too often they go to hospital emergency rooms. . . . Be prepared for that situation to get worse.”

This is the situation our government has created. As Goodman continues, “When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees.” James Capretta, of the Ethics and Public Policy Center, stated, “If you look at something where you get a dollar by treating a private payer, you get about 70 cents out of Medicare for that same treatment, you get about 55 cents out of Medicaid for that,” No wonder doctors are reluctant to take on Medicaid patients.

Another example: Medicaid also supposedly covers orthodontics. Unfortunately, there are only two orthodontist listed in Maine who take Medicaid patients. One is in Biddeford in the extreme South of the state and the other in Machias in the extreme east. For someone in the Bangor area, driving weekly to the mandatory appointments would make the free service prohibitively expensive. But, since Machias is closer, let’s try the orthodontist there. Sorry, they aren’t taking any more Medicaid patients as long as they aren’t being paid by the state. So, what good is the coverage?

This will only get worse. By the end of March, Obamacare is expected to increase the number of people on Medicaid by 9 million. But what happens if a social “safety net” program adds considerably more people to it? Eventually, the system collapses so that even those desperately needing help are left with no meaningful health care. More than 3,000 seriously disabled Mainers languish on waiting lists for Medicaid services because funding is currently unavailable.

According to Lockman, the Baldacci Administration “expanded access to free medical care for tens of thousands of able-bodied single men, while Maine’s most vulnerable citizens, including wheelchair-bound seniors who can’t feed themselves, remain to this day on waiting lists for needed services.” There has to be a better way, a smarter way.

Rep. Lawrence E. Lockman asks, “How do you compromise between the Democrats’ relentless push for yet another expansion of Medicaid enrollment under Obamacare, and the Republican view that Medicaid has cannibalized the state budget, and must be reformed and restructured? Democrat leadership is hell-bent on chaining us to the caboose of the Obamacare train wreck, even if it means piling more unsustainable debt on our kids and grandkids. I’m not willing to compromise on this issue, and I’m fully prepared to make that case to voters.”

Quoting Tom Selleck, “It’s not that conservatives don’t care. We just have different answers than liberals do. It’s a difference of the mind, not the heart.” In other words, we want the answers to actually work – to actually help those they are intended to help. Liberal answers do more harm than good. They waste money. They do not help those they claim to care for. As Winston Churchill claimed, “If a man isn’t a liberal at age twenty, he has no heart. If he isn’t a conservative at age forty, he has no brain.” We need both a heart and a brain. Then we might really do some good.

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Rev. Daniel Packer is pastor of the Orrington Center Church in Orrington, Maine. He is an active proponent of Biblical morality. His e-mail address is


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