Health Care is a Human Right Committee Statement & Call to Action on DHHS Proposed MaineCare Rule Change

We at the Southern Maine Workers’ Center (SMWC) are fighting for a universal, publicly-funded health care system that honors our human rights. The protection and expansion of existing public health care programs are important reform measures that also grant us platforms to demand the system we truly need. Right now, the Maine Department of Health & Human Services is attacking our state’s version of Medicaid (known as MaineCare) by seeking what’s called a Section 1115 waiver, which would result in rule changes for people on MaineCare.

Proposed changes for “abled-bodied adults” include:         Proposed changes for all MaineCare recipients include:

•Work or volunteer requirements                                                             • Copayments for “inappropriate” Emergency Department use

•Monthly premiums                                                                                     • Allowing providers to charge patients for missed appointments

                                                                                                                           • A $5,000 asset test

                                                                                                                            • Elimination of retroactive coverage

                                                                                                                           • Eliminating ability of hospitals to presume someone’s eligibility

In its application, DHHS expresses a desire to move away from MaineCare as an “entitlement program” and promote “cost-conscious consumption of health care resources.” The Department’s explicit aim is to make people’s experiences of MaineCare more like that of the private insurance market. This is the opposite direction of what Maine people want. Organizations collecting signatures on election day in support of a ballot initiative to expand MaineCare experienced overwhelming support from voters across the political spectrum for MORE access, not less. As stated  in SMWC’s  recently released report, Enough for All: A People’s Report on Health Care, a survey of more than 1,300 state residents found that 96% believe health care is a human right and 83% support the idea of a universal, public system.[1] It is clear that people in Maine are increasingly dissatisfied with the pitfalls of profit-driven, private industry. Public programs—like Medicaid and Medicare—are some of the only things that work in this broken system. We are prepared to defend health care as a public good until it is granted as such to every resident.We are also troubled by the disparaging underlying assumptions about low income Mainers that are conveyed through much of DHHS’ language. They highlight personal responsibility and wanting to educate MaineCare patients about their impact on taxpayers, thereby mischaracterizing poor people as irresponsible and entitled. The realities of ordinary people navigating Maine’s health care landscape tell a different story.

Nearly a quarter of Maine people with health insurance are MaineCare recipients[2]. 45% of Mainers live in what is called a “health professional shortage area,” and many face providers unwilling to accept MaineCare[3]. This means hospital emergency departments often become a last resort for treatment of non-life threatening injuries and illnesses. In a largely rural state with limited public transportation infrastructure even in its largest cities, missing appointments is often an unavoidable reality for patients without access to individual vehicles, or those with limited mobility. Workers in the service industries often experience unpredictable scheduling changes, forcing them to choose between making a doctor’s appointment or missing out on wages. People understandably need help navigating the red tape of applying for MaineCare, something that hospital and family planning clinic staff have been able to assist with, and practices that would be curtailed by the proposed changes.

These complications require systemic solutions. The answer is not to “incentivize” providers to accept MaineCare through enforcing burdensome financial penalties on patients. Nor to discourage low income workers from saving what little money they can by forcing them to undergo an asset test to remain eligible for health care. Poor and working people in Maine already face enormous barriers getting quality, comprehensive health care. In SMWC’s survey, 71% of people felt that their human right to health care is not currently protected. The proposed changes would further raise the barriers people face, which would deny people even more essential treatments and medicines. This is terrible healthcare policy and deeply immoral. In fact, none of these proposals are intended to improve healthcare in Maine: they are driven by a punitive ideology that blames poor people for structural poverty rather than recognizing it is our economy and public policies that impoverish entire communities and fail to meet our fundamental human needs.” For these reasons, the Health Care is a Human Right Committee of the Southern Maine Workers’ Center opposes the above rule changes, and we encourage our members and supporters to speak out against them by:

  • Attending one of the public hearings in Portland or Augusta in person
  • Participating remotely in the hearings via conference call line, or
  • Submitting written comments via email to Policy.DHHS@maine.gov

If you have questions, contact Cait Vaughan at 603-897-9676.

Hearing 1:

Portland Public Hearing Date: May 17, 2017 Time: 9:00AM Location: Cross Insurance Arena 45 Spring Street Portland, Maine 04101 Conference Line: 1-877-455-0244 Passcode: 7319892834

Hearing 2:

Augusta Public Hearing Date: May 18, 2017 Time: 9:00 AM Location: Augusta Civic Center 76 Community Drive Augusta, Maine 04330 Conference Line: 1-877-455-0244 Passcode: 7319892834

For more information:

Link to abbreviated public notice: http://www.maine.gov/dhhs/oms/documents/1115_MaineCare_Abbreviated-Notice.pdf

(You can participate in the public hearings by calling in on a conference line; the conference number and passcode are available in this document)

Link to full-length public notice by DHSS: http://www.maine.gov/dhhs/oms/documents/1115_MaineCare_Full_Notice.pdf

Link to DHHS waiver application:  http://www.maine.gov/dhhs/oms/documents/Draft_MaineCare_1115_application.pdf

[1] Southern Maine Workers’ Center, Enough for All: A People’s Report on Health Care, 2017

[2] Data Source: US Census Bureau, American Community Survey. 2011-15. Source geography: Tract; US Census Bureau, Small Area Health Insurance Estimates. 2014.

[3] Data Source: US Department of Health Human Services, Health Resources and Services Administration, Health Resources and Services Administration. April 2016.