April 05, 2020


The recent news from The Commonwealth Fund that Maine is among the states with the highest percentage of residents who have health coverage is good news here but sobering nationally. Maine improved partly by expanding coverage through MaineCare and by creating DirigoChoice, but mostly the state moved up in rankings because other states fell. This is a clear call for federal action.

In 1999-2000, the Commonwealth Fund, which supports independent research on health care issues, found that 16 states had rates of uninsured residents below 14 percent. By 2004-05 that had been reduced to only four states, including Maine. At the other end of the range, in ’99-’00 only four states had 23 percent or more of their residents without coverage; by ’04-’05, that number tripled to 12 states. The fund measures coverage for people from ages 18 to 64.

Did Maine’s total health coverage costs rise faster during that time than other states’? Sure, and one reason was that this state covered more people while elsewhere residents were losing coverage. According to the Governor’s Office of Health Policy and Finance, about 52,600 residents ages 18 to 64 gained coverage through MaineCare between 2001 and 2005, as did another 8,700 through DirigoChoice. Nationally, the number of uninsured nationally rose from about 40 million in 2001 to approximately 47 million today.

A common response to those unable to afford coverage is that they will still get care, often expensively through emergency rooms, but it’s still care. The fund’s study, part of its “National Scorecard on U.S. Health System Performance, 2006,” shows a different result. Preventive care visits show the starkest contrast, not surprisingly: 63 percent of covered children got them in 2003; only 35 percent of those without coverage did. Similarly, 63 percent of covered children needing mental health care got it, while only 34 percent of those without coverage did.

The disparity of care has gotten bad enough, with enough negative consequences that, according to a story Wednesday in The New York Times, some hospitals around the country are beginning to bring in the uninsured for free care for chronic conditions such as diabetes, hypertension and asthma. The hospitals have found it is less expensive to do that than wait until the uninsured are seriously ill and then provide treatment. The hospitals offering this service deserve credit, but their work shouldn’t be confused with solving the problem – it is a partial answer to a systemic failure.

The nation pays double the amount for health care than the rest of the industrialized world, rations that care so that millions have been doing without and miss receiving affordable early intervention, then pays enormously for complicated care. This cockeyed system increases both suffering and cost but is defended because parts of the insurance and health care industries have a huge financial stake in keeping it this way.

Good for Maine for moving in the right direction on this issue; but the fund scorecard shows a federal answer is needed more than ever.

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