Today, Mayors for six of the largest cities in the State of Maine wrote to U.S. Department of Health and Human Services Secretary Kathleen Sebelius asking her to resolve the current debate surrounding the applicability of the Maintenance of Effort (MOE) provision following the U.S. Supreme Court’s decision upholding the Patient Protection and Affordable Care Act (letter attached). The Mayors of Biddeford, Portland, Saco, South Portland, Waterville and Westbrook have asked Secretary Sebelius to clarify that the MOE provision still applies and therefore the state’s proposed eliminations of coverage for tens of thousands of individuals are in violation of the requirement.
“While the focus of this debate has been in Washington DC and at the State House, it is important to note that it’s the cities and towns of Maine that will have to bear the burden and address the impact on the health and lives of our residents,” stated Portland Mayor Michael Brennan. “We represent the front line and the costs associated with these cuts will be paid for by our residents, our hospitals and our businesses whether through increases in charitable care, rising health insurance premiums or by taxing our safety net with more families turning to City Hall for help.”
“The Maintenance of Effort provision was designed to ensure that states maintain consistent coverage as we move to greater access to health care with the implementation of the Affordable Care Act in 2014. The U.S. Supreme Court decision did not change this requirement and claims to the contrary do not hold legal merit.”
“As local leaders we are keenly aware of how important a healthy workforce is for the success of our communities. It is crucial that our residents are able to achieve stability, pursue employment and contribute to the local economy, which is why we are hopeful that Secretary Sebelius can remove any confusion about the applicability of MOE provision. The men and women whose lives hang in the balance deserve some peace of mind,” concluded Brennan.
The text of the letter:
The Honorable Kathleen Sebelius
US Department of Health and Human Services
200 Independence Avenue, SW
Washington DC, 20201
Dear Secretary Sebelius,
Since the U.S. Supreme Court released its decision upholding the Patient Protection and Affordable Care Act (ACA), you have received varying feedback from Maine leaders concerning the applicability of the Maintenance of Effort (MOE) provision. As the Mayors of the state’s largest cities, we are paying close attention to this debate because we will feel the impact of any decision to restrict access to Medicaid most directly.
Earlier this year, the Maine Legislature approved the elimination of coverage for three populations protected under the Medicaid MOE provisions as a stated budgetary savings measure:
- 5,300 seniors and people with disabilities in the Medicare Savings Program
- More than 7,000 19 and 20 year olds with income below 150% of the Federal Poverty Level
- Approximately 14,000 Parents with incomes between 100% and 133% of the Federal Poverty Level
The elimination of insurance coverage for thousands of Maine people, particularly during this time of recession, presents significant hardships not just to the families affected but also to the municipalities in which they reside. The financial burdens of these cuts and impacts of the loss of health insurance will be borne by our residents, our hospitals, and local social service programs. Eliminating coverage does not eliminate the need for health care. Rather, it shifts the cost to the local economy, be it increases in charitable care at hospitals, rising health insurance premiums or loss of employment and housing for a family struggling to pay for medically necessary health care. Even though the debate surrounding the applicability of the MOE provision is taking place in Washington DC, it is important to note that the day to day impacts of the elimination of coverage will be faced and addressed at the local level in the cities and towns of Maine.
While it may be appealing to some to restrict access to publicly funded health care during these challenging economic times, we would advocate that these are exactly the times to maintain coverage. The findings in a recent New England Journal of Medicine report support this opinion as their research concluded that the expansion of Medicaid coverage in Maine reduced mortality among covered adults. For Maine to be competitive and our economy to recover and grow, we need a healthy workforce where men and women can achieve stability, pursue employment and contribute to the community.
The MOE was designed to achieve this very goal by ensuring that states maintain consistent coverage as we move toward broader access to coverage in 2014. We believe that the Supreme Court decision does not change the current Medicaid program and the MOE requirement or its enforcement with the potential loss of all federal Medicaid matching funds. We believe that the MOE provision stands and is untouched by the Court’s ruling. We strongly disagree with assertions that the Supreme Court decision voids the provision that protects access to health care for thousands of Maine people.
Finally, though much of this discussion is a legal one based upon the interpretation of the U.S. Supreme Court’s decision, it is important that we not lose sight of the lives that hang in the balance. If Maine is allowed to eliminate coverage for thousands of residents, we will be taking away the tools we use to help Mainers rise out of poverty and illness, not just hurting them, but us all.
I thank you for your thoughtful consideration of this matter and hope that in the near future you will be able to settle this debate by affirming your commitment to the MOE provision and clarifying that the proposed eliminations of coverage are in violation of this requirement.
Michael M. Brennan, Mayor
City of Portland, Maine
Alan Casavant, Mayor Mark Johnston, Mayor
City of Biddeford, Maine City of Saco, Maine
Mayor Patricia Smith Karen Heck, Mayor
City of South Portland, Maine City of Waterville, Maine
Colleen Hilton, Mayor
City of Westbrook, Maine