AUGUSTA, Maine — As speaker after speaker pleaded with lawmakers to preserve Medicaid services targeted for cuts, Gov. Paul LePage defended his effort to address a projected $221 million shortfall and told news reporters Thursday he will not walk away from the problem of overspending.
His proposal to chop expenses could leave 65,000 Mainers without Medicaid coverage.
But the governor said at a news conference that a tax hike would be devastating in a weak economy and he dismissed a tax increase as a way to make up for the funding shortage projected through mid-2013.
"I'm not entertaining any more taxes," LePage said as two legislative committees at the other end of the State House listened for a second day to lines of advocates and people who would be affected by the funding cuts. Hearings conclude Friday.
Under the proposals, coverage would be repealed for childless adults, and 19- and 20-year-olds. Coverage for chiropractic, dental, occupational and physical therapy, podiatry, sexually transmitted disease clinics and some other services would be gone. There would be more use of generic drugs, and reduced payments for hospital services. A major chunk, $60 million, would be saved by eliminating the use of Medicaid funds to pay for housing.
Shawn Yardley, director of Bangor's Health and Community Services, told the Appropriations and the Health and Human Services committees that the cuts would "fundamentally alter the safety net" for people using Medicaid services and warned they would fill shelters and the state's Dorothea Dix Psychiatric Center in the city beyond capacity.
Referring to comments by the governor that the state cannot "kick the can down the road," Yardley said the cuts "are kicking people down the road — at a greater cost."
Chuck Smithson of Portland, a self-employed carpenter, told lawmakers he tries to avoid government help. While uninsured, he said, he has covered deep cuts with electrical tape instead of getting stitches and pulled out a nail he had driven through his hand with a nail gun rather than go to a hospital.
He also fought off depression as long as he could but finally sought MaineCare services to combat it, he said. That helped him function and go back to work, Smithson told the committees.
"But when I absolutely needed the help, MaineCare has been there for me," he said, noting he has "no intention of being a public assistance lifer." Medicaid is known as MaineCare in the state.
The administration has dismissed oft-repeated warnings that a cutback in services will fill hospital emergency rooms and shift costs, saying that the majority of states have smaller Medicaid obligations and lower insurance rates but their hospitals have not closed because of some crisis with Medicaid.
A $60 million chunk in the governor's budget rewrite for the two fiscal years ending in June 2013 would come from eliminating the use of Medicaid funds for room and board in private, nonmedical institutions in Maine. The state is one of only a few that allows Medicaid funds to be used for housing.
LePage said using Medicaid for room and board is inappropriate and providing housing is an issue for the Maine State Housing Authority.
LePage said the Legislature needs to act by the end of January so reductions in Medicaid services can go into place by April 1. Failure to do so will plunge the state $500,000 deeper per day into the red, he warned.
But lawmakers from both parties are not yet convinced the financial shortfall in Medicaid will be as large as the governor says. They also are far from deciding how to pay for the $120 million shortfall in the current fiscal year and whether to confine cuts to Medicaid or spread them through other state programs, as some advocates suggest.
One approach they might take is to treat each year's budget separately, dealing first with the current shortfall before tackling the remainder in fiscal 2013.
"But the important thing now is to see what the impact is. Then I think we need to come together to address the shortfall," said Rep. David Webster, D-Freeport, and a member of the Appropriations Committee.