Health care revolution within reach (minus the revolution part)

Maine is so close.

Despite the best efforts of Gov. Paul LePage, his Department of Health and Human Services and his acolytes in the Maine House of Representatives, a major achievement is within reach.

While all political eyes last week were focused on the rollout of Medicare for All by Sen. Bernie Sanders, there was other health care news.

According to the US Census Bureau, Maine’s uninsured rate is stuck stubbornly at about 8 percent. That means 106,000 people in Maine lack health insurance.

It’s a number that’s way too high.

The number of people without insurance has dropped across the country since the implementation of the Affordable Care Act, and it’s dropped faster and farther in the 31 states that have expanded Medicaid. The uninsured rate in states that have expanded is down to 6.5 percent, compared to 11.7 percent for states that didn’t expand.

Andrew MacLean, deputy executive vice president of the Maine Medical Association, voices his organization’s support for Medicaid expansion in 2014. Mario Moretto | BDN

This November, Question 2 will ask Mainer voters if they want to expand Medicaid to cover 70,000 people in the state. I’m working on that campaign and am a longtime supporter of Medicaid expansion.

If the Census estimates are correct, Question 2 could bring Maine within 36,000 people of a major health care accomplishment: universal coverage.

Universal coverage is often conflated with the idea of a single-payer health care system, such as Medicare for All. But the two things aren’t the same.

Universal coverage is the goal of making sure that everyone has access to affordable health care coverage. Single-payer is one way that the health care system can be structured to achieve universal coverage.

With new leadership in Augusta just a year away, Medicaid expansion puts us within striking distance of universal coverage and would position Maine to innovate around health care coverage to achieve the goal.

No doubt that the remaining 36,000 people without health insurance coverage are some of the most challenging people to reach, and there are real problems with some elements of the Affordable Care Act, which have kept insurance premiums too expensive for some families.

Medicare for All or other single-payer options are a worthwhile goal, particularly on the national level. So far, they have been impractical on the state level. Both Vermont and California have tried, without much success so far.

The biggest hurdle to overcome for the single-payer is real. In addition to reordering about one-sixth of the country’s economy and overcoming the initial sticker shock for the cost, more than 155 million Americans under the age of 65 receive their health care coverage through their employer.

Medicare for All would upend that system. For those families, Medicare for All would require a huge leap of faith.

In addition, the change in health care delivery would have real consequences. While jobs would surely be created inside the Medicare program, Medicare for All would be extremely disruptive for private insurance companies.

That’s not a reason to oppose the idea, but any serious discussion of this type of single-payer reform has to account for the thousands of jobs that would be lost or re-ordered.

Maine has seen this before with the downsizing of our forest products industry. While there are real frustrations with the insurance industry and the way it makes its profits, there’s no question that there are real people – our friends and neighbors – who work for those companies and who would face an uncertain employment future.

Medicare for All makes sense, particularly if you were able to go back in time and remake our health care system from scratch. But supporters of the idea should not underestimate the legitimate concerns of the switch, and the real fears it will create for millions of Americans.

In the meantime, we shouldn’t forestall real progress. (And we should continue to oppose the efforts in Washington to undermine the Affordable Care Act and take insurance away from millions of people.)

We have the chance to lower the uninsured rate to less than 3 percent in Maine. And with a new administration in Augusta determined to improve health care coverage instead of stand in its way, we could work on solutions to close that gap and make coverage more affordable for people who buy coverage on the private market.

Voters last year showed an appetite for big, bold ideas. Medicare for All certainly fits that bill.

But we have a real chance to make progress right now – to make our health care system more fair and our economy stronger – and to put universal coverage at the tip of our fingers.

Big and bold may be beautiful. But I have a soft spot in my heart for raging incrementalism – and universal coverage.

David Farmer

About David Farmer

David Farmer is a political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s campaign for governor and a longtime journalist. You can reach him at