HHS committee grills author of Medicaid report

AUGUSTA – State lawmakers Tuesday picked apart the first portion of a nearly $1 million report on Maine’s welfare programs that’s being completed by a private company hired by the administration of Republican Gov. Paul LePage.

While Republican lawmakers on the Legislature’s Health and Human Service Committee were largely complimentary of the work being done by the Rhode Island-based Alexander Group, Democrats said the state was not getting its money’s worth.

For the first time Gary Alexander, the former commissioner of the state of Pennsylvania’s Department of Public Welfare and the CEO of the Alexander Group, appeared before a legislative panel to discuss his work and defend his company’s methodology and the outcomes of a recent analysis that shows expanding Medicaid in Maine would cost the state $807 million over the next decade.

Lawmakers also quizzed Alexander and Maine DHHS Commissioner Mary Mayhew, who appeared with Alexander and one of his employees, Eric Randolph, on some of the report’s findings, which among other things projects a steep increase in Maine’s poverty level over the next 10 years.

Alexander also noted that many of the challenges facing Maine’s health care situation could not be fully addressed until reforms are made at the federal government that allow states greater flexibility in how they administer their Medicaid programs.

Legislative Democrats are again trying to expand the state’s Medicaid system to cover about 70,000 additional Mainers under provisions in the federal Affordable Care Act. The first public hearings on a bill that will do just that are set to begin Wednesday.

Under the ACA the cost of the expansion during the first three years would be reimbursed by the federal government 100 percent.

The reimbursement rate, under the federal law, is gradually winnowed down to 90 percent.

Republican argue that 10 percent cost will eventually equate to hundreds of millions of dollars for Maine taxpayers,. Meanwhile Alexander’s report suggests thousands more than what Democrats anticipate would sign up for Medicaid, compounding state costs even further.

But Democrats have argued the savings from achieving better health outcomes for Maine people and the inflow of nearly $600 million in federal funds will more than balance out an expenses on the state side.

That inflow of federal money, coupled with the state’s investment in health care coverage, will create jobs and bolster the economy, Democrats argue.

The Maine Hospital Association has also weighed in in favor of an expansion and is likely to bring significant political pressure to the debate as it moves forward this year.

Hospitals remain among the largest employers in Maine, especially in rural parts of the state, often represented by Republican lawmakers.

In 2013 the Legislature fell just a few votes shy of overturning LePage vetoes of bills that would have expanded Medicaid in the Pine Tree State.

Both Democrats and Republicans also spoke extensively on the state’s MaineCare waiting list of about 3,000 people who are elderly, children or developmentally disabled and without health care. Republicans have argued that before the state expands its general MaineCare rolls it should first eliminate that waiting list.

But Democrats said just the money the state is spending on the Alexander Group report could have been used to cover half of the elderly on the wait list.

“There’s big holes in it,” State Sen. Margaret Craven, D-Lewiston, said of the Alexander Group’s recently released 131-page report.

Craven, the Senate chair of the HHS committee, said the Alexander Group study also did not match up with other studies on a Medicaid expansion in Maine – even those done by conservative think tanks.

“Over and over people asked them about items that were not included in the assessment and they gave in, my opinion, some lame answers,” Craven said.

But Sen. James Hamper, R-Oxford, the ranking Senate Republican on the committee said he actually took the time to fully read the report and was satisfied with its findings.

“I’m staying away from the whole debate about Gary Alexander and Pennsylvania and all that,” Hamper said. “I’m taking the report as the report.”

Alexander has faced withering criticism for his tenure in Pennsylvania, including being the subject of an audit by that state’s Auditor General Eugene DePasquale.

DePasquale’s office found that changes Alexander made to the way contracts were paid for in-home health care providers ended up costing the state more than $7 million a year.

DePasquale has been outspoken in his criticism and in warning Maine about the credibility of Alexander’s work.

Democrats in the Maine Legislature have also taken to calling Alexander a crony of LePage. LePage has said he wanted to hire Alexander to be Maine’s DHHS commissioner but was unable to pay him enough money.

Hamper said the voting public should try to look at the report before passing judgment on Alexander or the credibility of his work. Hamper said much of the report also depends on federal Congressional Budget Office data.

But Democrats said the report was already tainted and clearly concocted to come up with an outcome that supports LePage’s position in opposition to a Medicaid expansion.

Democrats cut Alexander some slack, noting he was largely working with only the data provided to him from Maine’s DHHS.

“He kept calling back saying, ‘We used information the department gave us,'” Rep. Richard Farnsworth, D-Portland the House chair of the committee said. “Either the department intended to give false information or the department has not got good data.”

Craven also said that while the committee had hoped to hear more directly from Alexander it was Mayhew, the DHHS commissioner, who answered more than 50 percent of the committee’s questions Tuesday.

Mayhew also intervened when news media attempted to question Alexander about his background and reputation, when the report was first made public last Friday.

Tuesday a DHHS spokesman said target deadlines for subsequent portions of the study to be completed by Alexander’s company had been extended indefinitely.

The first part of the report, dealing with the impacts of a Medicaid expansion in Maine under the ACA, had a target due date of Dec. 1 under a contract signed with the state by Alexander.

State officials refused to publicly release the first installment of the report – which was delivered on Dec. 16, 2013 – until Jan. 10.

Also weighing in Tuesday were the candidates challenging LePage in the 2014 governor’s race.

Independent candidate Eliot Cutler said the report by Alexander showed LePage’s economic policies were a failure. He said the forecast that the state’s poverty rate would increase by more than 30 percent in the next decade was a case study for why LePage, “should be fired” by voters.

“Gov. LePage has held out the Alexander Group report as an example of why Medicaid expansion should not occur, that it would be unsustainable,” Cutler said. “In fact, it is his policies that are unsustainable. The one contribution that this report has made is to show that Gov. LePage’s own policies are a failure and he has no plan, no plan at all to grow Maine’s economy to one that generates jobs instead of poverty.”

Cutler also criticized the LePage administration for withholding the report for weeks after it was delivered to the state. LePage said he had not finished reading the report and would release it when he had.

“I think this government is a circus, I think it is non-transparent, I think it’s inexcusable this report wasn’t released on time, and the excuse that it took him however many weeks it’s been to read it – I read it yesterday and last night – the excuse it took him that long to read it, is about the flimsiest excuse I have ever heard.”

Cutler also challenged LePage and Democratic challenger Mike Michaud, Maine’s 2nd District congressman, to an early public debate on the issue of health care.

For his part Michaud said he’s long supported expanding Medicaid in Maine and LePage’s premise that it would hurt the state’s economy in the long run was simply unfounded.

“It’s clear that this was an illegitimate report that was a complete waste of taxpayer funds,” Michaud said of the Alexander Group report. “Rather than wasting time with political attacks we should move on, correct the record and focus on the facts: expanding access to Medicaid will provide health care to 70,000 Mainers and save the state hundreds of millions of dollars over the next decade. It’s the right thing to do.”

sthistle@sunjournal.com

More background:

: Gary Alexander, a consultant hired by the LePage administration, appears before the Health and Human Services Committee on Tuesday in Augusta.

: Gary Alexander, a consultant hired by the LePage administration, appears before the Health and Human Services Committee on Tuesday in Augusta.

: Rep. Richard Farnsworth, D-Portland, left, joined by Rep. Drew Gattine, D-Westbrook, right, questions Gary Alexander, a consultant hired by the LePage administration, during Alexander’s appearance before the Health and Human Services Committee on Tuesday in Augusta.

: Rep. Drew Gattine, D-Westbrook, left, questions Gary Alexander, right, a consultant hired by the LePage administration, during his appearance before the Health and Human Services Committee on Tuesday, Jan. 14, 2014, in Augusta.

: Mary Mayhew, commissioner of the Maine Department of Health and Human Services, right, joined by Gary Alexander, a consultant hired by the LePage administration, appears before the Health and Human Services Committee on Tuesday, Jan. 14, 2014, in Augusta.