Gov. Paul LePage says he will hold off on any decisions on state policy under the Affordable Care Act until after the November election and until President Obama clarifies how provisions of the ACA will be implemented following the recent U.S. Supreme Court decision.
"After November everyone is going to gear up for the January sessions and the states will be dealing with the issues in January and so will the federal government," he said. "The fact of the matter is they are already giving extensions for things that are supposed to happen in 2014."
LePage said one example is setting up state exchanges where the uninsured will be able to buy health insurance. He said Maine should let the federal government create its exchange because it would be less expensive, but clarified he has not made a decision on the issue.
"We have got to wait to get the answers on how everything is going to work, who is responsible for what and when they are responsible," LePage said.
LePage joined several other GOP governors on a conference call to discuss the ACA. He said they decided to write President Obama with a list of questions about the court ruling and implementing the ACA.
He said he won't decide on recommendations to the Legislature until he has answers on implementation and until after the election. He said he does not see how Maine can expand Medicaid as required by the ACA.
"We are already above most of their minimums," LePage said. "We have bills we have to pay. We owe the hospitals $500 million; we can't be expanding when we can't pay our bills."
More than 90,000 Mainers qualify for both Medicaid and Medicare, but the two federal programs are not sharing the data to ensure services and to reduce fraud and errors.
"This is a perfect example of what makes people frustrated about Washington," said U.S. Sen. Susan Collins. "Here we have two federally funded programs that are not communicating and it is costing the taxpayers."
Medicaid covers about 60 million low-income Americans in partnership with the states and costs $400 billion a year. Medicare provides health care for seniors and costs over $470 billion a year. Some low-income seniors and disabled people are called "dual eligibles" and qualify for benefits from both programs.
"Information about providers who have ripped off the system is not being shared," Collins said. "This is just not acceptable." She said improper payments alone were $22 billion for the federal share last year in the Medicaid program, and the Medicare tab was $43 billion.
"We don't want a silo approach to addressing fraud and abuse," said U.S. Sen. Olympia Snowe. She is supporting legislation that would require data sharing between the agencies. With sophisticated computer systems, she said the agencies should be able to share data between themselves and help the states.
"Medicaid is really administered at the state level and the states need to have the information from Medicare to get at mistakes and errors as well as fraud," Snowe said.
She said so much money is involved in the two programs that crooks have developed some sophisticated schemes to rip off taxpayers, noting the federal government needs to improve its computer capabilities to stop fraud.
"We have had hearings where it was shown we were paying benefits to dead people," Collins said.
U.S. Rep. Chellie Pingree said she is supporting legislation in the House similar to the Senate measure. She said while much of the discussion has been around preventing fraud, better communication between the programs would also result in better care.
"If you are dual eligible, that means you are a senior citizen or you have a serious disability," she said. "Those are the people who are most vulnerable. "
Pingree said it makes no sense that the programs are not sharing lists of doctors and other providers who have been caught defrauding the government. She said if a provider has been stealing from one program, they often are stealing from the other.
U.S. Rep. Mike Michaud said he has co-sponsored legislation that would require the agencies to share information. He said Maine has one of the highest percentages of seniors in the country and cooperation between Medicare and Medicaid is crucial to assuring quality care and combating fraud.
Michaud said he hopes the House will act on the legislation this summer, but that is not certain.
Students at the University of Maine System were relieved when trustees froze tuition for this coming academic year. The average total cost of attending the system is up more than 38% in the last five years, the second largest increase in the nation for four-year public institutions.
The UMS Board of Trustees froze tuition at the seven campuses before James Page took over as chancellor in March. He said simply freezing tuition will not be enough to get university costs under control.
"I've seen the report and those numbers, and that's a big whomping change," he said. "If you look at expenses and the trend line over the last couple of years, though, there's been a lot of effort to bring that under control."
Page said both he and the trustees also worry about another statistic: The system was the 14th most expensive public four-year institution in the nation last year, while Maine family income was ranked 39th. He said a four-year degree must be affordable for Mainers.
"The trustees were making a point in drawing a line in the sand that says, 'We fail in our mission if we make the University of Maine, at whatever campus, unavailable to average Maine families,'" Page said.
The plan outlined by the trustees in January starts to reduce costs in some areas to invest in other needed programs, he said.
Sen. Brian Langley, R-Ellsworth, the co-chairman of the Legislature's Education Committee, said the chancellor needs to thoroughly review administrative costs and not rely on past reviews and studies.
"Sometimes there are things that now cost more to do centrally that could be shipped out to a campus that really does that well," he said.
Rep. Richard Wagner, D-Lewiston, is the lead Democrat on the panel. He also was surprised at the size of the increase, even though he said energy costs and health care costs have gone up in five years.
"I don't think it's faculty salaries," Wagner said. "A lot of it is bureaucracy, and there could be some decrease in that, I think."
Wagner said his big fear is that academic quality will suffer with faculty salaries taking the hit to reduce costs. He said lawmakers from both parties will be watching to see what the chancellor proposes to change the system.