The Colorado experience with TABOR provides a concrete example of what is likely to happen in Maine if this measure passes on November 7th — major reductions in the Maine Medicaid program affecting the benefits and eligibility of children.
Colorado passed its TABOR in 1992. Because of the TABOR limit, Colorado could only afford to cover children up to 185% of the poverty level in its Medicaid/State Child Health Plan programs. This was the most restrictive and lowest level in the country. However, even this level was more than the state could afford so the legislature had to place a cap on enrollment, denying thousands of children health care coverage. As a result between 1992 and 2004 the proportion of low-income Colorado children without health insurance doubled. In 2004, Colorado ranked last among the 50 states in low-income children having health insurance.
During this time I remember caring for a 16 year old boy with diabetes who had to be hospitalized several times because of severe ketoacidosis (a complication of diabetes). His family was quite poor and at times had to choose between paying the rent and buying insulin. Going without his insulin had led to the ketoacidosis. Researchers documented that this was not an isolated case; they found that uninsured children, compared to children with insurance, were more likely to develop severe life threatening ketoacidosis.
TABOR also prevented the state from increasing Medicaid payments to physicians and hospitals. The willingness of Colorado physicians to accept Medicaid patients eroded and by 2003 only 24% of primary care physicians in private practice were accepting new Medicaid patients. This meant that the only option for many children was an emergency room.
A recent study published in a prestigious journal called Pediatrics found that Colorado children who were uninsured or on Medicaid were twice as likely to die when hospitalized, compared to children with private insurance, and had much higher hospitalization charges.
Under TABOR, Colorado also had one of the highest rates of hospitalization for vaccine preventable diseases such as whooping cough and viral influenza. TABOR prevented the state from purchasing vaccines or investing in a state immunization information system. In 1995 Colorado ranked 24th among states for immunizing its children on time but by 2003 we had dropped to 50th — dead last. That year there were at least eleven childhood influenza related deaths in children who were not fully immunized.
In November 2005, after 13 years of living under the TABOR restrictions, Colorado citizens voted to put it on hold for five years — to stop the decline in health care and other public services. This successful bi-partisan effort to suspend TABOR was led by a broad coalition that included 143 health care organizations from throughout the state.
When I visited Maine this month, I learned that one of her most vulnerable populations — children in poverty— is increasing. These children often need more health care services, not less. Thus, TABOR is likely to cause even greater harm in Maine than it has in Colorado.
Letter to the Editor, Bangor Daily News
Stephen Berman, MD
