Committee passes bill linking hospital payment to Maine Medicaid expansion

AUGUSTA — The debate over whether state government should link the payment of its $484 million debt to Maine hospitals to an expansion of Medicaid ratcheted up again Thursday.

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The debate began with dueling press conferences and moved on to a 7-5 party-line legislative committee vote that paired the issues.

Legislative leaders on opposite sides of the issue, with Republicans opposed to a link and Democrats supporting it, held back-to-back press conferences Thursday to expand on their views.

In a nutshell, Republicans loathe the idea of linking the two issues.

But Democrats say the two are inextricably connected because one of the biggest cost-drivers in health care comes from providing services to those who have no means of paying for it. Medicaid is a federal/state-funded health insurance program for people who cannot otherwise afford coverage.

Those who are not covered usually get medical care in the most costly setting — the emergency room — according to Democrats who said providing health care coverage to more Mainers means fewer cases of charity care for hospitals.

Democrats say the state, with nearly $3 billion in federal funding on the table, has a moral obligation to provide health care coverage to as many residents as possible. They say the Medicaid expansion here would allow 70,000 uninsured Mainers to get health care coverage.

"Maine should take these funds," said House Speaker Mark Eves, D-North Berwick. "It's a deal we cannot walk away from. We can do it as part of a comprehensive plan to repay Maine's hospitals."

Eves said the cost to Maine hospitals in 2012 for those who were unable to pay their bills totaled more than $450 million.

But Republicans worry what's promised by the federal government today may not be what transpires years from now. State taxpayers, they say, would be left paying for the added burden of providing health care coverage to thousands.

Sen. Roger Katz, R-Augusta, said the administration of Gov. Paul LePage had been working to negotiate a better deal on a Medicaid expansion with the federal government.

Katz said agreeing to the federal offer now would mean less of a deal for Maine and would undermine the work LePage's staff was doing to get more for the state.

Some Republicans said expanding government-funded health care would be the wrong course of action because both state and federal governments continue to have gaping budget shortfalls and face mounting debt.

Even with the federal match, after five years, the state's costs would increase to more than $103 million, said Rep. Deb Sanderson, R-Chelsea.

House Minority Leader Ken Fredette, R-Newport, said his caucus would stand united in opposition to any bill linking the hospital debt to expanded Medicaid in Maine. 

LePage, on talk radio Thursday morning, promised he would veto the bill if it reached his desk, even though paying the state's hospitals has been a top priority for the governor this legislative session.  

LePage threatened to veto any bill that came to his desk before lawmakers approved a plan to pay hospitals, but he has not followed through on that threat.

If the governor vetoes the Medicaid bill and supporters fail to override the veto, a long-worked and largely bipartisan plan to repay the hospital debt would die simultaneously with the plan to expand Medicaid.

Republicans complained that the process, which involved the Legislature's Health and Human Services Committee sending an amendment by letter to the Veterans and Legal Affairs Committee late Wednesday afternoon, was flawed and lacking adequate public input or oversight.

They said tacking the expansion onto a bill that previously had broad bipartisan support was a high-stakes gamble and one that would cost the hospitals money and the state jobs.

LePage has promised to release voter-authorized construction bonds valued at more than $120 million, which would trigger a wave of  state road, bridge and other infrastructure construction projects around the state, if lawmakers pay off the hospital debt.

If the bill fails, a more than $500 million infusion into the state's economy would be put in jeopardy, Republicans said.

State Rep. Mike Beaulieu, R-Auburn, a member of the Veterans and Legal Affairs Committee, said Democrats' determination to link the two issues was irresponsible.

"If, in fact, all of that crumbles as we leave this room, then we are pretty much the creators of a crisis," Beaulieu said. "We might tax the state a billion and a half, maybe more in the long run. If they veto the bill, everything goes. The hospitals don't get paid. If the hospitals don't get paid, they close down. People get laid off. Health care is not given to anybody."

Beaulieu said the federal government had already made changes in the implementation of the Affordable Care Act. He said the federal government has never fully paid what it has promised.  

"Then we have to pick up the tab," Beaulieu said. "Those additional costs are going to be paid by Maine citizens, Maine citizens who are already very poor."

Sen. Jim Hamper, R-Oxford, the lead Republican on the Health and Human Services Committee, expressed outrage at the process Thursday during a news conference earlier in the day.

Hamper said his committee was delivered the proposed amendment and not even given time to read it before a vote was called. "We were told, 'Let's adopt it and then we can discuss it,' Washington-styled politics," Hamper said.

He said Republicans were not refusing to expand Medicaid, but that the issue deserved more thoughtful deliberation.

Sen. John Patrick, D-Rumford, another member of the Veterans and Legal Affairs Committee, said he voted for the link because his party believes Maine people have a fundamental right to access to health care. He said to turn down the opportunity to expand that coverage would be "morally wrong."

Asked whether he was worried that connecting the hospital payment to the expansion could lead to both things failing, Patrick said that would be a decision the governor would make when he got the bill.

"I'm willing to take a chance," Patrick said. "Because America is the only industrialized nation in the world that does not cover all of its citizens.

"Here we are, probably the richest, most powerful nation in the world and millions and millions of people are without health care — a lot of them dying because they don't have health care. We are actually saying to those people who are on the margins, 'We want to protect your life; your life has value.' I'll take that vote every time."

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Bob White's picture

Sure we can have the feds pay

Sure we can have the feds pay most of it and then only have to pay 103 million later makes sense to me. NOT the problem with that thought is first the feds are broke and we are broke. Your just kicking the can done the road. If their was a way to really pay for it say with money that somebody would pay us then the problem would be solved. If only!!!!



It seems to me that if the governor can link hospital payment with liquor money and the hostage taking of our bonds that the democrats are perfectly free to do some linking of their own. Paying the hospitals without addressing the underlying causes for the debt is like wiping up flood damage in your house without fixing the leaky pipe. And you can bet there will be a ton of finger pointing over this but it is the governor who won't compromise. The democrats did not have hospital debt payment on their agenda at all but have met the governor half way on this issue. He needs to man up and do the same.

FRANK EARLEY's picture

LePage needs to do the right thing......

LePage has a golden opportunity to get his wishes, and help a large portion of the population. With just a quick swipe of his pen, he might just get those nasty hospital debts paid, and even be able to help insure many presently uninsured folks as well.
On top of that, what ever money he was planning to use to pay off the debt can now be used for the citizens of Maine, to hopefully improve the dismal atmosphere around the State lately.
If Paul LePage refuses to accept this golden opportunity, all bets are off. It will be proof positive, he is holding the people of Maine hostage with their own money. All we've heard is LePage spouting off about repaying the debt to hospitals, it's become his battle cry. Even the fact that he has no money to pay the debt, doesn't seem to deter him in his one man crusade to right the wrong.
This could be the one and only chance he has to come out of all this looking anything but foolish. If he doesn't accept this chance to do right by his constituents, the game is over. We will not allow him to continue to stockpile our money to help him finance his pipe dream. Why should he be allowed to continue, when he intentionally decided not to repay the debt, when given the chance. He will have deflated any confidence anyone had in his ability to govern responsibly.
If he looks this gift horse in the mouth, we need to give up on him, because he has definitely given up on us.............

Jim Cyr's picture

Do the RIGHT thing

is for sure ! One Bill=One solution. NO to "ear marks". The right thing is to clean up our own mess and " JUST SAY NO " to the Fed and have them clean up their own MESS and lets clean up our own long over due promises and put us in a better position for an eventual economic up turn by reducing our debt and upgrade our " rating ". Long live " States Rights ".

JERRY ARIPEZ's picture

Dog and Pony show

Sen. Roger Katz, R-Augusta, said the administration of Gov. Paul LePage had been working to negotiate a better deal on a Medicaid expansion with the federal government.

Better deal as if he can have it differently from all of the 13 Redneck state govs that didn't take it...

Even with the federal match, after five years, the state's costs would increase to more than $103 million, said Rep. Deb Sanderson, R-Chelsea.

Again with the arithmetic, with these repubs, that $103 million is less to pay than $450 Million and growing with no solution insight....

Time to get rid of the deadweight, party of NO, the republicans and get resolve accomplished to deal with other important issues at hand going forward.

 's picture

A Deadbeat is a Deadbeat

Jerry, you can attempt to spin this every which way but you failed miserably. The Democrats have put "programs" in place that they now refuse to pay for. Some of these overdue bills are nearly 6 years old. This is simply about paying overdue bills. Nothing more. As you comment from Minnesota, perhaps you would like to send $5,000 over to Maine to help us tapped out taxpayers pay for this delinquent bills. Does the Minnesota state government honor it's bills due and payable?

Rotundo and Craven are stiffing Lewiston's two largest employers and have been stiffing them for over 5 years. You either pay your overdue bill or you don't pay it. They are choosing not to pay it.

The Democrats' latest ruse is designed to get the Governor to veto their bill and then go out to the LIV's and say "Look, we tried to pay the bill but the Governor vetoed it." I'd veto it anyway and tell the Dems to get it right.

JERRY ARIPEZ's picture

"programs" in place that they now refuse to pay for.

Explain, that one? They actually said, refuse to pay or is it by the way that LePages wants. Bob I have property in Lewiston and have investments and pay taxes in Maine. So it is irrelevant as to where I live or comment from.

The ruse you so claim that you mean the guv opened his big mouth off his bully pulpit, to symbolize his intentions, to not do business and that is a ruse to use his own words, oh I get it!


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