House passes retooled MaineCare expansion

AUGUSTA — The Maine House has approved a bill to expand the state's Medicaid program — MaineCare — to include about 70,000 more people, a key component of the national Affordable Care Act.

UPDATE

The expansion would increase eligibility to childless adults who earn less than 133 percent of the federal poverty guideline — just over $15,000 a year.

Representatives voted 89-51 in favor of the bill Monday, adding changes to address worries of Republicans who've opposed expansion. The amended version says the state can opt out of the Medicaid expansion if the federal government doesn't match its share of the cost as promised.

Still, only five Republicans joined Democrats in supporting the measure Monday with several saying they wanted a vote on a bill that pays off the state's debt to 39 hospitals.

The state's share of that debt, about $186 million, would pull down federal matching funds for a total of nearly $500 million.

Gov. Paul LePage has made paying the debt a priority for the current lawmaking session but recently vetoed a measure that would have paid the debt and expanded MaineCare. LePage and Republican leaders in the Legislature have said the two issues should not be linked. But Democratic leaders have said the issues are related and that paying off the debt without covering more low-income Mainers with health insurance is "leaving the job half done."

"I understand Gov. LePage's position in trying to get the best deal for Maine," Rep. Jarrod Crockett, R-Bethel, said. "That being said, it's been made clear to me my constituents are in need and it's hard to do nothing when there are some funds available to do something."

Crockett was among the five Republicans to join Democrats in passing the bill.
 
House Majority Leader Jeff McCabe, D-Skowhegan, said even Republicans who said they supported the expansion previously decided to stick with LePage and vote against the expansion.
 
"Some Republicans choose to vote their districts and ensure nearly 70,000 Mainers are covered and then other Republicans decided to vote with the governor," McCabe said.
 
But many Republicans who voted against the measure did so because they believe Democrats won't hold a new vote on a bill that pays the hospitals using a proposal offered by LePage until a MaineCare expansion is passed.
 
Rep. Dennis Keschel, R-Belgrade, said he believes more Republicans would have voted for the expansion if a deal to pay the hospitals had been reached first. He also said the urgency to pay the hospitals the back debt was more immediate as the longer the state waits, the lower the matching amount from the federal government will be.
 
Keschel and other conservatives estimate a delay beyond October will cost hospitals $5 million in matching federal funds. Keschel also said the state needs to consider carefully whether it can afford the expansion.

The federal government has confirmed it will pay 100 percent of the cost of expansion for the three calendar years starting in 2014, and gradually reduce that match to 90 percent by 2020. Republicans said Monday even paying only 10 percent of the expansion will cost taxpayers $400 million in the seven years after the reductions from 100 percent federal funding.

Keschel said larger and larger portions of the state's budget are being consumed by MaineCare and other Department of Health and Human Services program expansions. Keschel, a former state employee, said the state hasn't been able to give state workers a pay increase in four years and also has cut retirement and health benefits.

"Why?" Keschel asked Monday after the vote. He said MaineCare and other DHHS programs were expanding, consuming those resources. MaineCare alone has grown by $100 million a year, averaged over the decade, Keschel said. He said DHHS and the Department of Education combined used to account for about 75 percent of the state budget but now those agencies consume 83 percent.

"People say we've got to help the people, which I agree with," Keschel said. "But I think it's got to be targeted for the most vulnerable." 

Republicans have said before expanding MaineCare for childless adults the state needs to take care of a backlogged waiting list of about 3,100 people that includes some elderly and disabled individuals.

The issue of expanding Medicaid has torn at GOP caucuses across the nation as several Republican governors, including those in Florida, New Jersey, Arizona and Michigan, have supported the expansion over the concerns of Republican legislators worried the states and the nation can't afford it.

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Comments

Eric  LeBlanc's picture

I can't wait until Obama

I can't wait until Obama starts jailing people for not buying into his socialized medicine scheme. I can't believe anybody actually voted for that piece of garbage.

JERRY ARIPEZ's picture

News Flash Pal

OBAMA 65,899,660 51.1%
ROMNEY 60,932,152 47.2%

Eric  LeBlanc's picture

Hopey Changey fix everything

Hopey Changey fix everything

JERRY ARIPEZ's picture

Certainly

Whatever you said Half Guv Sarah Palin...

JERRY ARIPEZ's picture

Health Care Rising and Families are forced to sell everything

http://www.huffingtonpost.com/2013/06/04/medical-bills-survey-americans-...

Medical Bills Survey Reveals One-Fifth of American Families Face Burdensome Health Care Costs

Health care costs in the U.S. typically are higher than in other developed nations, and about 50 million Americans have no health insurance to protect them against crushing medical bills. Even among those with government and private health care coverage, high expenses proved burdensome to significant portions, the survey reveals. Those with low incomes were most likely to report problems with medical bills.

Among American families with no health insurance, 36 percent told the CDC they struggled to pay medical bills during the previous 12 months, a slight but insignificant increase compared to the two earlier polls, according to the report. More than one-quarter of families enrolled in government programs including Medicaid, the Children's Health Insurance Program and Medicare said they had problems with medical bills, compared to 14 percent of people covered by private health insurance.

DONALD FERLAND's picture

I personally think those

I personally think those balking at the Mainecare expansion are those that can actually afford the insurance premiums and those that look down their noses at others. Just like the governor will not even talk about the expansion until those elderly and disabled on waiting lists for services are getting their needs met.....NEWSFLASH....the expansion has NOTHING to do with waiting lists for services....the waiting lists are due to the budget cuts the governor and republicans made in order to give the tax breaks to their rich buddies....fully funding these programs will take care of the waiting lists and taking the tax break away from the richest of the rich will take care of the funding....duh...how stupid can people be? Oh wait, I forgot....our schools are all failing because this governor and others before him chose to cut education funding so we are just popping out more and more stupid people....(said sarcastically)

JERRY ARIPEZ's picture

Medicaid Expansion Denial Will Cost States Billions: Report

States that refuse to expand Medicaid under President Barack Obama's health care reform law not only will deny health coverage to poor residents and lose access to a huge influx of federal dollars, they also will see increased spending on uninsured people's unpaid medical bills, according to a new report by the Rand Corp., a consulting firm.

The Rand Corp. analyzed 14 states with governors who oppose the Medicaid expansion. It found their actions will deprive 3.6 million people of health coverage under Obamacare, forgo $8.4 billion in federal funding, and cost them $1 billion for programs that partially compensate medical providers who care for the indigent, according to the report published in the journal "Health Affairs." Since nearly half of states may not undertake the Medicaid expansion next year, those figures could be even higher. Twenty-two states and the District of Columbia plan to broaden Medicaid in 2014, according to the Henry J. Kaiser Family Foundation.

http://www.huffingtonpost.com/2013/06/03/medicaid-expansion_n_3367301.html

Yes Maine and those that need to be insured, will lose big time if it continues on its attitude, I don't want to reduce health care for all.
California and New York, is working, have lower premiums for existing insurance holders and those that need it are getting it at affordable rates to find coverage for the first time ever.

Steve  Dosh's picture

Jer ? That's right ? . . .

Jer ? That's right ? . . . .and RAND is and has been a California Republican think tank since . .well. .way before the 1/2 brain dead Heritage Foundation came along . hth /s Steve , a former http://www.brookings.org intern . .

 's picture

Trusting the Feds is being naive

What will happen in Maine when the feds back out of paying that 90%? They have have promised 50 states, PR, US Virgin Island, Guam and US Samoa to pay thei cost. Either they raise all the tax rates and get rid of exemptions or they push all the cost back onto the states. If you think the tax rate in Maine is high now wait til this dumped back onto Maine. This will stifle the economy even more.

Steve  Dosh's picture

. .er . .. Trusting James

. .er . .. Trusting James is naive . . ;) /s, Steve

JERRY ARIPEZ's picture

Expanding Medicaid to the poverty level

Obamacare enables states to open their Medicaid programs to anyone whose income is below 133 percent of the federal poverty level, which is $15,282 for a single person this year. The expansion mainly will benefit adults without children who mostly are ineligible for the program today. The federal government will pay the full cost of covering these individuals from 2014 through 2016, after which the share declines until it reaches 90 percent in 2022 and future years. That compares to the average 57 percent the federal government pays for current Medicaid enrollees.

The Rand Corp. report predicts states that don't expand Medicaid will face higher spending on programs that provide money to hospitals for treating uninsured people because federal spending will decline in this area.

The American Hospital Association and other national lobbying groups endorsed Obama's health care law because it expands coverage, even though it reduces funding for uncompensated care.

CLAIRE GAMACHE's picture

What will

What will, what might , what could happen three years from now is no reason to deny coverage to thousands of people who could get pretty sick in the next three years. What if it works out exactly as the Fed says it will and they cover the 90%. What if the economy improves enough so that three years from now the 90% is covering fewer people. The ACA has already saved Americans nearly 150 million out of pocket dollars and it hasn't even been fully implemented yet. This from the extended coverage afforded to young people on the policies of their parents. They would have gone without care or come up with the 150 million dollars otherwise. It's time politicians put people ahead of ideology

Steve  Dosh's picture

Claire and Jer, It's waaay

Claire and Jer, It's waaay past the time your politicians should have put people ahead of ideology in your Great State of Maine . We - all - agree that nothing could be worse than what we had prior to the ACA . The USA were something like 16th in the world in health care stats . .and slipping . Even Cuba is still better than us ( and i've been worked on by Cuban trained doctors in Africa ) .
There are a lot of good things going on right now , thankfully
Bush was a fool , Dead-eye Dick Cheney was a walking heart attack , a poor shot and a manipulator and AG Ashcroft should be still be put in jail for approving criminal water boarding and torture
. Whoops . Way off topic . .HAhahahah !
Just one man's opinion hth ? /s Steve

CLAIRE GAMACHE's picture

Here we go

When people start complaining about how much this is going to bankrupt us they should also mention that the federal government is going to pay 100% of the cost for the first 3 years. I know that's our tax money but why people prefer to send our tax money to other states is beyond me. There is no excuse for denying medical coverage to thousands of Mainers. I would think there would at some point be some political cost to ignoring the wishes of the voters. Republicans have done every stunt imaginable to repeal the ACA. The voters in the last election spoke and what they said by re-electing Obama is that they want it implemented. I honestly believe the greatest fear Republicans have is not the cost of it but that it might just turn out to be a huge success.

Steve  Dosh's picture

You're right , Claire , and

You're right , Claire , and prevention is always the best cure. ...
in fact, laughter is the best medicine ( except for actual medicine )
/s, Steve :D

PAUL MATTSON's picture

Why is the Democrat Party

Why is the Democrat Party Hell bent on Bankrupting our state? New Hampstah has 9% of their residents on Medicaid and Maine has 20% on Medicaid and the Democrat Party wants to expand it by more than 70,000 more people? May God Help us.

Steve  Dosh's picture

Paul ? Off topic ? " Maine

Paul ? Off topic ? " Maine House passes retooled MaineCare expansion." Move to New Hamster [ sic. ] then . hth /s Steve

JERRY ARIPEZ's picture

Where is your info from?

http://kff.org/medicare/state-indicator/medicare-beneficiaries-as-of-tot...
Location
Medicare Beneficiaries as % of Total Pop
Maine 21%
New Hampshire 18%
-------------------
http://www.thedesk.info/state/maine/

Maine Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 61,500 people with disabilities covered by Medicaid in Maine. Maine spent $14,062 on each Medicaid recipient with a disability in 2007.

18% of all people covered by Medicaid in Maine have a disability, while the national percentage is 15%.

The state spends 45% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.
-------------
http://www.thedesk.info/states-and-territories/new-hampshire-medicaid-fa...

New Hampshire Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 23,000 people with a disability covered by Medicaid in New Hampshire. New Hampshire spent $17,550 on each Medicaid recipient with a disability in 2007.

16% of all people covered by Medicaid in this state have a disability, which is almost the same as the national percentage of people covered by Medicaid who have a disability (15%).

New Hampshire spends 42% of all of the money it spends on Medicaid on services for people with disabilities, which is the same as the national percentage of Medicaid spending on these services.

FRANK EARLEY's picture

News Flash..Maine is not NewHampsta.............

Don't forget, New Hampshire is between Maine and Massachusetts. A lot more of their state is an easy commute to some of the best paying jobs around. I lived in New Hampshire before it became a northern Suburb of Boston. Even then it was no comparison to Maine. No more than you could compare Maine to Massachusetts.
Evidently there are still those who feel that Medicaid is to blame for the debt to the hospitals, MaineCare is paid for both federally and locally. If the local part of that arrangement feels they don't need to play by the rules. How can that be Medicaids fault? It's a political problem, created right here in the State of Maine. Having more people covered by MaineCare, is no problem, unless, of course, the bills are ignored again. That is probably more likely than the Feds backing out of their end of the bargain. If that happens we have no one but who's in charge to blame. As long as everyone follows the rules there should be no problem

Thomas Hamilton's picture

Right on!

Right on!

GARY SAVARD's picture

Having more people covered by

Having more people covered by Medicaid is no problem, unless of course we don't have the money to pay the bill when it comes due. This deal is a lot like buying that high ticket item because there are no payments or interest due for 36 months. How can you lose? You lose if you can't pay the item off when it is due down the road. Also, once you add 70K people to Medicaid, you can't shut them off in 3 years if you have to, because ANY social program in Maine that has ever been approached for a cutback has caused a near revolt.

Steve  Dosh's picture

Gary ? It's not at all like

Gary ? It's not at all like buying that high ticket item . It is medicine. One takes it to get better • /s, Dr. Dosh

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