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.
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."
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.