Maine Senate passes Medicaid expansion bill without a veto-proof majority

AUGUSTA — After more than three hours of debate on a Republican compromise to a Democratic effort to expand Maine's low-income health care program, known as MaineCare, the compromise passed 22-13 Wednesday in the state Senate.

Scott Thistle/Sun Journal

The Maine Senate voted 22-13 Wednesday to pass LD 1487, a bill that would allow the state to accept federal funding while expanding eligibility for its Medicaid system, MaineCare. That is two votes shy of the number needed to override a veto. The bill will go to the Maine House of Representatives on Tuesday.

The measure failed to garner the 24 votes it would need to be considered safe from a Gov. Paul LePage veto.

The House is scheduled to take up the measure Tuesday.

In the past two years, the Senate has twice passed bills that would have expanded the program under the federal Affordable Care Act. Those bids, both in 2013, fell short by one vote of the veto-proof margin of 24 votes.

LePage is widely expected to continue his opposition.

Offered by the Senate's assistant minority leader, Roger Katz, R-Augusta, and state Sen. Tom Saviello, R-Wilton, LD 1487 was presented as a compromise in hopes of gaining more Republican support.

The bill incorporated a managed care provision that would have largely made health care providers more responsible for reducing the costs of care by better managing populations on the program. 

The bill was meant to address many of the concerns identified by Republican opponents, including LePage.

Among other things, the bill includes a sunset clause ending the expansion when federal funding dips below 100 percent, and an opt-out provision allowing the state to cancel the expansion if the feds fail to live up to their promise to pay the full cost over the next three years.

The bill adds two new Medicaid fraud investigators to the state's Department of Health and Human Services.

The measure also aims to create savings while providing home-care services to thousands of mentally disabled Medicaid recipients who have languished on wait lists with their conditions not fully covered.

"Expanding access to health care will strengthen our economy and create jobs and save money, but most importantly, it will save lives,” Senate Majority Leader Troy Jackson, D-Allagash, said in a prepared statement released ahead of the debate. 

Democrats have largely supported the expansion, but rank-and-file conservatives who are following the lead of LePage have rebuked the idea of an expansion, saying that despite federal funding for the program, the state would eventually face hundreds of millions in additional costs.

Democrats on Wednesday unveiled a new website highlighting the cases of individuals who would benefit from an expansion. 

But a better option, Republicans have argued, is to allow those eligible to purchase federally subsidized health insurance coverage on the federal insurance exchange, before expanding Maine's free-care system to between 70,000 and 100,000 new recipients.

Under the ACA, the federal government would cover 100 percent of the expansion costs for the first three years.

Over time, that reimbursement rate ratchets down to 90 percent.

Democrats say refusing the expansion not only puts the health of thousands in jeopardy, it costs the state nearly $1 million a day that would create health care jobs and bolster the state's flagging economy.

LePage has made a point of noting that the state, in 2013, paid off nearly $500 million in MaineCare debt owed to its hospitals, and expanding the program would become a new burden on state taxpayers. One study LePage points to shows the expansion, despite federal funding, would cost the state $800 million over the next 10 years.

LePage also has said 25 percent of the state budget is already consumed by health care spending. These were themes that Republicans speaking against the bill reiterated Wednesday.

"Imagine that for every dollar that you earn every week you had to walk over to your neighbor's house and give them 25 percent of that income," state Sen. David Burns, R-Whiting, said. "That's exactly what we are doing in this state."

Burns said other state agencies and departments had to cut their budgets to cover the costs of MaineCare over the years.

Democrats and Republicans in favor of the bill said their colleagues were ignoring the health and financial benefits of an expansion.

"I just don't think we can turn our back on the remarkable opportunity we have today to improve Maine's economy," Katz said, as he spoke in favor of the bill Wednesday. "Without expanding, we are losing out on $1 billion flowing into our state in the next three-and-a-half years. That's about a $1 million a day we are turning our backs on."

Saviello warned his colleagues who spoke in opposition to the bill because they believe it would add what they call "able-bodied" people to the state's health care rolls, to be careful of assuming too much. "Know their story," Saviello said.

He said that while Republicans argue that many would be able to purchase low-cost insurance on the federal exchange, they may not have the means to meet co-payments or deductibles in those plans. The cost of unpaid charity care for hospitals adds to the cost of those on private insurance and costs the hospitals income and jobs, Saviello said.

He said the hospital in his district, Franklin Memorial in Farmington, would benefit from an expansion, but more importantly, the people in his district would benefit. Expansion could lead to 120 new jobs and 1,880 more people would be eligible for health care while bringing in about $9.2 million a year to his county's economy.

Republicans voting against the expansion were not swayed by those figures or by dozens of stories about individual Mainers who would benefit from the expansion, as told to them by Democrats.

It's not because they're cold and heartless, said state Sen. Mike Thibodeau, R-Winterport. It's because they fundamentally disagree on expanding what they consider a welfare program. They also disagree that the state will win out financially in the end, under an expansion.

"I believe in my heart that they believe that this is the right path forward for the state of Maine," Thibodeau said of his political rivals. "But many Republicans truly believe it isn't the best path forward."

He said they couldn't support expanding a "welfare system" that was consuming a "tremendous portion" of the state budget.

The bill was scheduled to go to the House on Thursday for a floor debate, but the session was postponed to Tuesday due to heavy snow. 

sthistle@sunjournal.com

Scott Thistle/Sun Journal

Sen. Roger Katz, R-Augusta, argues before the Maine Senate on Wednesday in favor of the Medicaid expansion bill he co-sponsored.

An Act To Implement Managed Care in the MaineCare Program (LD 1487)

Scott Thistle/Sun Journal

In February, Maine state senators Thomas Saviello, R-Wilton, and Roger Katz, R-Augusta, explained their plan to expand Medicaid in Maine. Saviello and Katz rolled out a bill that incorporates a managed care proposal as a compromise plan that could expand the state's Medicaid program MaineCare.

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Comments

PAUL ST JEAN's picture

"Among other things, the bill

"Among other things, the bill includes a sunset clause ending the expansion when federal funding dips below 100 percent, and an opt-out provision allowing the state to cancel the expansion if the feds fail to live up to their promise to pay the full cost over the next three years."
One could almost draw the conclusion that there is a great deal of mistrust in our federal government. They are notorious for broken promises. Ask any Native American Indian.

CLAIRE GAMACHE's picture

And yet

Those Social Security checks have showed up on time for years. At least, until the Tea Party got involved. And the VA has been taking care of our veterans pretty reliably. And the Medicare checks have showed up on time so far. Maybe those who claim the federal government will renege are just sprinkling fairy dust to make us think it makes sense to give back our tax money to the federal government for no reason except that they refuse to ever admit they are wrong.

FRANK EARLEY's picture

Some people just have no.......

Some people just have no confidence in the Federal Government. I'll admit I had my doubts from time to time. I will say this though, I haven't missed a single benefits deposit since I started SSDI two years ago. I got real nervous when my private insurance company told me I was switching to Social Security. I always thought that was just for retirees. I thought I would have all sorts of problems being only 52. On top of that, aside from my monthly premiums, I haven't had a medical bill to pay yet, not even a co-pay.
I think any refusal to expand Medicaid is totally political in nature, it has nothing to do with cost. LePage is just to dependent on the Tea Party's influence in his bid for reelection. I kind of sucks that a politician will put the lives and health of that many people in jeopardy just to win an election. Pretty low if you ask me.................

CLAIRE GAMACHE's picture

70,000

Is the number of people who should make sure they make it to the polls to let these spineless Republicans know what they think about their willingness to sacrifice the truly needy on the altar of political expediency. The people who get sicker or even die as a result of this vote can take comfort in the fact that people who are getting health insurance paid by the government have deemed it a favor to inspire them to self-sufficiency by denying them the same privilege. If they are still alive come election day they should return the favor and kick them off government paid health insurance.

FRANK EARLEY's picture

I would think that by now...........

I would think that by now, no one would want to be named as actually following the "lead" of Paul LePage. The man is an embarrassment to the State and to the integrity of the people. He is doing nothing but dragging the State down. I think that when all is said and done, it will be clear that LePage has cost this State a lot more than he's saved. We need to just ignore him for the remainder of his term..........

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