AUGUSTA — A pair of Republican state senators rolled out a bill Tuesday that would expand the state's Medicaid program, MaineCare, a proposal that so far has been largely opposed by Republican Gov. Paul LePage and rank-and-file members of the party.
State Sen. Tom Saviello, R-Wilton, and Senate Assistant Minority Leader Sen. Roger Katz, R-Augusta, first pitched their plan to members of their party during a caucus meeting Tuesday morning and then to the press.
The measure, which would expand eligibility for up to 70,000 more people, also depends heavily on dramatically reforming the program to one that relies on managed care and competition among health care providers, Katz said.
If passed, the bill would allow the state to accept about $1 million per day in new federal funding to cover the cost of expanding Medicaid under the federal Patient Protection and Affordable Care Act.
"The centerpiece of this is imposing on the Medicaid system managed care," Katz said.
Katz said managed care was part of the Medicaid system in 45 other states and more than half of the recipients of Medicaid in the U.S. were in some form managed care patients.
"Managed care programs are like witches in the Wizard of Oz," Katz said. "There are good witches and bad witches. There are good managed care programs and there are bad ones, but they can all bring cost stability to state government."
The bill also aims to create savings within the program and to use those savings to better cover some of the 3,000 most impoverished and disabled MaineCare recipients who are on wait lists for services.
Katz also said the bill would add two Medicaid fraud investigators in the Maine Attorney General's Office.
He said their focus would be both on recipients and on health care providers who defraud the program, but he acknowledged dishonest providers are a larger problem for the state.
Saviello said the effort is an attempt at breaking the gridlock in Augusta around the Medicaid expansion debate by winning enough Republican votes to pass an expansion without losing Democratic support.
"This is a real test for us of whether divided government can work," Katz said. "We can be like Washington and the result will be that we get nothing done or we can each get something of what's really important to us. Hold our nose a little bit about the things we are not crazy about and actually make a change for the better."
Saviello said the bill was also the right thing to do for rural Franklin County because it would not only improve health, it would create jobs and grow the economy.
State Rep. Corey Wilson, R-Augusta, also joined Katz and Saviello to voice his support for the bill and noted Democrats, too, would have a large voice in deciding whether they wanted to take advantage of a historic opportunity to reform Maine's health care delivery system.
"We firmly believe in order for us to support the bill moving forward we need to have some real structural reforms," Wilson said.
The proposal by Katz and Saviello features several key elements:
* A three-year sunset, meaning the expansion would expire when federal funding declines from 100 percent. A vote by the Legislature would be required to continue the program.
* An automatic opt-out if the federal government reneges on its funding promise.
* The creation of a nonpartisan commission to monitor and study the expansion effort.
* The creation of another commission that would study ways to “transition people off MaineCare by finding sufficient employment.”
* A directive to the managed care organizations to work with current cost-saving DHHS initiatives.
* Additional fraud investigators for the Office of the Attorney General to investigate and prosecute fraud by consumers and providers of MaineCare service.
* Letters to every new MaineCare recipient, outlining the initial three-year limit on expansion of services and encouraging the beneficiaries to immediately establish a relationship with a primary care provider.
Democratic lawmakers appear to be largely supportive of the proposal but some may balk at parts of it. Also backing the expansion is the Maine Hospitals Association.
“We view the proposal as a step forward after months of debate over how to ensure more families can have access to a family doctor,” Speaker of the House Mark Eves, D-North Berwick, said in a prepared statement. “While we have been skeptical of managed care programs in the past, we look forward to hearing the details of the Republican proposal. We will want to make sure that the emphasis is on quality treatment; not simply denying care.”
Katz said Tuesday that one of the "bad witch" models of managed care was to deny care but the bill he and Saviello were offering was not intended to do that.
The LePage administration has staunchly opposed the expansion, saying it will cost Maine taxpayers about $800 million over the next decade and that the existing MaineCare program continues to consume a larger and larger portion of the state budget.
Meanwhile, House Republican leadership appeared to be posturing to oppose the bill with pre-emptive salvos issued in news releases Monday and Tuesday.
The releases sent by House Republican spokesman David Sorensen, titled, "Medicaid Mythbusters Round 1" and "Medicaid Mythbusters Round 2" outlined several talking points from opponents including:
* Many of those eligible for Medicaid under an expansion would already be eligible for a federal health care subsidy, were they to buy their own health insurance on the private market.
* The U.S. Congress "can't be trusted to sustain its Medicaid funding promises," suggesting the state would be stuck footing the bill for any health care expansion.
* An expansion of Medicaid would cause further defunding of existing state government programs, including those that help pay for nursing home care.
Meanwhile, House Minority Leader Rep. Ken Fredette, R-Newport, was quick to reject the proposal, saying it would increase taxes and reduce the state's ability to fund other services, including those for the disabled, schools and revenue sharing to towns and cities.
“ObamaCare’s welfare expansion would be so devastating for Maine’s economic future that we simply cannot support it or anything that’s attached to it,” Fredette said in a prepared statement. “We have reached many productive compromises with our Democratic colleagues over the past year, but Medicaid expansion will not be one of them — it’s too destructive of Maine’s economy.”
Some Senate Republicans also weighed in against the proposal.
“If welfare created prosperity, Maine would be one of the richest states in the nation," state Sen. Mason Garrett, R-Lisbon, said. "This is the single largest proposed expansion of welfare in our state’s history. The facts remain; we cannot afford this program at the federal or state level.”
Katz and Saviello both said they understood and respected their Republican colleagues who were philosophically opposed to the expansion.
Saviello also said for him changing the system and expanding it came down to some heartfelt personal beliefs.
"What reverberates in my head is my mother's voice and it's pretty simple," Saviello said. "She told me as I grew up — because we were not rich, we were poor — but she said to me take care of the people who are less fortunate than you. By the grace of God, I could be one of those people, it doesn't take much to get into that situation."
The bill is expected to come before the Legislature's Health and Human Services Committee on Wednesday and will likely go to the floor of the Senate sometime in early March.