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.

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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