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.

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

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