AUGUSTA – By a single vote Tuesday night, Sen. Tom Saviello, R-Wilton, secured approval of his proposal to expand the state’s Medicaid system, MaineCare, by using federal funds to buy private insurance for the state’s poorest residents.

But Saviello was joined by only two of his Republican colleagues, as well as the entire caucus of minority Democrats, who agreed for the sixth time in three years that Maine should expand state- and federally funded medical insurance programs under the federal Affordable Care Act, known as Obamacare.

GOP members joining Saviello in support of the expansion were Sen. Roger Katz, R-Augusta, and Sen. David Woodsome, R-North Waterboro.

Saviello’s victory is only bittersweet for supporters of expansion, which is likely to pass in the Democratically-controlled House of Representatives later this week, but it faces an all-but-certain veto by Maine’s Republican Gov. Paul LePage.

LePage has five times successfully vetoed bills to expand the health care program largely with the support of his Republican allies in the Legislature.

Saviello, who had hoped for more Republican support in the Senate, especially from rural lawmakers or those in Senate districts with large hospitals or facing the ravages of the state’s heroin epidemic, had little to say following the vote.

“You heard the speech — I’m going home now,” Saviello said as he left the Senate chambers at about 8:30 p.m.

During his floor speech, Saviello detailed why Maine should take advantage of a federal matching rate that provides $9 for health care for every $1 the state spends on coverage.

“Some have called my mission insanity,” Saviello said in reference to his support of the five previous unsuccessful attempts to expand Medicaid. “Because this is repeating over and over again past mistakes.”

But Saviello said voting against expanded health care for Mainers and their families, along with the federal support that came with it, was the real insanity.

“You will say no to our dollars coming back to our state to help the less fortunate and working poor,” Saviello said. “You will be saying no to the millions of dollars to help the drug addicted get treatment; you will be saying no to mental health care; you will be saying no to preventative medicine.”

And unlike the previous expansion efforts in Maine, Saviello highlighted how the state’s law enforcement leaders, including the Maine Chiefs of Police Association and the Maine Sheriffs Association, were for the first time supporting an expansion largely to remove those with drug addictions and mental health issues from the state’s jails.

He said those rejecting the expansion were “reaffirming the use of our law enforcement personnel as our doctors and nurses in the treatment of heroin addiction.”

Saviello said the only programs truly available for the impoverished with deep drug addiction issues depended largely on the charity of other states. He detailed the loss in revenue hospitals in Maine were experiencing as the federal reimbursement rates for care were being reduced under the ACA because the federal legislation instead pays states to provide health insurance to their residents. 

Saviello also detailed that arguments from the LePage administration against expansion hinged on the state’s projected costs, estimated at $500 million over the next five years. But that projection did not take into account the $2 billion the state would pull into its economy from the federal matching funds — funds that would not only help grow health care jobs in the state but also save health care costs and lives.

Supporters estimate an expansion would also create an estimated  3,000 jobs.

But lawmakers opposing the expansion said Maine had a clear track record from previous expansions of Medicaid in 2001 and again in 2003 that left the state owing its hospitals $450 million for the care they had provided under the program.

“We have only just in the last few years begun digging ourselves out of that hole,” Brakey said. “But now many would like to see us embark on that path again. It risks putting our state in an untenable financial position yet another time.”

Brakey said Maine had rejected the expansion five times previously but Saviello later noted that a majority of state lawmakers actually approved expanding under the ACA. He said it was only an inability to gain the two-thirds support needed in both the House and the Senate to override LePage’s vetoes that stopped the expansion effort.

Sen. Amy Volk, R-Scarborough, also spoke in opposition to the expansion, noting the state’s previous Medicaid debt as well.

“Maine is already doing a lot of what’s covered in this legislation,” Volk said. “Is it perfect? No. But within the confines of the Affordable Care Act Maine is on far more stable ground than other states that have expanded Medicaid.”

Volk said the state should learn from its past experience in trying to expand Medicaid when thousands more joined the program than were projected. She and Brakey also noted the debt other states that expanded were now facing, including Maine’s New England neighbors.

But other supporters of expansion noted none of those state’s had pulled out of the program. Sen. Anne Haskell, D-Portland, said a provision in Saviello’s bill that sunsets the expansion in 2020, if the next Legislature decided not to continue the program, and one that allows the state to leave the program if the federal matching rate was reduced, amounted to a “belt and suspenders” approach to protecting Maine’s taxpayers.

Saviello said all the economic arguments against expansion would ultimately have to be weighed against the moral ones for providing people with health care coverage.  

Quoting Ohio Gov. John Kasich, who supported a Medicaid expansion in his state, Saviello said it would be when lawmakers met St. Peter at the end of their lives that they would have to answer the ultimate question.

“He’s probably not going ask you much about what you did about keeping  government small; he’s going to ask you what you did for the poor — and you better have a good answer,” Saviello said.

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