AUGUSTA – When Republican lawmakers took office with majorities in both chambers nearly two years ago, they pledged to cut state spending and, in particular, the state’s Medicaid program.

At the time there were 361,000 Mainers on MaineCare, the state’s version of Medicaid. Today, there are 343,000, according to the Department of Health and Human Services. And while some of that drop is due to attrition and other factors, much of it is because of new limits imposed on the program.

After all the cuts take effect — some require federal permission — 38,000 people in Maine will be dropped from Medicaid health care coverage and an additional 12,000 will lose some of their coverage, according to the Legislature’s nonpartisan fiscal office as well as estimates from social service advocates.

To some, the cuts amount to nibbling around the edges of a very large program. To others, the cuts go too deep already.

“We’d like to see a much more aggressive pace in getting back to the national norms,” said Lance Dutson, executive director of the Maine Heritage Policy Center.

For the past few years, the policy center has pushed lawmakers to trim the system, pointing to statistics that show Maine has the third highest percentage of its population on Medicaid. Gov. Paul LePage has urged lawmakers to be more aggressive, too, chiding them for modifying his proposals and saying he will bring back rejected cuts next year.

Over the past two years, the Republican-led Legislature has voted to eliminate Medicaid for 19- and 20-year-olds; frozen health insurance for childless adults, which prevents any new enrollees from getting the benefit; changed the income levels for parents of children on MaineCare so fewer parents qualify; cut funding to programs that help senior citizens pay for prescription drugs; and cut funding for programs such as Head Start.

Overall, state and federal spending on MaineCare has dropped from $2.6 billion in fiscal year 2010 to $2.4 billion in fiscal year 2012, according to DHHS.

Assistant Senate Majority Leader Justin Alfond, D-Portland, said when he campaigned two years ago, he heard from voters that they wanted the Legislature to focus on jobs.

“None of them said go cut 50,000 people off basic health care,” he said. “I don’t think anyone thought it was a top priority.”

When he campaigns this year, Alfond said, he and other Democrats will talk to voters about the cuts.

And while much of the attention has focused on cuts, the budget passed last week by Republicans added about $500,000 to a program to help reduce the waiting list for people with intellectual disabilities or autism. Republicans say that’s part of their effort to refocus the program to help those they consider to be truly in need, and get away from coverage for healthy adults.

Sen. Roger Katz, R-Augusta, said that while MaineCare supporters packed the hallways of the State House to protest the cuts, when he leaves the building, he hears a different story from average voters.

“When I go to the grocery store, I see people walking up to thank us for getting Maine back to the national mainstream,” he said. “Most people understood when you had the third highest percentage of the population on MaineCare in the country, that’s not sustainable.”

Meanwhile, some question whether the budget passed last week is even balanced. The state needs the federal government to grant three waivers in order to cut certain programs, and some advocates think it’s unlikely the state will get the permission it needs to scale back coverage.

Sara Gagne-Holmes, executive director of Maine Equal Justice, said everyone will be touched by the cuts.

“If people take the time to look at their families, neighbors, friends, this impacts everybody in the state of Maine,” she said.

Even if there’s no personal connection, Gagne-Holmes said those who no longer have health care coverage will show up at hospitals needing care, a cost that will get passed on to those who have health insurance.

House Speaker Robert Nutting, R-Oakland, said Republicans passed the budget last week without Democratic support because they felt they had to make the hard choices.

“Those are the people who are frankly most able to get assistance from other programs or fund their own health care,” he said. “It’s mostly trying to begin to cut back on the explosion of MaineCare without doing harm to our most vulnerable.”

Nutting said he hopes the cuts, coupled with signs that the economy is improving, will mean the next Legislature won’t be faced with the same kind of deficits at DHHS.

“I think after the general election, particularly after we settle on a president, a lot of companies sitting on money waiting to see who’s going to be in charge — what the economy is going to look like — I think then no matter who is elected president we’ll see the economy start to come back,” he said.

State House Writer Susan Cover can be contacted at 620-7015 or at:

scover@mainetoday.com