AUGUSTA – With a veto from Gov. Paul LePage looming, Democrats in the Legislature continued their high-stakes bid Tuesday to link the governor’s hospital payback plan with the expansion of Medicaid.

Democrats in the Senate and House advanced L.D. 1546 despite attempts by Republicans to delay or change the bill, which would extend health care coverage to about 60,000 Mainers while paying the state’s $186 million share of debt to its 39 hospitals.

The Senate voted 20-15 to approve the bill. Independent Sen. Richard Woodbury of Yarmouth voted with the Democrats. The House debate went well into the evening before members voted 87-57 in favor of the bill, largely along party lines.

In his first speech of the legislative session, House Speaker Mark Eves, D-North Berwick, urged Republicans to join Democrats to support a bill that settles both issues at once.

“The members of this body have a choice,” he said. “Will you support a plan that pays the hospitals and accepts federal health care dollars to cover more Mainers? Or will you chose to deny and delay health care for tens of thousands of Maine people, putting politics ahead of the people’s health and our hospitals?”

Republicans were united in their opposition. Some suggested that the push by the Democratic majority could have implications for other legislative work.

“The die has been cast,” said House Minority Leader Kenneth Fredette, R-Newport.

The most contentious policy conflict of the session is one that has unfolded in other state legislatures over expanding Medicaid through the politically divisive Affordable Care Act. Medicaid expansion is considered a key component of the law.

So far, 21 states have agreed to participate in Medicaid expansion. Six states, including Maine, have not yet decided. Maine’s proposal could land on LePage’s desk this week.

Although LePage has not publicly guaranteed that he will veto the measure, Republicans’ opposition and statements from the governor’s allies suggest it is likely.

If the bill is vetoed, it’s not yet clear whether Democrats will reintroduce a separate bill designed to pay the hospitals for overdue Medicaid reimbursements, as LePage and Republicans have requested.

If they don’t, the majority party may risk additional public criticism from LePage and Republicans, who have used the hospital-debt issue to great effect since LePage ran for governor in 2010.

Democrats have said it’s Republicans who are refusing to pay the hospitals, by rejecting L.D. 1546.

Rep. Jeff McCabe, D-Skowhegan, the assistant House majority leader, said Tuesday that he isn’t sure how Democrats will proceed if Republicans and LePage reject the combination bill. He suggested the outcome may hinge on the hospitals. The Maine Hospital Association supports Medicaid expansion and the debt payment, but as separate bills.

McCabe said the hospitals’ opposition to the combination shows that they “want their cake and eat it, too.”

“I think they hitched their wagon a little too closely to the governor,” he said.

Democrats, using their legislative majority, see the combination as their best and only chance to pass the expansion of Medicaid, the public health insurance program for the poor.

Democrats in states like Florida have gone to great lengths to advance expansion, risking other legislative initiatives. While some Republican governors have agreed to expand Medicaid, Republican lawmakers have fought just as hard to delay or kill it, citing the financial risks of expansion.

They say it is unrealistic to expect the federal government to reimburse states for 90 percent of the expansion, as promised, after paying 100 percent of the cost from 2014 to 2016.

On Tuesday, Rep. Richard Malaby, R-Hancock, said the program encourages recipients to “overconsume and undervalue” insurance. And he said hospitals exploit the program and overbill for services.

Rep. Lawrence Lockman, R-Amherst, said the program is unsustainable and contributes to the country’s fiscal woes. He said the United States is the most bankrupt country, and expanding Medicaid will saddle future generations with debt.

“Why should my grandchildren not view you as a thief?” Lockman said.

Other Republicans said they are open to Medicaid expansion, but not combined with the hospital bill.

During the Senate debate Tuesday morning, Sen. Doug Thomas, R-Ripley, said linking the popular hospital plan to Medicaid expansion doesn’t make sense.

“If Medicaid is such a good idea, why do we have to tie it to such a popular proposal? Why can’t it stand on its own merits?” Thomas said. “Is it because it’s not as good a proposal as we’re being told?”

Democrats say the combination would erase the hospital debt while reducing charity care and emergency room visits.

“We all know that people using emergency rooms for their health care are driving up costs,” said Sen. Seth Goodall, D-Richmond.

Republicans said linking the two plans jeopardizes both.

Sen. Roger Katz, R-Augusta, has said that some Republicans are open to Medicaid expansion but need to know more about the long-term consequences and allow LePage to continue negotiating a deal with the Obama administration.

The administration has given some Republican governors additional flexibility over their respective Medicaid programs in exchange for participating in expansion. However, Democrats say LePage’s counterproposal is a non-starter and are not convinced that the governor is genuinely bargaining.

Democrats said the combined proposal is a win for hospitals and low-income Mainers. The nonpartisan Office of Fiscal and Program Review estimates that an additional 50,000 residents would qualify for Medicaid coverage. If the state doesn’t expand Medicaid, about 25,000 childless adults and parents will lose insurance on Jan. 1.

According to the Congressional Budget Office, the expansion would cover non-elderly adults earning as much as 133 percent of the federal poverty level, just over $20,500 a year for a two-person household.

The office estimated that 49 percent of those affected by expanded Medicaid eligibility earn $5,745 a year or less.

The same study estimated that 37 percent of the people who would gain coverage would be 35 to 54 years old, and 11 percent would be 55 to 64.

Steve Mistler can be contacted at 620-7016 or at:

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